Prostate surgery can affect the muscles, nerves and structures that help control your bladder. Urinary leakage is very common in the early weeks and months after surgery, and some men also experience urgency, changes in bladder sensation or sexual difficulties. The good news is that bladder control usually improves significantly with time and the right rehabilitation. Pelvic floor physiotherapy can play an important role in recovery. Why does prostate surgery affect bladder control? The impact depends on the type of surgery and which structures are affected or preserved. Radical prostatectomy During a radical prostatectomy, the prostate is removed. This can affect: · The bladder neck: This normally contributes to urinary control. In some surgeries, it can be preserved. · The external urethral sphincter: After prostate removal, this becomes particularly important for keeping urine in. · The pelvic floor muscles: These muscles support the urethra and help with bladder control. They can become weak, poorly coordinated or, in some cases, overly tight. · Nerves: Nerves involved in bladder and sexual function can be affected during surgery and may take months or longer to recover. · Urethral support: Removing the prostate changes the anatomy and the way the bladder and urethra work together. Surgery for an enlarged prostate (BPH) Procedures such as TURP and TUIP affect the prostate and bladder neck in different ways. The amount of tissue removed and whether the bladder neck is preserved depends on the procedure used. What can you expect after surgery? The first few months Urinary leakage is very common after prostate surgery, particularly after the catheter is removed. Leakage is often worse with coughing, sneezing, lifting, walking or exercise. You may also notice: · Difficulty activating your pelvic floor muscles · Reduced awareness of bladder fullness · Urgency or increased frequency · Pelvic floor tightness or muscle guarding · Changes in sexual function Recovery over time Recovery is different for everyone, but bladder control generally improves significantly during the first 3–6 months. Some men continue to notice improvements beyond 12 months as the pelvic floor muscles and nerves recover and coordination improves. Factors such as age, pre-existing bladder symptoms, prostate size and muscle strength can influence recovery. You may need pads for a while, but needing a pad in the early stages doesn't mean you'll always need one. How can a pelvic health physiotherapist help? A pelvic health physiotherapist can assess how your pelvic floor is working and develop a rehabilitation program specific to you. This may include: · Checking pelvic floor strength, endurance and coordination · Teaching you how to correctly contract and relax your pelvic floor · Bladder training and strategies for urgency · Improving your breathing and muscle coordination during movement · Addressing pelvic floor tightness or pain · Helping you return to exercise and everyday activities · Working alongside your urologist or medical team if further treatment is needed When should you seek help? Consider seeing a pelvic health physiotherapist if you: · Have urinary leakage after your catheter is removed · Are using pads regularly · Have urgency or frequent urination · Have difficulty emptying your bladder · Experience pelvic pain or tension · Are concerned about sexual function · Feel you're not making progress with your exercises Frequently Asked Questions How soon can I start pelvic floor exercises? Pelvic floor exercises can generally begin after your catheter has been removed, once your surgical team says it is appropriate. Don't perform pelvic floor exercises while your catheter is in place. Will I need pads after prostate surgery? Many men use pads during the first few weeks or months. Leakage usually reduces as the pelvic floor and bladder control mechanisms recover. What if my leakage doesn't improve? If leakage continues despite consistent pelvic floor exercises and bladder training, speak with your urologist. Further treatment options may be available, including surgical options for persistent incontinence. Can pelvic floor physiotherapy help with erectile dysfunction? Pelvic floor rehabilitation may support sexual function after prostate surgery, although erectile difficulties can also be related to nerves and blood flow. Your physiotherapist can work alongside your medical team as part of your recovery. The Bottom Line Prostate surgery can temporarily disrupt the muscles and structures responsible for bladder control, but leakage is not something you simply have to put up with. Recovery takes time, and everyone's journey is different. The right pelvic floor exercises, bladder strategies and individualised rehabilitation can help you regain bladder control and confidence after prostate surgery. You don't have to manage it alone. Our pelvic health physiotherapists can assess what's happening, make sure you're doing the right exercises for your body and help you work towards getting back to the things you enjoy.

Sexual health is an important part of overall wellbeing, yet it is something many men find difficult to talk about. One factor that is often overlooked is the role of the pelvic floor in sexual function. The pelvic floor is a group of muscles at the base of the pelvis. In men, these muscles help support the bladder and bowel, and they also play a key role in erections, ejaculation, and sexual sensation. When these muscles are not functioning well - whether they are too tight, too weak, or not coordinating properly - it can contribute to sexual difficulties. Some men may experience erectile dysfunction, difficulty maintaining an erection, changes in ejaculation, reduced sensation, or discomfort during or after sex. These concerns can occur at any stage of life and are more common than many people realise. There are a range of factors that can affect pelvic floor function. Stress and anxiety can increase muscle tension, while surgery (such as prostate surgery), prolonged sitting, or chronic pelvic pain can also play a role. Often, it is a combination of factors rather than a single cause. It is also important to recognise the role of the mind-body connection. Stress, performance anxiety, and emotional wellbeing can all influence sexual function. Addressing both the physical and psychological aspects of health often leads to the best outcomes. Pelvic health physiotherapy can help identify how the pelvic floor is functioning and guide treatment. This may include exercises to improve strength or relaxation, breathing techniques, and strategies to reduce tension and improve coordination. Education and small changes can often make a meaningful difference. Sexual dysfunction in men is common, and support is available. Understanding the connection between the pelvic floor and sexual health can be an important step toward improving confidence, comfort, and overall wellbeing.

Pelvic Health Is for Everyone Pelvic health is often talked about as a women’s issue, but in reality it affects people of all genders across every stage of life. The pelvic floor is a group of muscles and connective tissues that support the bladder, bowel, and reproductive organs. These muscles also play a role in sexual function and everyday movements like lifting, bending, coughing, or laughing. Because they are involved in so many aspects of daily life, looking after pelvic health is important for everyone. Pelvic health concerns can show up in many different ways. Some people experience bladder leakage, urgency, constipation, or changes in bowel habits. Others may experience pelvic girdle pain, including discomfort around the sacroiliac joints, pubic symphysis, or coccyx (tailbone). Pelvic pain can also occur in the lower abdomen or in the genitals and may affect comfort with sitting, exercise, or sexual activity. These symptoms can affect people of any gender, yet they are often not openly discussed. Pelvic floor challenges can appear at different stages of life. Children may experience constipation, bedwetting, or daytime bladder accidents. Adolescents and adults may notice pelvic pain, bladder urgency, or bowel changes. Men may experience pelvic pain or bladder symptoms, including leakage, particularly after prostate surgery. Older adults may notice changes in bladder or bowel control or pelvic comfort as the body changes with age. While these experiences are common, many people are surprised to learn that help is available. Hormones also play an important role in pelvic health for people of all genders. Changes in hormone levels; during puberty, pregnancy, menopause, or as part of gender-affirming hormone therapy, can influence tissue health, bladder control, sexual function, and comfort in the pelvic region. Understanding these changes and supporting the body with the right care can make a meaningful difference. Pelvic health physiotherapy offers practical support, education, and treatment for many of these concerns. Physiotherapists can help people better understand their pelvic floor, improve bladder and bowel habits, manage pelvic girdle or pelvic pain, and support comfortable movement in daily life. Often, small changes can make a big difference to daily comfort and confidence. Pelvic health isn’t limited to one gender or one stage of life. By talking about it more openly and recognising the many ways it can affect the body, we can make it easier for everyone to seek support and care for their pelvic health.