Regaining Control: Urinary Urgency and Frequency After Radical Prostatectomy
Undergoing a radical prostatectomy—the surgical removal of the prostate gland—can be a life-saving step in treating prostate cancer. But for many men, it also brings along a deeply personal and often frustrating side effect: urinary urgency and frequency.
If you find yourself constantly rushing to the bathroom, or unable to control your urge to urinate after surgery, know this—you’re not alone, and there is hope. One of the most effective, evidence-backed approaches for managing these symptoms is pelvic floor physical therapy.
Let’s break it down.
Why Does Urinary Urgency and Frequency Happen After Radical Prostatectomy?
The prostate sits just below the bladder and surrounds the urethra. When it’s removed, it changes the anatomy and function of the lower urinary tract, impacting both storage and voiding mechanisms.
Common Urinary Issues After Prostatectomy:
Urinary urgency: a sudden, intense need to urinate.
Urinary frequency: needing to urinate often, sometimes every hour.
Urge incontinence: leaking urine before reaching the toilet.
Stress incontinence: leaking with coughs, sneezes, or movement (also common).
These problems usually stem from weakened or uncoordinated pelvic floor muscles, disrupted nerve signaling, and bladder irritation due to surgical trauma.
The Role of the Pelvic Floor in Urinary Control
The pelvic floor muscles (especially the levator ani group, including the pubococcygeus and iliococcygeus) support the bladder and help control the urethra. Two key muscles relevant to male urinary continence include:
External urethral sphincter: Voluntary muscle that controls the flow of urine.
Pelvic floor stabilizers: Support the bladder neck and urethra, helping maintain pressure and control.
After prostatectomy, the internal sphincter (part of the prostate complex) is removed. This puts extra pressure on the remaining pelvic floor muscles and the external sphincter to do all the work—making rehabilitation crucial.
How Pelvic Floor Therapy Can Help Urgency and Frequency
Pelvic floor physical therapy isn’t just about doing "Kegels." It's a comprehensive approach tailored to retrain, strengthen, and coordinate the muscles and nerves involved in urinary control.
What Pelvic Floor Therapy Typically Involves:
✅ 1. Pelvic Floor Muscle Training
Learning to properly contract and relax the pelvic floor muscles.
Teaching timing and control—especially during urges.
✅ 2. Bladder Retraining
Creating a voiding schedule to gradually increase the time between urinations.
Using urge suppression strategies (like pelvic floor squeezes or deep breathing) to delay the urge.
✅ 3. Manual Therapy
Addressing muscle tension, scar tissue, or fascial restrictions in the pelvic region that may be affecting nerve function or bladder mobility.
Soft tissue work and myofascial techniques to reduce guarding or spasm around the urethra and perineum.
✅ 4. Breathing and Core Integration
The diaphragm and pelvic floor work together—poor breathing mechanics can increase abdominal pressure and worsen urgency.
Therapy teaches proper breathing patterns to reduce pressure on the bladder.
✅ 5. Behavioral & Lifestyle Modifications
Identifying bladder irritants (like caffeine, alcohol, citrus).
Adjusting fluid intake to avoid both overhydration and dehydration.
Posture and movement education to reduce pelvic strain.
How Long Does Recovery Take?
Every man’s recovery journey is different. Some see improvements within 4-6 weeks of starting therapy, while others may need a few months for the muscles to fully recover and coordinate.
Early intervention—starting therapy soon after catheter removal or when symptoms emerge—is associated with better long-term outcomes.
Evidence Supports Pelvic Floor Therapy
Multiple studies have confirmed that pelvic floor rehabilitation significantly improves urinary continence after radical prostatectomy, especially when compared to no intervention or verbal instruction alone.
A 2020 meta-analysis in European Urology found that men who participated in supervised pelvic floor therapy regained continence sooner than those who didn’t.
Even men with persistent symptoms 6+ months post-op can benefit from therapy tailored to urge suppression and muscle retraining.
Don’t Just "Wait It Out"—You Deserve to Feel in Control
Urinary urgency and frequency can feel isolating and even embarrassing, but they are common and treatable side effects of prostate surgery. With the right support—especially from a trained pelvic floor physical therapist—you can regain your freedom, confidence, and peace of mind.
Final Thought:
If you've had a radical prostatectomy and are dealing with urgency or frequency, don’t assume it’s something you just have to live with. Pelvic floor therapy offers a powerful, non-invasive way to reclaim control. Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.