STOP THE LEAK: PELVIC FLOOR TRAINING AFTER PROSTATE SURGERY
Understanding Urinary Leakage After Prostate Surgery
Urinary leakage after prostate surgery is a common experience for men recovering from a radical prostatectomy. Right after the catheter is removed, up to 90 percent of men experience some degree of leakage. This is normal and expected. The body is adjusting to a major change, and healing takes time.
Over the course of a year, incontinence rates can range from 5 percent to more than 50 percent, depending on age, health, surgical and other factors. While that range may seem large, it highlights how individual recovery really is. Every person heals differently.
What Is a Radical Prostatectomy?
A radical prostatectomy is a surgical treatment for prostate cancer that removes the entire prostate gland, the seminal vesicles, and sometimes surrounding lymph nodes. Some surgeries are done with robotic assistance through small abdominal incisions, while others are performed as open abdominal procedures with a larger incision.
Some studies suggest robotic surgery may be associated with slightly lower rates of incontinence, but results are mixed. Regardless of the surgical approach, urinary leakage and erectile dysfunction is a well-known part of the recovery process.
Why Leakage Happens
Several factors can increase the risk of urinary incontinence after prostate removal. These include:
A history of transurethral resection of the prostate (TURP)
Pre-existing bladder conditions such as overactive bladder or neurological disorders
Prior radiation therapy
Surgical injury to nerves, blood vessels, or the bladder neck
Damage to the internal or external urethral sphincter during surgery
Older age
More complex tumor involvement
Surgeon experience
Even though many of these factors are outside your control, there are steps you can take to support your recovery and regain confidence.
The Role of Pelvic Floor Training
Pelvic floor muscle training has been shown to help men recover continence more effectively than doing nothing at all. These exercises strengthen the muscles that support the bladder and urethra, improving control and coordination.
Most men can begin pelvic floor training once their catheter is removed, usually about a week after surgery. Early on, holding in urine may feel difficult or impossible. This is normal. Over time, as the muscles rebuild strength and control, leakage tends to improve.
Nighttime bladder control is often the first to return since the bladder is less active while you are asleep. Daytime leakage, especially during activities such as coughing, bending, or exercising, usually takes longer to improve (12 months or longer at times). This is known as stress urinary incontinence because it occurs when pressure increases inside the abdomen and pelvis.
Getting Started with Pelvic Floor Activation
Start by learning how to properly identify and engage your pelvic floor muscles.
Sit comfortably on the edge of a chair.
Gently contract your pelvic floor muscles as if you were stopping the flow of urine or drawing your penis inward.
Hold the contraction for up to 10 seconds while breathing normally.
Release and rest for 10 seconds.
Avoid holding your breath or tightening your glutes, thighs, or abdomen. The goal is to isolate the pelvic floor muscles, not recruit the rest of your body.
Repeat this up to 10 times. If you cannot hold for 10 seconds at first, start smaller and build gradually. Consistency and good form are more important than duration.
Quick Contractions for Reflex Control
Once you can perform slow holds comfortably, add quick contractions to train your reflexes.
Contract your pelvic floor quickly and strongly for one to two seconds.
Relax for two seconds.
Repeat up to 10 times.
These fast-twitch contractions prepare your pelvic floor for sudden movements like coughing, sneezing, or lifting, when leaks are most likely to happen.
Mastering “The Knack” Technique
“The knack” is a timed pelvic floor contraction done right before an activity that usually causes leakage. It is a proactive way to support your bladder during pressure changes.
Here is how to practice it:
Gently contract your pelvic floor muscles as if stopping the flow of urine.
While holding the contraction, cough or laugh.
Release and rest.
Use this same technique whenever you anticipate leaks, such as when lifting, standing up, or exercising. Over time, it helps your body automatically engage the pelvic floor when needed.
How Often to Practice
In the early phase, aim for six short sessions spread throughout the day, totaling about 120 contractions per day. Practice in different positions such as lying down, sitting, and standing. The more consistently you train, the faster you will feel results.
Once you are confident with technique, you can integrate pelvic floor work into movement. This prepares your muscles for real-life situations that may trigger leakage.
What to Expect During Recovery
Regaining continence after prostate surgery takes time. Some men notice improvement within a few months, while others may need a full year or more. Progress may not be linear. Some days will feel better than others, but with consistent practice and patience, most men see meaningful improvement.
The key is to stay consistent, use correct form, and avoid comparing your timeline to anyone else’s. Healing is personal.
When to Seek Professional Help
If you are unsure whether you are doing the exercises correctly, want to recover from incontinence faster, or continue to experience leakage greater than three months, seek guidance from a pelvic health therapist. A trained clinician can assess your muscle coordination, breathing patterns, and movement strategies, then tailor a plan to your specific needs.
A pelvic floor therapist can also teach you how to integrate pelvic floor work into your lifestyle, address contributing factors such as posture or breathing mechanics, and provide ongoing support as you progress.
Recovery takes time, but it is possible. Stay consistent, stay patient, and celebrate every step forward.
For more in-depth pelvic floor tutorials, model demonstrations, and live Q&A sessions, join my educational community at https://www.patreon.com/cw/drsusieg.
This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.
