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Beyond Kegels: How Pelvic Physical Therapy Can Help With Incontinence After Prostatectomy

A Survivor’s Success Story

A man in cold weather jogging attire stretching on the side of the road

Gary is a Veteran and a prostate cancer survivor. This is his Success Story. Through it, I hope you can learn more about what pelvic floor physical therapy is and how it can help with treatment side effects, especially incontinence after prostate removal. Gary was referred to me for physical therapy 3 months following his radical prostatectomy. He was still having severe incontinence which kept him home-bound. He was going through 10 briefs per day. He was unable to work, he could not even get out of bed without major urine leakage. He was very frustrated. “I hate wearing these stupid Depends!” he told me. Here in the U.S., physical therapy is not often recommended for men recovering from prostate cancer. Many men are given only Kegels and told to wait 6-12 months before considering other treatment options for their incontinence.

Starkly contrast that to the country of Australia. The Prostate Cancer Foundation of Australia (PCFA) recommends that men planning surgery for prostate cancer consult with a pelvic floor physical therapist. Men are encouraged to start pelvic rehab before the surgery is done! PFCA also states that pelvic floor exercises are best learned under the guidance of a physical therapist who specializes in pelvic floor muscles.

Gary was a great candidate for pelvic physical therapy: he was fairly young, active, and had no problems with incontinence or erectile dysfunction prior to his surgery. He wanted to be proactive in his rehab. He wanted to avoid surgery or medications. He was willing and able to put in the time and effort needed to get that control back. And so his rehab journey began. Gary wasn’t sure what this physical therapy would entail. He learned that it was much more than Kegels or biofeedback! A pelvic floor therapist does thorough assessment of the problem, finds out why it is happening, and creates a plan to retrain the muscles to work with the rest of the body as a team. A plan to get you the results you want. (*The pelvic floor is a group of over 20 muscles in your pelvis area; they form a sort of hammock or “floor”, from pubic bone to tailbone, and in between each sit bone). We found several problems contributing to Gary’s incontinence, not just pelvic floor muscle weakness. His treatment strategy was based on some of the latest research studies in prostate cancer rehab. In a nutshell, it consisted of:

  • Education, lots of it! Just having that information provided Gary reassurance and some hope
  • Breathing and Coordination. Coordinating the breath with pelvic floor movements is a key part in successful rehab.
  • Learning how to activate the FRONT part of the pelvic floor, not just the back part.
  • Reducing muscle tightness in the pelvic floor and surrounding muscles. Kegels can make this tightness worse!
  • Retraining pelvic floor muscles not only for strength but also for power and speed (very useful when coughing or sneezing!)
  • Functional Integration. Learning to use the pelvic floor muscles correctly when doing daily activities. Sometimes a few simple movement changes can dramatically reduce leakage.

Now, after 6 sessions and 10 weeks, Gary is down to only one pad a day. He is back to working full-time, riding his motorcycle, and even traveling. His incontinence is 90% better and it doesn’t get in his way anymore. Even if his progress stops here, he is happy with the results he’s gotten. (I expect Gary to make a full recovery, however.) He knows that he must continue to do his pelvic floor exercises daily, but he sees that as a fair exchange for getting his urinary control and his lifestyle back. Since he has learned to incorporate these exercises into his daily activities, he finds it easy to keep his pelvic floor strong and in good working order. I often wonder, if Gary had started physical therapy earlier, could he have gotten results faster? I think so. Results from the studies we followed showed that 75% of men were dry after 12 weeks post-prostatectomy. DRY. That means no pads, no nothing. Full bladder control restored. By the way, pelvic floor physical therapy can help with other side effects, such as:

  • Erectile dysfunction
  • Urinary urgency and frequency
  • Rectal pain or pain with sitting, from radiation therap

Want to take charge of your incontinence problem? Try pelvic physical therapy. There are directories that can help you find a physical therapist in your area who specializes in men’s health issues. Check out and If your doctor doesn’t suggest it, advocate for yourself and ask for it. What have you got to lose–except a closet full of Depends? To read Gary’s story in more detail, go to ​Laura McKaig's Physical Therapy website and download the free e-book.

  1. Prostate Cancer Foundation of Australia, Dec 03 2019
    By Dr Wendy Winnall, Scientific Writer for PCFA
  2. Pelvic floor muscle training in radical prostatectomy_ a randomized controlled trial of the
    impacts on pelvic floor muscle function and urinary incontinence
    Milios et al. BMC Urology (2019) 19:116
  3. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical
    prostatectomy – PubMed
    Hodges et al., Urol Oncol. 2020 May;38(5):354-371.
  4. Kegel Exercises After Prostate Surgery Called Into Question. Renal and Urology News,
  5. Scott, KM, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment
    of post-prostatectomy stress urinary incontinence and pelvic pain
    [published online December 5, 2019]. Int Urol Nephrol.
  6. Milios J. et al, PFM Training and ED In Radical Prostatectomy_A Randomized Controlled
    Sexual Med 2020;8:414e421