Yes, pelvic floor exercises after a prostatectomy can help erectile function come back, and the evidence for them is better than for most “ED exercises.” Several randomised trials found that men who trained their pelvic floor, ideally starting before surgery, recovered erections faster than men who didn’t. They are an add-on to standard penile rehabilitation, though, not a replacement for it, and how much they help depends heavily on whether the nerves were spared.
If you’re new to the general idea, start with our guide to pelvic floor exercises for erectile dysfunction, which covers the original research in men without surgery. This article is specifically about recovery after prostate cancer surgery, which is a different situation.
Why Prostatectomy Affects Erections
A radical prostatectomy removes the prostate, which sits right next to the cavernous nerves that trigger erections. Even when a surgeon uses a nerve-sparing technique, those nerves are often stretched or bruised. They can take one to two years to recover, and sometimes they don’t fully recover.
There’s a second problem. Without regular erections, the penile tissue gets less oxygen-rich blood, and over time that can lead to scarring and a venous “leak,” where blood doesn’t stay in the penis. This is why urologists talk about penile rehabilitation: keeping the tissue healthy while the nerves heal.
The pelvic floor fits in here because two of its muscles, the ischiocavernosus and bulbocavernosus, squeeze the base of the penis and help trap blood during an erection. Stronger, better-coordinated muscles can make the most of whatever nerve function returns.
What the Research Shows
The evidence is real but modest. Here are the studies worth knowing:
- Prota et al. (2012, International Journal of Impotence Research): a randomised trial of men after radical prostatectomy. The group doing pelvic floor training with biofeedback had better erectile function at 12 months than controls.
- Milios et al. (2019, International Braz J Urol): a randomised trial of perioperative pelvic floor training (starting before surgery and continuing after). Men in the training group recovered both urinary control and erectile function faster in the early months.
- Systematic reviews of randomised trials (published on PubMed and summarised on UroToday): pooled results suggest pelvic floor training improves erectile function scores after prostatectomy, but the trials are small, use different programmes, and the overall quality of evidence is rated low to moderate.
So the honest summary: likely helpful, low risk, and cheap, but not a guaranteed fix. Most of the benefit seems to be in speed of recovery rather than whether you recover at all.
When to Start
The best results in trials came from men who started training before surgery. Learning the right contraction while you’re well and not leaking urine is much easier than learning it with a catheter just out.
| Stage | What to do | Notes |
|---|---|---|
| 2–4 weeks before surgery | Learn the contraction, ideally with a pelvic health physiotherapist | Biofeedback helps confirm you’re using the right muscles |
| Catheter in (about 1–2 weeks) | No pelvic floor exercises | Follow your surgeon’s instructions |
| After catheter removal | Restart gently, short holds, lying down | Focus on continence first |
| 6 weeks to 12 months | Build to longer and stronger holds, standing and walking | Combine with any penile rehab your urologist prescribes |
If you’ve already had surgery and didn’t train beforehand, it’s still worth starting once your surgeon says it’s safe. Starting late is better than not starting.
A Simple Routine
Programmes in trials varied, but most looked something like this. Check with your care team before starting.
- Find the muscles: imagine stopping the flow of urine and holding in gas at the same time. You should feel the base of the penis lift slightly and the testicles rise. Your buttocks, thighs and stomach should stay relaxed.
- Slow holds: squeeze for 5 seconds, relax for 5 seconds, 10 times. Work up to 10-second holds.
- Quick flicks: 10 fast, strong squeezes, fully relaxing between each.
- Frequency: three sets a day, in different positions (lying, sitting, standing).
- Functional use: squeeze before you cough, sneeze or stand up. This also helps with leaks.
Relaxing fully between squeezes matters as much as the squeeze itself. For more detail on technique, see our guide to Kegel exercises for men.
How It Fits With Penile Rehabilitation
Pelvic floor training is one part of recovery. Your urologist may also recommend:
- PDE5 inhibitors (such as tadalafil or sildenafil), sometimes taken regularly at a low dose
- A vacuum erection device to bring blood into the penis and keep tissue healthy
- Injections or urethral medication if tablets don’t work
These work on the blood flow and tissue side, while pelvic floor training works on the muscle side. They aren’t competing options. Some trials combined them, and that combined approach is what most specialist guidelines now favour.
General fitness helps too. Regular aerobic exercise improves blood vessel health, which matters for erections; see our piece on cardio and erectile dysfunction.
Realistic Expectations
- Erectile recovery after prostatectomy is slow. Many men see gradual improvement for 18–24 months.
- Nerve-sparing surgery, younger age and good erections before surgery all predict better recovery.
- If nerves were removed on both sides, pelvic floor exercises are unlikely to restore natural erections on their own, though they may still help with continence and climax-related leakage.
- Results in trials were average improvements. Some men gain a lot, some very little.
When to See a Doctor
Talk to your urologist or GP if:
- You have pain, blood in your urine, or a fever after surgery
- You aren’t sure you’re doing the exercises correctly after a few weeks (ask for a referral to a pelvic health physiotherapist)
- You have no erections at all by around 3 months and aren’t on any rehabilitation plan
- Low mood or relationship strain is building. This is common after prostate cancer treatment and worth raising.
FAQ
Do Kegels help erectile dysfunction after prostate surgery?
They can. Randomised trials such as Prota et al. (2012) and Milios et al. (2019) found faster or better erectile recovery in men who did pelvic floor training. The effect is modest and works best alongside standard penile rehabilitation.
How long after a prostatectomy can I do pelvic floor exercises?
Usually once the catheter is out, about one to two weeks after surgery, but follow your surgeon’s advice. Ideally you’ll have learned the exercises before the operation.
How long does it take for erections to return after a prostatectomy?
It varies widely. Some men notice partial erections within months; for many, recovery continues for up to two years. Nerve-sparing surgery and good pre-surgery function improve the odds.
Can I overdo pelvic floor exercises?
Yes. Too many hard squeezes without relaxing can leave the muscles tight and sore, which can cause pelvic pain. Stick to the programme and make sure you relax fully between holds.
The Bottom Line
Pelvic floor exercises after a prostatectomy are one of the few “ED exercises” with randomised trial support. They’re cheap, low risk, and seem to speed up erectile recovery, especially if you start before surgery. They won’t replace nerve healing or medical penile rehabilitation, so use them as part of a plan agreed with your urologist, ideally with help from a pelvic health physiotherapist.
Related Reading
- Pelvic Floor Exercises for Erectile Dysfunction
- Kegel Exercises for Men: How to Find the Right Muscles
- Erectile Dysfunction Exercises: What Actually Helps
This article is for general information and is not medical advice. Always follow the guidance of your surgical and urology team.