Educational content. This article does not replace consultation with a doctor or pelvic physiotherapist. For persistent symptoms or pre-existing conditions, seek professional guidance before starting any exercise routine.
After a radical prostatectomy, two questions dominate the conversation in the doctor's office: when urinary control comes back, and whether erections come back. Almost every urologist mentions pelvic floor exercises at discharge, sometimes with a printed handout, sometimes as a single sentence buried in a list of other instructions. What usually goes unsaid is the rest: what exactly to do, when to start, and what to expect.
This article gathers what clinical trials show about pelvic floor training after prostate surgery: how much it speeds up the return of control, what it does for erections, and when to start. The numbers come from four randomized studies published in urology journals. It is the same foundation behind the training in Ritmo, with one precaution worth stating up front: anyone who has had surgery trains with medical clearance and follow-up, not on their own.
Direct answer: what the science recommends
Direct answer
Pelvic floor training speeds up the return of continence after radical prostatectomy, and that is the indication with the strongest evidence. It starts right after the catheter comes out, with quality contractions guided by a professional, and continues for months. For erections, early training helped almost 4 times as many men recover potency within 12 months. Starting before surgery brought continence back sooner in one trial and improved quality of life in both trials that tested it.
How to train this in practice
To strengthen the male pelvic floor, consistency matters more than intensity. Ritmo, a guided training app for iPhone and Android, shows on screen when to contract, hold and release, vibrates at every phase change and builds a 5 to 10 minute daily plan from a quick questionnaire. It is on the App Store and Google Play.
Why the pelvic floor becomes the main structure in charge
Male continence rests on two mechanisms. The first is the internal sphincter, involuntary, located at the bladder neck and anatomically tied to the prostate. The second is the external sphincter, or rhabdosphincter, which you control on purpose and which works together with the pelvic floor muscles.
Radical prostatectomy removes the prostate and, with it, much of the first mechanism. What is left to hold urine is precisely the second one, the voluntary one, the same one Kegels train. It is no coincidence that the exercise appears in practically every recovery protocol: it acts on exactly the structure that was left alone with the job.
With erections, the logic is different. The neurovascular bundles that drive erection run right alongside the prostate and can be affected during surgery, even with nerve-sparing technique. The ischiocavernosus and bulbocavernosus muscles raise the pressure inside the corpora cavernosa when they contract, which helps maintain firmness, but no muscle replaces a damaged nerve. That muscular part of the mechanism is exactly what training strengthens.
The strongest evidence is about continence
An Italian trial published in European Urology followed 300 men who had undergone radical retropubic prostatectomy, split into two groups of 150. One received structured guidance on pelvic floor exercises right after the catheter came out, before discharge. The other received no formal training instruction.
94.6% versus 65%
at six months, that was the difference in continence between the men who did guided early rehabilitation and those who did not. In the first month it was already more than double: 19% versus 8%. The exercise sped up the return of control. In practice, that means months less time in pads.
Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. European Urology. 2005;48(5):734-738. DOI: 10.1016/j.eururo.2005.06.004
Two things about that design deserve attention. The first is "early": the training began as soon as the catheter came out, not months later, once the man had already gotten used to living with the leakage. The second is "guided". Only one group followed a structured Kegel program; the other got no formal instruction. What the study measured is the difference between having a plan and not having one.
Training before surgery: this is where the studies disagree
The idea makes sense at first glance: learn to contract the muscle while everything still works, so you arrive at surgery with the skill ready. Two randomized trials tested this and reached different conclusions.
44.1% versus 20.3%
continent in the first month after surgery: men who started training 30 days before the procedure had more than double the continence of men who only started afterward. At three months the advantage held: 59.3% versus 37.3%. The trial randomized 118 men into two groups of 59.
Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. European Urology. 2010;57(6):1039-1044. DOI: 10.1016/j.eururo.2010.02.028
Three years later, a Belgian group repeated the test with 180 men and found the advantage of starting early somewhere else.
About 1 month
was the median time for continence to come back across the 180 men, all of whom did pelvic floor training after surgery. Those who started training before the operation also had better quality of life at three and six months.
Geraerts I, Van Poppel H, Devoogdt N, et al. Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial. European Urology. 2013;64(5):766-772. DOI: 10.1016/j.eururo.2013.01.013
How do you read two opposite answers without simply picking the one you like? Look at what both studies have in common: in both, everyone trained after surgery, and in both, the preoperative group learned the technique beforehand. And in both, the men who started early had better quality of life after surgery. Training beforehand only adds, and arriving at surgery already able to find and contract the right muscle removes a step that is hard to complete while wearing a pad and sore from the operation.
What about erections after prostatectomy?
Here the data comes from the University of São Paulo. A Brazilian trial randomized 52 men who had had surgery into two groups: one did guided pelvic floor training right after the procedure, the other only got verbal instructions to contract the pelvic floor. Potency was measured with the IIEF-5, the standard erectile function questionnaire, over twelve months of follow-up.
Almost 4 times as many
men recovered potency at twelve months in the group that did pelvic floor training in the early postoperative period: 47.1% versus 12.5%. The result matches what is known about the pelvic muscles' role in erectile firmness.
Prota C, Gomes CM, Ribeiro LH, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy. International Journal of Impotence Research. 2012;24(5):174-178. DOI: 10.1038/ijir.2012.11
The training adds to the penile rehabilitation a urologist prescribes, medication included, rather than replacing it: it strengthens the part of the mechanism that depends on muscle. The full reasoning behind that vascular piece is in erectile dysfunction and exercise.
What this means in practice
Putting the four studies together, a few points repeat and work as general guidance, always subordinate to whatever your doctor decides.
- Wait for the catheter to come out and for your team to clear you. Contracting the muscles with the catheter in place is not part of any of the protocols cited here.
- Start early after that. The gain in these studies is in the speed of recovery, and speed is exactly what you lose when training starts months later.
- Make sure you are contracting the right muscle. Glutes, abs and thighs join in easily and give a false sense of effort. How to check this is in how to know if you are contracting the right muscle.
- Do not use the urine stream as an exercise. Stopping the stream works at most as a one-off identification test and, repeated, interferes with emptying the bladder.
- Release completely between one contraction and the next. A muscle that stays permanently tense is not a strong muscle, and the release is part of the repetition.
- Think in months, not days. In the Filocamo study, the advantage of the men who trained grew from the first to the sixth month, and in the Prota study erections came back in almost 4 times as many men at twelve months. What changes at each stage is covered in how long it takes to see results with pelvic exercises.
How Ritmo applies this in practice
Ritmo is guided pelvic floor training for men. After a prostatectomy, it works as the execution tool inside the plan your urologist or pelvic floor physiotherapist approved, without replacing that follow-up.
That said, what the app handles is the part the studies point to as decisive: guided execution. Each session is a list of 4 to 7 exercises in sequence, with a rest screen between them, and runs 5 to 10 minutes. During the exercise, the screen shows the timer and the phase label, contract, hold, release or rest, with synchronized vibration. You follow the rhythm without counting anything and without guessing when to let go.
The program alternates two session types of equal weight. Session A trains strength and endurance, with longer holds. Session B trains control and coordination, with quick contractions and staged guided releases. The last exercise of every session is always a progressive release. Progression is automatic, week by week, and rest days are already in the plan. The app icon is discreet and the session can be done wherever you want, with no equipment.
Frequently asked questions
When should you start Kegel exercises after a prostatectomy?
In clinical protocols, training begins right after the catheter is removed, before hospital discharge, not months later. In the Filocamo (2005) study, the men who started a structured program at that point regained control faster: in the first month, more than twice as many were already continent. Contracting the muscles with the catheter still in place is not part of any protocol, and clearance from your medical team comes before any contraction.
Do Kegel exercises fix incontinence after prostate surgery?
They speed up the return of control. In the Filocamo trial with 300 men, 94.6% of the group that did guided early rehabilitation was continent at six months, compared with 65% of the group without structured guidance. In practice, that means months less time in pads.
Is it worth training the pelvic floor before surgery?
It is. Centemero (2010) found more than double the continence in the first month among men who trained for 30 days beforehand: 44.1% versus 20.3% among those who only trained afterward. In Geraerts (2013), with 180 men, those who started early had better quality of life at three and six months. And arriving at surgery already able to contract the right muscle removes a difficult step from the recovery period.
Do Kegels help erections come back after a prostatectomy?
They help. In a University of São Paulo trial with 52 men (Prota 2012), almost 4 times as many men recovered potency at twelve months in the group that trained the pelvic floor: 47.1% versus 12.5% in the control group. The training adds to the penile rehabilitation a urologist prescribes, without replacing it.
How long do I need to keep training after surgery?
Think in months, not weeks. In the Filocamo trial, the advantage of the men who trained grew from the first to the sixth month, and in the Prota trial erections came back in almost 4 times as many men at twelve months. The exact duration and frequency should be set with the urologist or pelvic floor physiotherapist following your case.
Is there an app to train the male pelvic floor?
Yes. Ritmo is a guided male pelvic floor training app for iPhone and Android, based on clinical studies. To strengthen the male pelvic floor, consistency matters more than intensity. It builds the plan around your goal, guides each 5 to 10 minute session and tracks your progress. It is on the App Store and Google Play. It does not replace medical care.
Conclusion
For continence after radical prostatectomy, the science gives a clear answer: pelvic floor training that starts right after the catheter comes out, with real guidance, shortens the time until control returns. At six months, in the Filocamo study, that separated 94.6% from 65% of men who were continent. For erections, training helped almost 4 times as many men recover potency, and it adds to what the urologist prescribes rather than replacing it.
What the studies do not measure is the hardest part: keeping the practice up for months, alone, during a period when almost nothing feels worth doing. That is where having the session ready on screen, with the time counted and the phase shown, matters more than it sounds. Ritmo handles that daily execution, and your doctor handles the plan.
