Pelvic Floor Therapy and Prostate Cancer
- ereul93
- 2 days ago
- 4 min read
Hi friends! Did you know prostate cancer treatments often cause pelvic floor muscle problems? One in every nine men will be diagnosed with prostate cancer. The treatments—especially surgery and radiation—can temporarily or sometimes persistently change how your pelvic floor works, leading to urinary leakage, urgency, erectile changes (including urine leakage with orgasm called climacturia), and bowel symptoms. The good news is evidence shows pelvic floor muscle training (PFMT) helps, particularly when taught and supervised by a specialist!
Your pelvic floor is a group of muscles and connective tissues that form a hammock at the bottom of the pelvis. They keep you dry, support erections and ejaculation, and coordinate with your diaphragm and deep abdominals for posture and pressure control. When these muscles are weakened, overactive, uncoordinated, it causes symptoms. You may feel it in bladder, bowel, and sexual function. After prostate cancer treatment, this system has to re-learn efficient control.
Surgery temporarily alters pelvic anatomy and can affect the external urethral sphincter and its
nerve supply. Early after surgery, many men notice urinary leakage, urgency, or control issues while the pelvic floor recovers strength and timing. A frequent, but not often talked about symptom is climacturia (urine leakage at orgasm). A 2025 systematic review across 5,208 men found climacturia happens in about 1 in 4 men.
Pelvic radiation can irritate the rectum and pelvic nerves, contributing to bowel urgency or leakage and changes in pelvic floor muscle activation. A 2025 analysis (ICONES) linked radiation with fecal incontinence and a higher rate of pudendal nerve dysfunction showed reduced pelvic floor muscle (EMG) activity after radiation. Pelvic floor therapy can address coordination, endurance, and sensation.
ADT helps control cancer but is associated with sarcopenia (generalized muscle loss). Recent studies show measurable declines in muscle mass during ADT—changes that can cause weakness and poor endurance in the muscles throughout the body.
Many studies show that pelvic floor muscle training will help to treat urinary leakage after a prostatectomy. Men who participated had improvements in leakage by 3 months. When compared to men who did not perform pelvic floor muscle training, there were not significant differences by 6 months, but why leak for an extra three months if you don’t have to?
Pelvic floor muscle training can be tricky. It is important to know how to properly engage the muscles. Studies show learning how to work the muscle with a trained therapist improves leakage when compared with doing exercises on your own. A pelvic floor therapist can also help address any other related issues like in the hips and back, too!
A pelvic health therapist will typically:
Confirm correct muscle activation (you’d be surprised how often we see breath-holding or glute squeeze instead of true pelvic floor lift). Real-time ultrasound or EMG/biofeedback helps. Supervision improves outcomes.
Build a progressive plan: endurance holds, quick “knack” contractions for cough/sneeze, and task-specific drills for lifting, changing positions, and intimacy.
Layer whole-body exercise to counter ADT-related muscle loss and fatigue, while minimizing leakage while at the gym
Prehab, or pelvic floor therapy before surgery, can help many men. Sometimes a few weeks pre-op can significantly improve leakage after surgery.
Changes in pelvic floor strength, timing, and sensation are common, but they are treatable. Find a pelvic floor therapist near you at www.mypfm.com/find-a-pt.
To learn more about your pelvic floor muscles, check out these great resources:
Check out our YouTube channel
Learn more about your pelvic floor on our Instagram
Visit our Amazon store for our favorite pelvic health products
For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources.
Written by Emily Reul, PT, DPT
References
Yang JM, et al. Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: An umbrella review of meta-analysis and systematic review. Clin Rehabil. 2023 Apr;37(4):494-515. doi: 10.1177/02692155221136046. Epub 2022 Oct 27.
Zhou L, et al. Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis. Front Public Health. 2023 Jul 31:11:1186067. doi: 10.3389/fpubh.2023.1186067. eCollection 2023.
Gerlegiz ENA, et al. Structured and supervised pelvic floor muscle training following confirmed contraction in post-prostatectomy urinary incontinence: a systematic review of randomized controlled trials. J Cancer Surviv. 2025 Aug 28. doi: 10.1007/s11764-025-01882-6.
Ferrão JV, et al. The pevalence of climacturia in patients after radical Ppostatectomy: a systematic review. Int Braz J Urol. 2025. PMID: 39556847
Belkacemi Y, et al. Relationship Between Radiation Therapy and Fecal Incontinence in Patients Treated for Localized Prostate Cancer: Results of the French ICONES Study. Prostate. 2025 Apr;85(5):492-501. doi: 10.1002/pros.24852. Epub 2025 Jan 14.
Ribeiro AM, et al. Pelvic floor muscles after prostate radiation therapy: morpho-functional assessment by magnetic resonance imaging, surface electromyography and digital anal palpation. Int Braz J Urol. 2021 Jan-Feb;47(1):120-130. doi: 10.1590/S1677-5538.IBJU.2019.0765.
Reimer N, et al. Effects of exercise on sexual dysfunction in patients with prostate cancer-a systematic review. J Sex Med. 2021 Nov;18(11):1899-1914. doi: 10.1016/j.jsxm.2021.09.001. Epub 2021 Oct 13.