# Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy

Source: https://onco.cc/technologies/rejuv-rehab-pelvic-floor/  
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## TL;DR

Pelvic floor exercises are offered to almost every man after prostate surgery, and the largest randomised trial found formal one-to-one training made no difference at twelve months: 76 per cent of treated men were still leaking against 77 per cent of controls. Training before the operation does speed early recovery.

## Summary

The pelvic floor is the sheet of muscle that holds continence, supports the pelvic organs and contributes to sexual function. Prostatectomy removes part of the continence mechanism, low rectal surgery disturbs the rest, and pelvic radiotherapy stiffens all of it.

The negative trial that is rarely quoted. MAPS was two parallel randomised trials in United Kingdom men who were still incontinent six weeks after radical prostatectomy or after transurethral resection of the prostate. Men were randomised to four one-to-one sessions with a therapist over three months, or to standard care and lifestyle advice. In the prostatectomy trial, urinary incontinence at twelve months affected 148 of 196 (76 per cent) in the intervention group and 151 of 195 (77 per cent), an absolute risk difference of minus 1.9 per cent (minus 10 to 6). In the transurethral resection trial it was 126 of 194 (65 per cent) against 125 of 203 (62 per cent), a difference of 3.4 per cent (minus 6 to 13). The intervention cost more per patient and produced no detectable gain in quality-adjusted life years. The authors' conclusion is worth reading in full because both halves matter: "In settings where information about pelvic-floor exercise is widely available, one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be effective or cost effective. The high rates of persisting incontinence after 12 months suggest a substantial unrecognised and unmet need for management in these men."

What that trial does and does not say. It tested adding formal one-to-one therapy on top of widely available written advice, in men already incontinent at six weeks. It did not test teaching the exercises at all against teaching nothing, and it did not test starting before the operation.

Before the operation. A 2026 meta-analysis of 16 randomised trials and 1,542 men found that prehabilitation before radical prostatectomy reduced the incidence of urinary incontinence at one month (odds ratio 0.58, 0.39 to 0.84) and six months (0.52, 0.28 to 0.96), with a borderline non-significant effect at three months and no significant benefit at twelve. Severity of incontinence and erectile function did not improve at any time point. The pattern is that preoperative training brings continence back sooner and does not change where men end up.

Biofeedback adds nothing. The question of whether electromyographic biofeedback improves on ordinary pelvic floor training was settled in women by the OPAL trial, which randomised 600 women with stress or mixed urinary incontinence to six appointments of training with or without biofeedback. At 24 months the mean incontinence scores were 8.2 and 8.5 out of 21, a difference of minus 0.09 (minus 0.92 to 0.75, p equals 0.84), with similar costs and quality-adjusted life years. The trial was not in a cancer population and its conclusion was that routine biofeedback should not be recommended.

Where pelvic floor training does work. In women with pelvic organ prolapse, the POPPY trial randomised 447 outpatients to individualised pelvic floor muscle training or a lifestyle advice leaflet, and symptoms at twelve months improved more with training (adjusted difference 1.52 on the prolapse symptom score, 0.46 to 2.59, p equals 0.0053). That is not a cancer population either, and it is the best randomised demonstration that the exercises themselves do something when the problem is support rather than a surgically disrupted sphincter.

After rectal surgery and pelvic radiotherapy. This is where the evidence runs out. Pelvic floor rehabilitation is offered for low anterior resection syndrome and for faecal urgency after pelvic radiotherapy, and the randomised evidence specific to those indications is thin. The honest statement is that it is reasonable, it is low risk, and there is no trial of the size of MAPS in either population.

What comes back, and when: continence after prostatectomy improves most in the first six to twelve months and then plateaus. The figures from MAPS are the ones to quote to a man asking how likely he is to be dry at a year, and they are higher than most patient information admits, because MAPS recruited men who were still leaking at six weeks rather than everyone who had the operation.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; rehabilitation; evidence:moderate
- Principle: Continence after prostatectomy depends on the external urethral sphincter, its nerve supply and the support of the pelvic floor. Exercise can strengthen the striated muscle but cannot repair a damaged sphincter or a divided nerve, which is why training shortens the recovery curve without raising its plateau. In prolapse, where the problem is support rather than a disrupted sphincter, training changes the outcome.
- Strengths: Preoperative training brings continence back sooner after prostatectomy; No harm, and widely available written and digital instruction; Randomised evidence of benefit in prolapse, where support is the problem
- Limitations: Formal one-to-one therapy after prostatectomy changed nothing at twelve months in the largest trial; Biofeedback adds nothing over plain training; Almost no randomised evidence for low anterior resection syndrome or radiation-related urgency

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Pelvic_floor
- MAPS: pelvic-floor muscle training after radical prostatectomy or transurethral resection (Lancet 2011): https://doi.org/10.1016/S0140-6736(11)60751-4
- The impact of prehabilitation on postoperative outcomes in patients undergoing radical prostatectomy (Support Care Cancer 2026): https://doi.org/10.1007/s00520-026-11182-z
- Pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: the OPAL trial (BMJ 2020): https://doi.org/10.1136/bmj.m3719
- Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY) (Lancet 2014): https://doi.org/10.1016/S0140-6736(13)61977-7

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Bowel function after pelvic radiotherapy](https://onco.cc/technologies/bowel-after-pelvic-radiotherapy/), [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Recovery after pelvic exenteration](https://onco.cc/technologies/rejuv-recon-pelvic-exenteration/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Stoma reversal after rectal cancer surgery: who gets the bowel joined up again](https://onco.cc/technologies/rejuv-recon-stoma-reversal/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/)
- terms: [Pelvic floor muscle exercises](https://onco.cc/terms/pelvic-floor-muscle-exercises/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Stress urinary incontinence](https://onco.cc/terms/stress-urinary-incontinence/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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