Choosing the Right Options for Post-Pelvic Surgery Management and Rehabilitation

Pelvic surgery is an option for patients who may have cancer or other issues in the bowel, urinary system, reproductive system, or prostate. The pelvic region – including the pelvic floor muscles (PFMs) – consists of structures important to bowel, urinary, and sexual function. Any trauma to the area, including surgery, may cause postoperative dysfunction and therefore worsen the patient’s quality of life immediately following surgery.

In women, pelvic surgery includes pelvic organ prolapse surgery, hysterectomy (total, partial, and salpingo-oophorectomy), and other urogynecological surgeries. Several studies state that some patients either sustained or developed sexual and urinary dysfunction in the recovery period, such as dyspareunia (pain with sex), vaginal dryness, vaginismus (vaginal pain), anorgasmia (absence of or difficulty achieving orgasm), and low libido.

Men who’ve had urethral slings or artificial sphincters placed or radical surgery for prostate, bowel, or bladder cancer may develop erectile dysfunction, urinary or bowel incontinence, ejaculatory disorders, or penile length loss or curvature postoperatively.

It is important to consider patient satisfaction and quality of life when managing postoperative complications in pelvic surgery patient populations. This article intends to summarize some of the pelvic pain and sexual dysfunction treatments for pelvic surgery patients.

Pain Management

First-line treatment for managing immediate postoperative pelvic pain includes pharmacotherapy with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and, when appropriate, opioids depending on pain severity. Providers may also consider alpha-blockers, anticholinergics, beta-3 agonists, and phosphodiesterase-5 inhibitors (PDE5-i).

Second-line treatment for postoperative pelvic pain may include:

• Pharmacotherapy options like gabapentin or pregabalin. If these options are considered, side effects should be taken into account.
• Pelvic floor physical therapy (PFPT) to strengthen the PFMs, which may have been weakened or damaged during surgery. Because the pelvic floor is such a complex neuromuscular structure, some pelvic surgeries may affect its function, despite careful surgical technique. PFPT can play an important role in strengthening and recovering this complex structure.
  • PFPT may also help to relax overly tight muscles, which can also cause pelvic pain.
  • If recommending PFPT to a pelvic surgery patient, it is best to refer them to a pelvic floor physical therapist.

Sexual Function Management

Sexual dysfunction is a common complication of some pelvic surgeries because of the complexity of pelvic organs, PFMs, and the nervous system that are altered, even with minimally invasive options. Treating specific sexual dysfunction may also improve libido and sexual satisfaction.

For men who have had pelvic surgery, providers may find success in prescribing PDE5-i, penile injection therapy, or other mechanical options like vacuum erection devices. For those whose erectile dysfunction is persistent, it may be best to recommend penile prosthesis surgery, based on recommendations.

For women who have had pelvic surgery, topical options such as vaginal estrogen, moisturizers, and lubricants are recommended to mitigate sexual dysfunction like vaginal dryness and dyspareunia. PFPT is also recommended for women to retrain the PFMs and improve blood flow to the area. In turn, this may mitigate issues like vaginismus, anorgasmia, and dyspareunia.

Urinary and Bowel Function Management

Pharmacological management of urinary incontinence is similar to that of pain management options, including anticholinergics, beta-3 agonists, PDE5-i, and Duloxetine. Also recommended are botulinum toxin injections and vaginal estrogen (in women).

For postoperative bowel dysfunction, providers may consider the use of laxatives or trans anal irrigation for constipation or antidiarrheal medication for bowel incontinence or fecal urgency.

PFPT may also be considered; the PFMs play a key role in pelvic organ function and strengthening them may help reduce urinary or bowel incontinence by improving pelvic floor muscle tone and the strength of the urinary and anal sphincters.

Ultimately, post-pelvic surgery management requires a multidisciplinary approach that involves shared decision-making between provider and patient. Considering patient needs and desires can strengthen treatment results and improve quality of life.

Key Takeaways

• Pelvic surgery takes a large toll on sexual, urinary, and bowel function, resulting in a lower quality of life during recovery.
• A multidisciplinary approach should be taken to help with postoperative pain and sexual function management.
• Pharmacological and physical therapeutic options may be the best way to assist patients with their sexual function and pelvic pain post-pelvic surgery.
• Providers should collaborate with patients to create an effective management plan.

Resources

Gandi, C., & Sacco, E. (2021). Pharmacological management of urinary incontinence: Current and emerging treatment. Clinical Pharmacology: Advances and Applications, Volume 13, 209–223. https://doi.org/10.2147/cpaa.s289323

Lamberti, G., Giraudo, D., Ciardi, G., & Levis, J. K. (2026). Pelvic floor muscle training following surgery for pelvic organ prolapse: Recommendation from scientific literature. Journal of Clinical Medicine, 15(3), 1116. https://doi.org/10.3390/jcm15031116

Manocchio, N., Vita, G., Giordani, L., Ljoka, C., Monello, C., & Foti, C. (2025). Rehabilitation for women and men experiencing sexual dysfunction after abdominal or pelvic surgery. Surgeries, 6(2), 40. https://doi.org/10.3390/surgeries6020040

Martellucci, J., & Orlandi, S. (2026). Management of bowel dysfunction after pelvic surgery for endometriosis. International Journal of Colorectal Disease. https://doi.org/10.1007/s00384-026-05163-1

Traeger, M., Walther, T., Teoh, J. Y.-C., Wroclawski, M. L., Herrmann, T., Miernik, A., Wilhelm, K., Glienke, M., Pohlmann, P.-F., Gratzke, C., & Schoeb, D. (2025). Management of prolonged post-operative pelvic pain after transurethral prostate surgery: A clinical real-world survey and international comparison of therapy regimens. BMC Urology, 25(1). https://doi.org/10.1186/s12894-025-01943-z