Urinary Leaking After Prostate Surgery? Here’s Why-and What You Can Do About It

You did everything right.  You got diagnosed, had the surgery, and you feel like everything is smooth sailing from here.  Then you stand up from a chair and leak urine.  You go to lift something and feel a small gush.  You sit and wonder what is going on and if this is for the rest of your life. This type of urinary leakage (stress urinary incontinence) is a common side effect after prostate surgery. 

If you had prostate cancer surgery (radical prostatectomy), prostate removal surgery , HoLEP (Holmium Laser Enucleation of the Prostate), or TURP  (Transurethral Resection of the Prostate) procedure and you have leaking now, you are not broken or alone.  Urinary leaking also known as urinary incontinence is one of the most common and predictable side effects of prostate surgery.  It is also very treatable.  The problem is that often men don’t know what to do about it, or that anything can be done about it.

Why Urinary Leaking Happens After Prostate Procedures

If you have had prostate cancer surgery, here’s what changes inside your body. After a radical prostatectomy, the prostate is completely removed and the urinary tract is reconnected.  Think of an orange with a straw going through it- they remove the orange and reattach the ends of the straw together.  This significantly changes the anatomy of the urinary control system.  There are also nerves in the area that get disturbed.  

After surgery, urinary control (continence) depends a lot on the supporting pelvic floor muscles, which don’t always know how to handle this new situation.  You also have to learn to control the internal abdominal pressure that pushes down on the bladder with every cough, lift, sneeze and movement.  This situation is very different from before surgery and you sometimes need to learn a different way of controlling urine. 

The American Urology Association (AUA) reports that short-term urinary incontinence after prostate surgery is expected and generally improves in the first 12 months (and possibly sooner).  Some men continue to have persistent leakage after that time period and require additional treatment. The AUA recommends pelvic floor physical therapy and pelvic floor muscle training (PFMT) as a primary, first-line conservative recommendation for managing urinary leakage following a radical prostatectomy.

Urinary leaking after treatment for Benign Prostate Hyperplasia (BPH) or enlarged prostate can be similarly frustrating.  Common procedures such as HoLEP (Holmium Laser Enucleation of the Prostate) , GreenLight Laser, and TURP (Transurethral Resection of the Prostate) work by removing tissue from the prostate, allowing for urine to flow freely instead of being blocked by the enlarged bulk of the prostate tissue.  In these procedures, the muscle and sphincter have been stretched and the raw surgical area gets irritated more easily causing the bladder to potentially spasm.

BPH procedures may also take up to 12 months to regain control but recovery is often faster than complete prostatectomy. 

Time and healing does help some men eventually, but often men need education and training on how to get control back better and faster.  That is where pelvic floor physical therapy from a PT specializing in this area can really help. 

PELVIC FLOOR EXERCISES (KEGELS) AFTER PROSTATE SURGERY:  WHY THEY NEED TO BE DONE RIGHT

Sometimes men think if they wait, things will get better on their own.  Other times, they desperately search for answers online, only to be told to “do Kegels” (Kegels are a contraction of the pelvic floor muscles) or they find generic information on social media without any real instruction or knowledge on what they really need to do. 

It is understandable that men who leak are desperate for answers and yet are embarrassed to seek help in person for this type of problem.  This leads to looking for answers online which tend to be confusing at best or may be telling you to do the exact wrong thing for your specific situation.  

It is also very hard to teach the correct exercise in written or video form.  The muscles and systems at play are deep and internal and you can’t see them act on the outside like you would be able to do with other types of exercises. 

There are also different muscular reasons for leaking.  Sometimes it is a classical “weak muscle” situation which responds well to strengthening.  Other times it is the exact opposite- a tight/tense muscle that needs to relax.  In this case strengthening “Kegel” exercises might make the situation worse. 

To complicate things further, strength is only one component of whether or not you leak. Factors like pressure in the abdomen and pelvis, endurance, quick muscle contraction when needed for certain tasks, and the ability to relax appropriately between contractions are just as important to controlling urine leakage.   

Another issue is that more Kegels are not necessarily better.  Men are used to thinking about muscle training from a “more is better” perspective.  They think that if 10 repetitions are good then 100 must be better, or that working “harder” with more effort is helpful.  While this can work for a biceps arm muscle, it doesn't quite work that way for the pelvic floor.  

Coordination, control, endurance, contraction of the right muscles (and relaxation of the right muscles), along with integration of abdominal pressure control and breathing are crucial for the system to work properly. The whole system is quite interconnected and interactive.  It is not as simple as “do more Kegels” or “exercise harder”.  

This is why seeing the right therapist matters. Not all physical therapists treat the pelvic floor, and not all pelvic floor therapists regularly treat men. 

At Clemens Physical Therapy, we not only treat pelvic floor issues, but we also specialize in pelvic floor physical therapy for men with issues like urinary leakage after prostate surgeries.  We have both the knowledge and experience to help you get your life back on track.  

While we know it is frustrating to deal with this problem, with patience and the right knowledge and assistance, we often get men back to full control quicker than they would if they did not do anything. 

“I had no idea the correct way to do kegels.  I was never actually shown.  I was doing it all wrong.  Marnie showed me the correct way of doing them, which helped me greatly.  She is very knowledgeable about Kegels.”    James

WHAT BETTER LOOKS LIKE

Picture standing up from the dinner table without a second thought.  Picture playing eighteen holes without mapping out where the restrooms are.  Picture sleeping through the night and waking up in a dry bed.  That is a realistic goal for men who commit to a proper pelvic floor program after prostate surgery.  It is what we work toward with every patient we see.  

You already fought the harder battle when you went through prostate cancer surgery or BPH/HoLep/ TURP surgery.  This next part, getting your bladder control and your confidence back, has a clear path.  You don’t have to figure it out with a stack of pads, adult diapers, and crossed fingers for the best.  

READY TO GET YOUR URINARY CONTROL BACK?

Schedule an evaluation at Clemens Physical Therapy and let us give you a solid plan built around your individual needs. If you are searching for a male pelvic floor physical therapist who provides treatment for urinary leaking after prostate surgery in the Bridgeport, WV area, this is what we treat every day.  Call our Bridgeport WV office at 304-842-6008 to schedule an appointment or ask any questions you may have.  

FREQUENTLY ASKED QUESTIONS about urinary leaking

Is it normal to leak urine after prostate surgery?

Yes.  Urinary leakage is one of the most common side effects after prostate surgery, especially during the first few weeks/months.  Pelvic floor physical therapy can help speed the recovery of bladder control. 

How long does urinary leakage last after prostate surgery? Is this problem permanent?

Every man’s recovery is different.  For most men, short term leaking is expected after prostate surgery and generally improves within the first 12 months.  Some men have leakage for even longer. Pelvic floor physical therapy may help you recover more quickly and with greater confidence.  

Can pelvic floor physical therapy really help urinary leakage after prostate surgery?  I have never even heard of this before. 

Yes it is and it can really help for issues like leaking in men, especially after prostate surgery or a BPH procedure like HoLEP or TURP.  

Patients I see are often very surprised by how helpful their treatment is.  Many notice a few, quick, meaningful improvements after the very first visit and over time they often recover more efficiently because they understand what to do- and what not to do.  They often say they thought about not coming in but were very glad they did! Our goal is to help you regain bladder control and return to the activities that matter most to you. 

What should I expect on my first visit?

We start by talking about your symptoms, medical or surgical history, and what you want to get back to doing. 

Your exam may include your back, hips, abdomen, movement, and pelvic floor. You also begin treatment and leave with a home plan. 

Evaluation of the pelvic floor can be external (with clothes on) or internal (rectally). 

 AN INTERNAL EXAM IS NOT REQUIRED. 

I am often able to get the information I need from an external-only examination so please don’t let your concern about this stop you from coming in to get help.

A rectal exam can provide useful information but is NOT required and is only done when appropriate and with your permission. If it is determined that one might be useful, we will go over the procedure and why it is helpful before you decide what you want to do.   

I see plenty of men for urinary leaking without needing to do an internal exam and they still get better. 

I am nervous about the exam, should I still come in?

Absolutely.  Many men feel unsure or uncomfortable about what to expect, and that is completely understandable.  We will explain everything first, go at your pace, and only do what you are comfortable with. 

Is treatment just Kegel exercises?

No, and for some men, Kegels may be the wrong place to start.  We evaluate what your muscles are actually doing first and build your program around that instead of a one-size-fits-all Kegel program.  Pelvic floor physical therapy involves much more than simply doing Kegel exercises, and we can help you figure out the best approach. 

What if I am doing Kegels but still leaking?

That doesn't mean pelvic floor exercise won't work. You may be contracting the wrong muscles (most common error), managing abdominal pressure badly, or just having difficulty coordinating the pelvic floor with daily activities. We can help assess the problems and modify the exercise to get you back on track.

Can I just learn pelvic exercises online?

Look, I get it.  This problem is embarrassing and you would rather not see anyone or talk about it.  Online information seems like the easiest way to go.  

Online information can sometimes be helpful, but pelvic floor problems are very difficult to self-assess.  It is very common to use the wrong muscles, hold your breath, over-tighten, or strengthen muscles that need to relax.

A few focused visits can help determine what you actually need and stop you from wasting time doing the wrong thing- or worse- training things incorrectly. There really is no online substitute for a skilled expert assessment of your condition to determine the correct treatment for you as an individual. 

Can pelvic floor therapy for urinary leakage help after a procedure for enlarged prostate (HoLep, TURP)?

Leakage after these procedures can be improved with pelvic floor exercises. Treatment should be individualized to the type and pattern of leakage. We can help you determine what to do.

How many visits will I need?

It depends.  After an uncomplicated prostatectomy or BPH procedure many men only need a few focused visits- often around 3-4- to make sure they are using the right muscles, progressing correctly, and managing leakage during everyday activities.  You may not be fully continent at that point yet but you will have the exercises and knowledge you need to continue to work on it at home. Occasionally, some men need more visits than others. Surgical or medical complications, returning to a physically demanding job, or starting therapy later in the recovery process may all influence how much treatment is needed.  We will talk about what makes sense and adjust the plan as you improve.  

When after surgery should I consider pelvic floor PT?

Anytime after your catheter has been removed and you are cleared by your surgeon to start physical therapy. This is usually around 2 weeks after surgery.  

Do I need a referral?

No referral is required to start physical therapy in Bridgeport, West Virginia, though your insurance may need one for coverage, so it’s worth a quick call to confirm before you come in.  Call us at 304-842-6008 if you have any questions or to schedule an appointment.  

Want to find out more? Check out About Us or Pelvic Floor Rehab pages or Blog posts: Leaking When You Cough or Exercise?, Incontinence and PT, Male Pelvic and PT. 

This article is for general educational purposes only and is not a substitute for individualized medical evaluation, diagnosis, or treatment. It should not be used to diagnose a condition or to delay seeking appropriate medical care. Reading this information does not establish a physical therapist-patient relationship. Because each person’s situation is different, decisions about your care should be based on an individual assessment by an appropriate healthcare professional.