Same Muscles, Different Conversation: Teaching PfilAtes™ to Men After Prostate Surgery

PfilAtes™ Instructor Notes · Week 3

More men are walking into studios after a prostatectomy, often embarrassed. Many have been told to "do Kegels" and quietly given up. Your job isn't to treat their incontinence. It's to make pelvic floor training feel normal, doable, and worth showing up for.

Start with the conversation

• Normalize it early. "Leaking after prostate surgery is common, and the pelvic floor is trainable. It's the same muscle group in men and women."
• Use plain anatomy. The pelvic floor is a hammock from the pubic bone to the tailbone. It works best alongside three partners: the glutes, the inner thighs, and the deep abdominals. When those switch on, the pelvic floor joins in.
• Promise effort, not outcomes. Say "this is training," never "this will fix it."

What the research says (and doesn't)

The only published trial of PfilAtes™ in men is Au et al., PM&R 2020, a small feasibility RCT from Toronto. Fifty men were randomized around the time of prostatectomy, and 37 completed it. Adding PfilAtes™ and Hypopressives to standard pelvic floor exercises, at a matched exercise volume, was associated with fewer self-reported daily leaks at 26 weeks (rate ratio 0.45), with no reported adverse events. The authors call it preliminary and ask for larger studies.

Erections are the question you'll get next, and pelvic floor training can help there too. In a randomized trial of 52 men after prostatectomy, 47.1% of those who did biofeedback-assisted pelvic floor training had recovered potency at 12 months, compared with 12.5% of men given verbal instructions only (Prota 2012). A meta-analysis of the trials found the same 12-month benefit for training plus biofeedback (Kannan 2019). In a small UK trial of men with erectile dysfunction from other causes, 40% had regained normal erectile function after 6 months of pelvic floor exercises (Dorey 2004/05). Results across trials are mixed, so pelvic floor training belongs alongside the urologist's recovery plan, not in place of it.

Two movements to teach first

Squat (seated hover for beginners, standing at a counter for steadier clients) and Lunge. Both reach peak pelvic floor engagement at the low point, and both feel like "real exercise" to men who are skeptical of lying on a mat squeezing.

At the low point, layer in the pulse: tiny dips around that bottom position, a sharp open-mouthed "ha!" that fires the deep abdominals right as you dip, and a deliberate pelvic floor lift on the same beat. Then let everything go as you rise.

Cue to borrow: "Sink to the bottom, small dip, 'ha,' lift. Now let it go." For men who can't find the contraction, try: "Gently draw the base of the penis up and in, like stopping gas."

Know when to refer

Pause and refer to a pelvic health physical therapist or the client's urologist if he reports pain, blood in the urine, burning, leaking that's getting worse, or no contraction he can feel at all. Ask before the first session whether his surgical team has cleared him for exercise.

Your drill this week

Teach one male client the squat and lunge with the pulse. Have him rate each (0 none, 1 mild, 2 moderate, 3 strong) on the Movement Selection Worksheet, note anything that hurt, and pick his best pain-free movement for five minutes morning and evening.

References

• Au D, et al. Pfilates and Hypopressives for the Treatment of Urinary Incontinence After Radical Prostatectomy: Results of a Feasibility Randomized Controlled Trial. PM&R 2020;12(1):55-63. doi:10.1002/pmrj.12157.
• Prota C, et al. Int J Impot Res 2012;24(5):174-8. doi:10.1038/ijir.2012.11.
• Kannan P, et al. Clin Rehabil 2019;33(8):1298-1309. doi:10.1177/0269215519840392.
• Dorey G, et al. Br J Gen Pract 2004;54(508):819-25; BJU Int 2005;96(4):595-7. doi:10.1111/j.1464-410X.2005.05690.x.