Advances in Pelvic Floor Muscle Training for Post-Prostatectomy Incontinence: From Isolated Muscle Contractions to Integrated Functional Training

Post-prostatectomy incontinence (PPI) is a common complication that affects patients' functional recovery and quality of life after radical prostatectomy. Pelvic floor muscle training (PFMT) is widely used as conservative treatment for PPI, but existing programs vary substantially in their target muscles, contraction types, training dose, body positions, and progression criteria. Conventional PFMT first requires patients to correctly identify and voluntarily contract the pelvic floor muscles involved in continence. Sustained contractions train muscular endurance, whereas brief, rapid contractions train rapid recruitment. However, in patients with PPI, urine leakage usually occurs during activities that may increase or rapidly change intra-abdominal pressure, such as coughing, standing up, and walking. This pattern implies that continence during daily activities may depend on more than voluntary pelvic floor muscle contraction. Timely pelvic floor muscle recruitment and coordination with breathing and postural adjustments may be important when intra-abdominal pressure changes. In response to these functional demands, recent studies have incorporated breathing and trunk coordination, progressive postural loading, and task-specific strategies such as the Knack into PFMT. This narrative review focuses on PFMT content and progression while distinguishing training content from training dose, intervention timing, delivery methods, and adjunctive technologies. Some multicomponent programs have reported favorable early- or intermediate-term continence outcomes and changes in pelvic floor muscle function. Comparisons remain difficult due to heterogeneity in interventions, comparator PFMT quality, outcome definitions, and follow-up schedules, and because added components are usually bundled, making their individual contributions hard to separate. No functional approach can therefore be considered universally superior to well-delivered conventional PFMT based on current evidence. We use four conceptual layers to organize the training elements identified in the literature: muscle identification and motor learning, contraction control, coordination and postural-load progression, and functional integration. These domains provide a framework for describing PFMT content rather than a validated clinical sequence.