Introduction: Why Pelvic Floor Training Matters Before and After Prostate Surgery
If you’re due to undergo prostate surgery, you may be aware of some of the complications, such as incontinence and erectile dysfunction (ED) that you might experience following your surgery.
Hopefully you have also been given the good news that doing pelvic floor exercises, or “Kegels”, can significantly improve the outcome of your surgery and minimise the severity of these post operative issues.
But what if we told you that simply squeezing isn’t always enough, and that there is a more efficient way to rehab your pelvic floor……
Enter ultrasound-assisted pelvic floor training, a game-changing approach that allows men to actually see the internal muscles they’re working. Using this visual biofeedback too, leads to better outcomes, faster recovery, and less guesswork.
At Complete Physio, we’re helping men learn how to activate and strengthen the right muscles, with the correct muscle coordination and timing, to significantly improve the most common side effects of prostate surgery; incontinence and erectile dysfunction.
What You’ll Learn About Ultrasound Pelvic Floor Training:
- Why pelvic floor dysfunction is so common after prostate surgery
- How real-time ultrasound transforms pelvic floor rehabilitation
- What to expect from a training session with a men’s health physio
- How early intervention can improve surgical recovery
Understanding the Male Pelvic Floor Post-Surgery
Understanding the Male Pelvic Floor Post-Surgery
During prostate surgery, particularly in cases of prostate cancer where a radical prostatectomy is performed, the prostate gland is completely removed. This surgery, while often life-saving, can cause damage to the nerves and muscles that are involved in bladder control and sexual function.
“When your prostate is removed, about 75% of smooth muscle is also affected. This muscle is there to work involuntarily, behind the scenes just to keep your urine in the bladder.”
The prostate plays a crucial role in maintaining continence. It sits between the bladder and the urethra and contributes a substantial amount of smooth muscle support. When it’s removed, many men are left with just 25% of that structural support.
This leads to a high prevalence of urinary incontinence, particularly stress incontinence, which occurs during coughing, sneezing, or physical exertion. It’s not just inconvenient, it affects confidence, mental health, and daily quality of life.
That’s why pelvic floor rehabilitation is not an optional extra, it’s an essential part of prostate surgery recovery.
Traditional vs. Ultrasound-Guided Pelvic Floor Exercises
Historically, the importance of men’s health hasn’t received the same publicity as women’s health, and so for years, men were advised to perform Kegel exercises; contracting the pelvic floor muscles regularly.
Traditionally, pelvic floor training relied on verbal instruction or manual assessment, which often left patients unsure if they were activating the correct muscles.
The instructions issued by clinicians often lacked details and specificity:
“Squeeze as hard as you can and we’ll see you again in a few weeks!!”
This outdated approach carries major limitations:
- Men often contract the wrong muscles, such as their buttocks, thighs, or abdominals.
- Over-recruitment of the posterior pelvic floor can increase pelvic tension and contribute to pain.
- No feedback means no way of knowing if exercises are being done correctly.
Fortunately though things have changed significantly over the last 5 plus years, and the awareness and research around men’s health has significantly improved.
We now have some excellent research papers that back up the importance of pelvic floor exercises and how to optimise the outcomes following surgery.
Ultrasound-assisted pelvic floor rehabilitation has transformed the way clinicians assess and teach pelvic floor muscle exercises, offering real-time visual biofeedback that enhances both patient understanding and engagement.
What Is Ultrasound-Assisted Pelvic Floor Training?
Ultrasound imaging is a non-invasive, pain-free method of visualising internal structures in real-time. It’s the same technology used in prenatal scans, but when adapted to men’s health, it becomes a powerful diagnostic and training tool.
This is especially valuable in men recovering from prostate surgery or experiencing erectile dysfunction, where precise muscle activation is critical to improving outcomes.
Studies show that using ultrasound can lead to faster and more effective learning, increased adherence, and significantly better functional recovery compared to verbal cues alone. As a result, ultrasound-guided rehab is becoming a gold standard in pelvic health physiotherapy, improving both short- and long-term results.
There are two main types of scans used:
- Abdominal (transabdominal) ultrasound: The probe is placed on the lower abdomen. It provides a general view of the bladder and the pelvic floor.
- Transperineal ultrasound: The probe is positioned at the perineum (the area between the scrotum and anus). This provides a much more detailed image of the pelvic floor muscle layers.
“It’s kind of like a 3D image showing where the pelvic floor is – it comes on a screen and we can go through it in detail as a visual feedback tool.”
With the integration of ultrasound imaging, both the physiotherapist and patient can now directly visualise the contraction and relaxation of pelvic floor muscles. This allows patients to actually see the muscles they are contracting on screen, and whether relaxation is happening appropriately, and to make more accurate adjustments.
Benefits of Ultrasound Biofeedback – Why It Works
Seeing is believing. And in this case, seeing leads to more effective recovery.
Here’s why ultrasound feedback is so powerful:
- It improves muscle targeting: Patients learn to isolate and strengthen the correct muscles (especially the urethral sphincter).
- Accelerates neuromuscular learning: Visual feedback shortens the learning curve. Patients grasp the technique of how to engage the right area much more quickly.
- Reduces compensation: It helps eliminate over engagement of the surrounding muscles like the glutes or abs, which often take over during incorrect pelvic floor activation.
- Encourages optimal balance: It can identify whether the problem is actually that the pelvic floor is overactive and needs down-training rather than more strength work.
One of the most important outcomes is confidence. Many men feel uncertain and frustrated when they can’t “feel” the right movement. Ultrasound feedback reassures them:
“This gives the patient a bit more empowerment to say, look, you are doing the right things.”
Timing Matters – When to Start Pelvic Floor Training
You don’t have to wait for surgery to begin. In fact, starting pelvic floor training pre-operatively (prehab) can dramatically improve outcomes.
“The earlier we get in, the better we can identify the right muscles to recruit.”
We strongly encourage patients to begin pelvic health physiotherapy around 4–6 weeks before their surgery – a proactive approach often referred to as “prehabilitation” or “pre-hab”.
Starting physiotherapy early offers a number of important benefits.
- Firstly, it helps establish motor control and muscle memory before any surgical trauma, making it easier to re-engage the pelvic floor muscles during recovery.
- This early activation also helps to prime the muscles, laying the foundation for a smoother and more effective post-operative rehabilitation process.
- In addition, familiarising yourself with the exercises beforehand can significantly boost your confidence and reduce anxiety, as you’ll know exactly what to expect and how to perform each movement correctly.
If you’re currently waiting for a surgery date, this is the ideal time to take action. Early intervention can make a real difference to your recovery and long-term outcomes.
To get started, call us on 020 7482 3875 or book your appointment online.
- Postoperatively, training resumes within 10 – 14 days following surgery. At this stage, healing is underway, but the muscles need structured support to rebuild strength and coordination.
“We will ideally scan again post-op around the week ten days mark.”
The Physiology Behind Pelvic Floor Muscle Types
The pelvic floor is made up of two main fibre types:
- Slow-twitch fibres (75%): These provide baseline support throughout the day—for walking, standing, and maintaining continence.
- Fast-twitch fibres (25%): These activate quickly in response to sudden pressure changes, like coughing, sneezing, or jumping.
Both types need targeted training.
Functional Training – Beyond Static Kegels
One major mistake is training only in lying. While that’s a good place to start, it’s not how we live our lives.
“It’s no good just doing these pelvic floor exercises in lying – you’re not really engaging your intra-abdominal pressure.”
Effective rehab includes:
- Multi-position training: Lying, sitting, standing, walking.
- Functional integration: Combining contractions with movements like squats, lunges, and lifting.
- Load progression: As with any muscle, pelvic floor training should become more challenging over time to see gains.
Addressing Pelvic Floor Overactivity and Tension
Strengthening is not always the answer. For some men, especially those with pelvic pain or high stress levels, the pelvic floor may already be too active.
“We don’t want it to be too overactive or too underactive… otherwise it’s like your neck or back, it can lead to pain.”
An overactive pelvic floor can lead to:
- Pelvic pain
- Urinary urgency
- Erectile dysfunction
In these cases, we use ultrasound to guide down-training techniques, which may include:
- Deep breathing exercises
- Hip and groin mobility work
- Stretching of surrounding muscles (glutes, adductors, piriformis)
Maintaining harmony between inner (pelvic) and outer (global) muscles is key.
The Bigger Picture – Whole-Body Assessment
Pelvic health isn’t just about the pelvic floor. A skilled physio will also assess:
- Core stability
- Hip mobility
- Lumbar spine function
- Breathing patterns
“We’ll do a full assessment of the musculoskeletal system, as one system can affect another.”
For example, tight hip flexors or weak glutes can alter pelvic mechanics and exacerbate pelvic floor issues.
FAQs
How long before prostate surgery should I start pelvic floor exercises?
We recommend starting 4–6 weeks before surgery to give muscles time to adapt and improve control.
Can ultrasound help with overactive pelvic floors?
Yes. It helps visualise both underactive and overactive patterns, allowing tailored interventions.
How many sessions will I need?
Most patients benefit from 3–6 sessions, split between pre-op and post-op phases. Severe cases may require longer-term support.
What does a session feel like?
You’ll lie or stand depending on the scan. The probe is gently applied with gel, and the physio will guide you through specific contractions while you observe the muscle movement on screen.
Is this covered by insurance?
Pelvic floor physiotherapy is covered under many private health plans. We can help you verify your cover.
Conclusion – See It. Strengthen It. Recover Smarter.
Ultrasound-guided pelvic floor training is an evidence-based, patient-centred approach that dramatically improves the quality of recovery for men undergoing prostate surgery.
Rather than guess, you can train with clarity, precision, and the confidence that you’re doing the right thing. Whether you’re preparing for surgery or dealing with symptoms afterwards, now is the time to take control.
Let’s get you back to living confidently. The first step starts with a scan.
✅ Book an Appointment Today
Want to take the guesswork out of pelvic floor training?
Book your session now or call us on 020 7482 3875.
Don’t let pain hold you back, book now!
