Pelvic floor exercises after prostate surgery: a month-by-month Australian protocol

If you've recently had prostate surgery — or you're preparing for one — learning pelvic floor exercises after prostate surgery is one of the most important steps you can take towards regaining bladder control. Each year, thousands of Australian men undergo radical prostatectomy or transurethral resection of the prostate (TURP), and post-operative urinary leakage is among the most common side effects. The good news is that a structured, month-by-month exercise protocol can dramatically improve continence outcomes, and Australian men have access to world-class physiotherapy support, Medicare-funded consultations, and practical products that make the recovery journey far more manageable.

Why pelvic floor exercises matter after prostate surgery

The prostate gland sits directly beneath the bladder and surrounds the urethra. When a surgeon removes or resects part of the prostate, the muscles and nerves that help control urine flow can be disrupted. The pelvic floor — a hammock of muscles stretching from the pubic bone to the tailbone — plays a crucial role in keeping the urethra closed between trips to the toilet. After surgery, these muscles are often weakened, stretched, or temporarily impaired, which is why leakage occurs.

Pelvic floor muscle training (PFMT) works by systematically strengthening these muscles so they can once again support the bladder and urethra effectively. Research endorsed by the Australian Physiotherapy Association (APA) consistently shows that men who begin pelvic floor exercises before and after prostate surgery regain continence faster than those who don't exercise at all. In many cases, a disciplined programme can reduce or eliminate the need for pads and absorbent products within six to twelve months.

Worth knowing: results vary from person to person. Factors such as age, the type of surgery performed, pre-operative pelvic floor strength, and overall fitness all influence recovery timelines. But the evidence is clear — doing nothing is the slowest path to improvement.

Understanding post-prostatectomy incontinence in Australia

Post-prostatectomy incontinence (PPI) is a well-recognised condition across Australian urology and physiotherapy practice. It typically presents as stress urinary incontinence — leakage triggered by coughing, sneezing, lifting, laughing, or sudden movements. Some men also experience urgency incontinence, where a sudden, intense need to urinate arises without much warning.

The Continence Foundation of Australia estimates that a significant proportion of men experience some degree of leakage in the weeks and months following prostate surgery. For many, this resolves progressively as tissues heal and muscles regain strength. For others, persistent incontinence requires ongoing management. If you or someone you know is navigating this challenge, the National Continence Helpline on 1800 33 00 66 offers free, confidential advice from continence nurse advisors — a valuable resource for men across Sydney, Melbourne, Brisbane, Perth, Adelaide, and regional Australia alike.

Understanding that PPI is common — and treatable — is the first step towards taking control of your recovery. There's no reason to suffer in silence when effective support and proven protocols exist.

A month-by-month pelvic floor exercise protocol

The following protocol is a general guide based on physiotherapy principles widely used across Australia. Your urologist, GP, or pelvic floor physiotherapist may adjust the programme to suit your individual circumstances. Ideally, you should begin pelvic floor exercises before your surgery date (known as "prehabilitation") so your muscles are as strong as possible going in.

Pre-surgery and weeks one to four

Before surgery, practise identifying your pelvic floor muscles. The simplest method is to imagine you're trying to stop the flow of urine midstream or hold back wind. You should feel a lift and squeeze around the base of the pelvis — without clenching your buttocks, thighs, or abdomen. Once your catheter is removed post-surgery (usually one to two weeks after a radical prostatectomy), you can gently resume these exercises. During weeks one to four, aim for:

• Three sets of pelvic floor contractions per day (morning, afternoon, evening).
• Hold each contraction for three to five seconds, then relax for an equal period.
• Repeat eight to ten contractions per set.
• Practise in lying, sitting, and standing positions as comfort allows.
• Avoid heavy lifting, straining, or high-impact activities during this early phase.

During these initial weeks, leakage is entirely normal. Many men find that wearing purpose-built absorbent underwear — such as Men's Washable Incontinence Briefs — provides reassurance and comfort while they rebuild strength. Unlike disposable pads, washable options are discreet, environmentally friendly, and cost-effective over the course of a multi-month recovery.

Months two and three

As your body heals, you should notice gradual improvements. During months two and three, your physiotherapist may progress your exercises:

1. Increase hold times to five to eight seconds per contraction.
2. Add quick-flick contractions (rapid squeeze-and-release, ten repetitions) to train the fast-twitch muscle fibres that prevent leakage during coughs and sneezes.
3. Introduce "the knack" — a deliberate pelvic floor contraction immediately before coughing, sneezing, or lifting to pre-empt leakage.
4. Begin gentle walking and low-impact cardiovascular exercise, which supports overall recovery.
5. Maintain three sessions per day, gradually increasing repetitions to twelve per set.

Many men find that leakage decreases noticeably during this period, although some activities — particularly bending, lifting, or sudden movements — may still cause minor dribbling. Consistency is key. You'll get the best results from your pelvic floor exercises after prostate surgery by performing them daily without exception.

Months four to six and beyond: building long-term strength

By month four, your pelvic floor muscles should be noticeably stronger. Your physiotherapist may introduce more challenging exercises, such as performing contractions during light resistance training or while standing on an unstable surface. The goal during this phase is to integrate pelvic floor activation into everyday functional movements — standing up from a chair, climbing stairs, carrying shopping bags — so that continence becomes automatic rather than something you have to consciously manage.

Between months four and six, many Australian men report a significant reduction in leakage episodes. Some achieve full continence during this window. Others, particularly those who had larger tumours or more complex surgeries, may need to continue dedicated exercises for up to twelve months. The APA recommends maintaining a baseline pelvic floor exercise routine indefinitely, even after continence is restored, to preserve muscle tone and prevent future issues.

For men who still experience occasional leakage during physical activities or at the end of a long day, having reliable protection makes all the difference. Men's Washable Incontinence Boxer Briefs offer a comfortable, everyday option that looks and feels like regular underwear — ideal for men returning to work, sport, and social life with confidence.

Evidence-based care pathways Australians can access

Australia's healthcare system provides several avenues for men recovering from prostate surgery. Understanding what's available can help you get the most out of your recovery without unnecessary out-of-pocket costs.

Your GP is the natural starting point. Under Medicare Australia, you can obtain a referral to a pelvic floor physiotherapist, and if your GP prepares a Chronic Disease Management Plan (formerly an Enhanced Primary Care plan), you may be eligible for up to five subsidised allied health visits per calendar year. Many bulk-billing GPs across the country can initiate this process. The RACGP (Royal Australian College of General Practitioners) guidelines encourage GPs to discuss pelvic floor rehabilitation as a standard part of post-prostatectomy care.

Specialist pelvic floor physiotherapists — accredited through the APA — can conduct a thorough assessment using real-time ultrasound or biofeedback to ensure you're activating the correct muscles. This is particularly valuable because research suggests that up to 30 per cent of men initially perform pelvic floor exercises incorrectly, squeezing the wrong muscle groups. A single assessment session can make a substantial difference to outcomes.

Hospital-based continence clinics, particularly in major centres such as Melbourne, Sydney, and Brisbane, also offer multidisciplinary support combining urology, physiotherapy, and continence nursing. Ask your surgeon or GP for a referral if you feel your progress has plateaued.

How Orykas washable incontinence underwear supports your recovery

Recovery from prostate surgery isn't just physical — it's emotional and psychological too. Many men report feeling embarrassed, anxious, or reluctant to leave the house during the weeks and months when leakage is at its worst. Having discreet, reliable protection can be transformative for confidence and quality of life.

Orykas washable incontinence underwear is designed specifically with this in mind. Made from ultra-absorbent, breathable materials, the range for men offers protection that's virtually undetectable under regular clothing. Unlike disposable pads, which can rustle, shift, or cause skin irritation over time, washable underwear stays in place and feels like a normal pair of briefs or boxer briefs.

For men in the early post-operative weeks experiencing heavier leakage, The Essential Briefs Set provides a practical starting point — giving you multiple pairs to rotate through the wash cycle so you've always got a clean pair ready. As your pelvic floor exercises after prostate surgery take effect and leakage diminishes, many men transition to lighter-protection options or simply keep a pair on hand for high-activity days as a safety net.

Orykas ships Australia-wide, making it accessible whether you're in a capital city or a regional area where specialist continence products may not be readily available in local pharmacies.

NDIS, CAPS and funding options for Australians

Managing incontinence can carry ongoing costs — from physiotherapy appointments to absorbent products. Fortunately, several Australian government programmes exist to help offset these expenses.

The Continence Aids Payment Scheme (CAPS), administered by Services Australia, provides an annual payment to eligible Australians to help cover the cost of continence products. To qualify, you generally need a referral from a continence nurse or GP confirming that you have a permanent or long-term condition. While CAPS was originally designed with disposable products in mind, the payment can be used towards any continence aids, including washable underwear — which often delivers better value over time given its reusability.

For men with a disability or chronic condition that qualifies under the National Disability Insurance Scheme (NDIS), continence supports may be included in your plan under the "consumables" or "assistive technology" categories. Speak with your NDIS planner or support coordinator about including continence products and allied health visits in your next plan review.

Additionally, some private health insurance policies cover pelvic floor physiotherapy under their extras or allied health benefits. It's worth checking your policy or calling your fund to confirm what's included. Between Medicare, CAPS, NDIS, and private health cover, most Australian men can access meaningful financial support during their recovery journey.

Frequently asked questions

How soon after prostate surgery should I start pelvic floor exercises?

Most urologists and physiotherapists recommend beginning gentle pelvic floor exercises as soon as the catheter is removed — typically one to two weeks after a radical prostatectomy. Ideally, you'll have started practising the exercises before surgery so you already know how to activate the correct muscles. If you're unsure about timing, consult your surgeon or GP for personalised advice.

How long does it take for pelvic floor exercises after prostate surgery to work?

Results vary, but many men notice improvements within four to six weeks of consistent daily exercise. Significant gains are often seen by three to six months. Some men regain full continence within this timeframe, while others may need up to twelve months. The Continence Foundation of Australia advises patience and consistency — skipping sessions or giving up too early is the most common reason men don't see results.

Can I do pelvic floor exercises wrong?

Yes. A common mistake is bearing down (pushing) rather than lifting and squeezing, or over-engaging the abdominal muscles, buttocks, or thighs instead of isolating the pelvic floor. That's why an initial assessment with a qualified pelvic floor physiotherapist is highly recommended. They can use biofeedback or real-time ultrasound to confirm you're contracting the right muscles effectively.

Are washable incontinence briefs suitable for post-surgery leakage?

Absolutely. Washable incontinence underwear, such as the Orykas range, is designed to handle light to moderate leakage — which is the level most men experience during the recovery months following prostate surgery. They're comfortable for all-day wear, easy to wash and reuse, and far more discreet than bulky disposable pads. Many men find they prefer washable options for both comfort and cost savings over the duration of their recovery.

This article is informational and does not replace advice from your GP, a qualified continence nurse or a specialist.