penile rehabilitation, post prostatectomy recovery

Restoring Strength: The Path to Penile Rehabilitation

Why Penile Rehabilitation Deserves Your Attention

Recovery after prostate cancer or a prostatectomy doesn’t stop once the surgery is over. Many men experience ongoing issues such as erectile dysfunction, urinary incontinence, and reduced libido. These concerns, though common, are often left unspoken or unmanaged, yet they can be addressed.

Penile rehabilitation is not only about physical function; it’s about restoring confidence, intimacy, and daily comfort. Our affiliated clinics focus on helping you recover with structured pelvic floor physiotherapy that improves circulation, muscle function, and nerve awareness. This episode of Ask Giri explores exactly how we approach it and how physiotherapy becomes a powerful tool in your recovery journey.

Common Post-Surgical Challenges We Address

After prostate cancer treatments or surgery, men may experience a broad range of physical and functional changes. Understanding these challenges is the first step to addressing them.

  • Peyronie’s Disease (Curvature): A condition where scar tissue causes curvature of the penis, making erections uncomfortable or painful. Physiotherapy can support tissue mobility and reduce restriction through targeted soft-tissue and movement-based strategies.

  • Penile Shortening: Loss of length can occur due to structural and muscular changes in the pelvic area. With strengthening exercises and fascial release techniques, we help maintain tissue flexibility and support length retention.

  • Ligament Laxity: Ligaments around the penis may lose their natural tone, contributing to a feeling of instability. We provide exercises that engage surrounding muscles and ligaments to restore control and support.

  • Urinary Incontinence & Climacturia: Leakage with movement, arousal, or orgasm can occur due to compromised pelvic floor function. Our treatment approach involves retraining bladder control and enhancing pelvic floor coordination.

  • Reduced Libido: Psychological and hormonal changes post-treatment can reduce sexual desire. We address this through breath work, mindfulness, and patient education on the nervous system’s role in sexual health.

Each of these conditions may seem isolating, but with proper support, you can navigate recovery more effectively.

Pelvic-Floor Training: Much More Than a Kegel

Many assume that Kegels are the go-to solution for all pelvic floor issues, but the truth is, your recovery requires more depth and variety.

1. Choosing the Right Position Matters

Your pelvic floor doesn’t work the same in every position. That’s why we train it across different postures:

  • Unloaded (Lying Down): Best for beginners. It’s the least demanding but offers a safe space to learn the basics of muscle activation.

  • Supported Sitting: Adds light core engagement while still maintaining comfort. Good for transitioning from lying to more active positions.

  • Unsupported Sitting: Activates deeper stabilizers and challenges your posture muscles while training the pelvic floor.

  • Standing (Fully Loaded): This mimics real-life demands, where the pelvic floor supports weight and movement. It’s where we eventually aim to get you for functional outcomes.

These progressions help your muscles adapt to the realities of daily life, from walking to lifting to intimacy.

2. Mastering Four Distinct Contraction Styles

Different muscle fibres in the pelvic floor respond to different training techniques. We use four unique contraction types to address this:

  • The Pumper: A rhythmic, sub-maximal contraction that targets surface-level muscles. It’s excellent for warming up and preparing for deeper activation.

  • The Rocker: Combines gentle pelvic rotation with sustained contractions. This adds motion to the training, helping improve coordination and control during dynamic tasks.

  • The Boner: Performed during sexual stimulation or erection, this targets the muscle function required to maintain erections. It improves control, blood flow, and tissue tone.

  • The Shooter: Rapid, maximal contractions that mimic the muscular effort involved in ejaculation. This builds endurance and fast-twitch fibre function in key pelvic floor areas.

These drills are performed in various positions, giving us a total of 16 combinations. Each combination serves a unique purpose in building back pelvic strength and function.

Relaxation and Breathing: The Unsung Heroes

Penile health isn’t just about strength; it’s also about letting go. Too much tension will interfere with blood flow and nervous system regulation. That’s where relaxation and breathwork play a critical role.

  • Breath Awareness: Techniques like parasympathetic breathing reduce the body’s stress response and help shift the nervous system into a more receptive state.

  • Mindfulness Practices: These techniques calm the mind and allow the parasympathetic system, which one responsible for arousal and erections, to function optimally.

  • Letting Go of Tension: Many men unknowingly clench their pelvic muscles, which restricts flow and function. Learning to relax is as essential as learning to contract.

This phase of recovery builds the foundation for better erections, reduced anxiety, and more fulfilling intimacy.

Understanding How Erections Work Helps Us Rebuild Them

To rehabilitate the penis, it’s essential to understand the basic mechanics behind an erection. It’s not just about arousal, it’s about hydraulics and neuromuscular control.

  • The Nerves: Nerve bundles near the prostate send signals from the brain to the pelvic region. These can be disrupted during surgery or radiation.

  • The Muscles (Corpora Cavernosa): These paired muscles fill with blood during arousal. A healthy muscle tone ensures proper blood trapping for a strong erection.

  • The Tunica Albuginea: This outer covering maintains firmness. If damaged or restricted, maintaining an erection becomes harder.

Pelvic floor rehab addresses each of these elements, helping restore nerve signalling, support blood flow, and improve muscular coordination.

Using Shockwave Therapy as an Adjunct Option

Low-intensity shockwave therapy is another tool we may incorporate, based on your needs:

  • Focused Shockwave: Deeper penetration (~12 cm) used for restorative treatment around the base and shaft.

  • Radial Shockwave: More surface-level (~3 cm), often used for general tissue health and circulation.

These treatments are never used in isolation. They’re paired with guided exercises, education, and progress tracking to enhance results.

Tailoring the Rehab Plan to You

There is no one-size-fits-all approach in penile rehabilitation. We always consider:

  • Your history and comfort level
  • Your goals (e.g., better bladder control, improved intimacy)
  • Your preferred positions for exercise
  • Your consistency with home programs

We build a plan that works with your lifestyle, not against it, so progress feels sustainable, realistic, and empowering.

What’s Next in Your Recovery?

Penile rehabilitation is about small wins that build over time, whether it’s stronger contractions, fewer leaks, or renewed confidence in intimacy. With a mix of structured exercises, functional breath work, and the right education, you can restore strength in both your body and your sense of self.

Schedule a session. Be sure to watch more videos on our channel and explore past episodes for additional guidance.

Watch. Learn. Move Better.

Only on Ask Giri, The Physio Show