Reaching for a pad every time you stand up, cough or climb the stairs is one of the hardest parts of recovering from a prostatectomy, and for many men it is the part nobody quite prepared them for. Incontinence after prostate surgery is common, it is rarely talked about openly, and it can knock your confidence hard. The reassuring part is that it is usually temporary and it responds well to the right training. I am Fara Sonday, a specialist pelvic health physiotherapist registered with the HCPC, CSP and the Pelvic Floor Society, and I help men rebuild bladder control at PhysioReform, just off Tottenham Court Road between Fitzrovia and Bloomsbury.
Why incontinence after prostate surgery happens
Removing the prostate disturbs part of the muscular system that keeps urine in, so the pelvic floor has to take on more of the work than before.
The prostate sits just below the bladder and wraps around the urethra, the tube that carries urine out. A radical prostatectomy removes it, and this can affect the internal sphincter and the surrounding support, leaving your external pelvic floor muscles as the main mechanism holding urine back. Until those muscles are strong and well coordinated again, leakage on effort, coughing, lifting, or moving from sitting to standing is common. This pattern is called stress incontinence, and some men notice urgency as well. It is expected after this operation, not a sign that the surgery has failed.
How long does incontinence last after prostate surgery?
For most men leakage is worst in the first few weeks and improves steadily over three to twelve months, particularly with consistent pelvic floor training.
Recovery is not identical for everyone. It is influenced by your age, the surgical technique used, your general health, and how strong and coordinated your pelvic floor was to begin with. Many men are noticeably drier by three months and continent or close to it by six to twelve months. A smaller number take longer or need more targeted help along the way. The two things most within your control are doing the right exercises and doing them correctly, which is where proper guidance makes a real difference.
Why generic pelvic floor exercises often fail
Many men are told to “do their pelvic floor exercises” but never shown how to find or coordinate the right muscles, so the effort is misdirected and progress stalls.
It is very common to squeeze the buttocks, tense the abdomen, or hold the breath while believing you are working the pelvic floor. It is just as common to over-tighten and never learn to fully relax, which can actually feed urgency. A specialist assessment confirms you are activating the correct muscles at the right intensity, with a healthy balance of contraction and release, then builds a programme that progresses as you improve. This individualised approach is the core of our men’s health physiotherapy, and because leakage is often the dominant concern, it frequently overlaps with our wider work on urinary incontinence. Assessment is discreet and, if you would prefer, we can talk through what it involves before you commit to anything.
Starting before surgery: the prehab advantage
Learning and practising pelvic floor exercises before your operation gives you a head start, and the evidence suggests it speeds early continence recovery.
A 2023 systematic review and meta-analysis found that pelvic floor muscle training started before radical prostatectomy improved continence at three months after surgery. That early window matters, because the first few months are usually when leakage is heaviest and most disruptive to daily life. Building the skill in advance means you already know how to engage the right muscles the moment your catheter comes out, rather than learning from scratch when you feel at your most vulnerable. This is exactly the kind of preparation our pre- and post-operative rehabilitation is built around. If your surgery has already happened, it is not too late, and starting now still helps.
Common questions
Can I control incontinence after prostate surgery without medication?
For most men, yes. Pelvic floor muscle training combined with sensible bladder and fluid habits is the first-line approach, and further options exist through your medical team if leakage persists.
Does prostate surgery always cause incontinence?
No. Many men have only mild, short-lived leakage, and some have very little at all. Where it does occur, it is usually manageable and improves with time and the right training.
Whether you are in Fitzrovia, Bloomsbury or elsewhere across the West End, you do not have to accept ongoing leakage as simply the cost of treatment.
Book an appointment
If incontinence after prostate surgery is affecting your daily life or your confidence, help is available and it works. Book Appointment and we will assess your pelvic floor, answer your questions honestly, and start you on a clear, discreet plan to regain control.