Pelvic Floor Physical Therapy After Back Surgery?

Urinary leaking, also known as urinary incontinence, is something many people feel embarrassed to talk about—especially when it happens after back surgery. But problems with bladder control after a lumbar laminectomy are more common than most people realize. Even though the exact type of urinary problem varies from person to person, changes in bladder function after spine surgery are well-documented in medical research. 

The good news is that physical therapy—especially pelvic floor physical therapy—can play an important role in recovery. Understanding why leaking happens and how the body changes after surgery can help people feel more confident and in control during the healing process. 

A lumbar laminectomy is a common surgery performed to take pressure off the spinal nerves in the lower back. It is often done to treat spinal stenosis or disc herniation. During the procedure, the surgeon removes part of the bone on the back of the spine, called the lamina, to make more space for the nerves. 

While the surgery often improves leg pain and nerve symptoms, it can also affect the muscles and nerves around the spine. This includes the deep spinal stabilizer called the multifidus, which sits directly next to the surgical site. Research shows that after a laminectomy, the multifidus can lose 14–40% of its strength, partly because of surgical injury and partly because of changes in nerve supply. Over time, this muscle can also develop inflammation, scar tissue, and fat infiltration. 

All of these changes matter because the multifidus and deep core muscles work closely with the pelvic floor, which plays a major role in bladder control. When one part of this system becomes weak or uncoordinated, the entire system can be affected. 

Many people expect that urinary leaking must come from the bladder itself, but bladder problems can also come from nerve issues. The nerves that control the bladder and pelvic floor muscles come from the lower spinal levels (sacral nerves). If these nerves were compressed before the surgery—or irritated during healing—they may not work normally right away. 

Stress urinary incontinence is leaking with coughing, sneezing, or physical movement. True stress incontinence directly caused by laminectomy is not well-documented in large studies. However, SUI can occur after surgery due to: 

• Weakening of the pelvic floor after long-term nerve compression 

• Reduced strength of the deep core muscles, including the multifidus 

• Changes in posture and movement patterns during recovery 

• Deconditioning after surgery 

Even if the surgery itself does not directly cause stress incontinence, the cascade of muscle and nerve changes in the deep core and pelvis can make leaking more likely—especially in people who already had mild symptoms before surgery. 

To understand how physical therapy helps, it’s important to see how deeply connected the pelvic floor is to the spine. 

The pelvic floor, transversus abdominis, diaphragm, and multifidus form a deep core cylinder that helps stabilize the spine, support organs, and manage pressure in the abdomen. When these muscles work together, they keep the pelvis steady and help control the bladder. 

After a laminectomy, the multifidus often becomes weak or loses nerve input. When this happens, other muscles try to compensate. This compensation can change movement patterns, increase pressure on the bladder, and reduce coordination with the pelvic floor. 

Studies show that: 

• Pelvic floor muscles naturally co-contract with the multifidus and internal obliques during activity. 

• Training the pelvic floor also activates other deep core muscles. 

• Dysfunction in the pelvic floor often matches dysfunction in the multifidus—and vice versa. 

This means pelvic floor physical therapy can indirectly improve deep core stability, even without directly targeting the spine. 

Physical therapy helps through several evidence-backed mechanisms: 

1. Pelvic floor muscle training (PFMT) 

PFMT improves strength, endurance, coordination, and relaxation of the pelvic floor. Research shows that: 

• 74% of women improve or are cured of urinary incontinence after 3–6 months of supervised training. 

• Supervised therapy is more effective than home exercises. 

While these studies focus mainly on women, the principles apply to men as well. 

2. Deep core and multifidus retraining 

After laminectomy, the multifidus needs targeted rehabilitation because: 

• It loses strength and size 

• It undergoes inflammation and eventual scarring 

• It often cannot “turn on” properly without retraining 

Physical therapists use motor-control exercises to help restore activation. Research shows that: 

• Starting deep core retraining 10 days after surgery can improve multifidus and transversus abdominis activity. 

• These improvements reduce pain and disability in the long term. 

3. Coordination and pressure management 

Many people leak urine not because their pelvic floor is weak, but because it does not contract at the right time. Therapy improves: 

• Reflex timing 

• Breathing patterns 

• Pressure control during lifting, walking, or coughing 

This coordination is often disrupted after back surgery and must be retrained. 

4. Rebuilding hip and trunk strength 

Weak hip muscles—especially the hip abductors—can change pelvic alignment and increase pressure on the bladder. Exercises that stabilize the pelvis can also increase deep multifidus activation. 

5. Education and bladder training 

A therapist can help with: 

• Strategies to reduce urgency 

• Behavioral routines to improve bladder control 

• Lifestyle changes that support recovery 

This is especially useful for people with detrusor overactivity or mixed symptoms. 

Most effective physical therapy programs last 6–12 weeks, with improvements building over time. Many people notice early improvements in urgency, frequency, or leaking within the first month, but changes in strength and deep core coordination continue for several months. 

Because bladder symptoms after laminectomy can come from both muscle dysfunction and nerve injury, recovery varies from person to person. But even when nerve healing is slow, the pelvic floor and core can often learn new activation patterns that greatly reduce leaking. 

Urinary leaking after a lumbar laminectomy can be frustrating, confusing, and sometimes frightening. But it is also understandable once you know how closely the bladder, pelvic floor, and spinal muscles are connected. Physical therapy—especially pelvic floor physical therapy—offers a safe, effective path to regaining strength, control, and confidence. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.