Urinary Leakage After Prostate Surgery
Urinary leakage is common after radical prostatectomy. For most men, it improves over time, especially during the first year after surgery.
Pelvic floor training can help you regain control by improving the strength, endurance, coordination, and timing of the muscles involved in continence.
And if nobody told you to start pelvic floor rehab after surgery, it may still be worth doing — even if you are more than a year out.
Why does leakage happen after prostatectomy?
Prostate surgery changes the anatomy responsible for urinary control.
After surgery, the external urinary sphincter and surrounding pelvic floor muscles have a larger role in keeping the urethra closed. If those muscles are weak, fatigue quickly, or do not respond at the right time, leakage can occur.
Common symptoms include:
Leakage with coughing or sneezing
Leakage when standing up from a chair
Leakage with lifting or exercise
Leakage that gets worse later in the day
Continued pad use after surgery
Urgency or frequent urination
Leakage during sexual arousal or orgasm
It’s not just about doing more Kegels
A lot of men leave surgery knowing they are supposed to “do Kegels,” but not much else.
The problem is that urinary control requires more than squeezing as hard as possible.
I want to know whether you can find the right muscles, generate an effective contraction, fully relax afterward, maintain that contraction when needed, and use it at the right time during the activities that actually cause leakage.
Training also needs to progress into standing, walking, lifting, exercise, and the other situations where you need control.
Should I start before surgery?
If your prostatectomy is already scheduled, a pre-operative visit can be useful.
It gives you a chance to learn how to identify and control the pelvic floor muscles before you are recovering from surgery and dealing with a catheter.
We can establish a program ahead of time so you know exactly what to return to once your surgeon clears you after surgery.
Research on whether pre-operative training changes long-term continence outcomes is mixed, so I would not promise that starting beforehand prevents leakage. But it can make the rehabilitation process much less confusing.
What does rehab look like after surgery?
Pelvic floor training usually resumes after the catheter has been removed and according to your surgeon’s instructions.
At Pelvic Lab, treatment is based on what you are actually having trouble with.
That may include:
Assessing pelvic floor strength, endurance, and coordination
Practicing control during coughing, standing, lifting, and walking
Building endurance so control holds up later in the day
Improving timing during activities that trigger leakage
Addressing excessive pelvic floor tension when it is present
Progressing back to gym training, running, and other exercise
Building a home program that fits your actual schedule
Is it too late to start pelvic floor PT?
No.
A lot of men come in months or even years after prostate surgery because nobody told them pelvic floor rehabilitation was an option, or because they were simply told to do Kegels on their own.
Most spontaneous continence recovery happens during the first year after prostatectomy, but that does not mean the pelvic floor stops being trainable after that point.
Research has shown meaningful reductions in leakage even in men whose incontinence had persisted for more than a year after prostatectomy, including men several years out.
If you never learned how to contract the right muscles, have been using them inefficiently, fatigue quickly, or never progressed beyond basic Kegels, there may still be useful gains to make.
You did not miss your chance just because nobody referred you earlier.
What about sexual function?
Urinary recovery and sexual recovery after prostatectomy overlap, but they are not the same thing.
Your urologist should remain involved in erectile rehabilitation and medication management.
Pelvic floor PT can address pelvic muscle function and may also be relevant for men who experience urinary leakage during sexual arousal or orgasm, sometimes called climacturia.
If erectile dysfunction is a major concern, I coordinate the pelvic rehabilitation side of recovery rather than trying to replace medical management.
Working with your urologist
Post-prostatectomy rehabilitation works best when it is coordinated with the surgeon managing your recovery.
With your permission, I can communicate relevant evaluation findings and progress with your urologist so your rehabilitation stays coordinated with the rest of your care.
Pelvic floor PT after prostate surgery in NYC
Pelvic Lab is a men’s pelvic floor physical therapy practice in the Flatiron District of Manhattan.
Every appointment is private and one-on-one with Dr. Joshua Weber, PT, DPT.
Not sure whether you should come in before surgery, soon after surgery, or even if you are already more than a year out?
Schedule a free 15-minute call.
Pelvic Lab is out of network. Payment is due at each visit, and you will receive a superbill you can submit to your insurance for possible reimbursement.
Dr. Joshua Weber, PT, DPT, is the owner of Pelvic Lab in Manhattan, a practice dedicated to men’s pelvic floor physical therapy. This page is educational and is not a substitute for individualized medical or physical therapy care.