The catheter comes out about a week after the surgery. For a lot of men, that is the moment they find out the cancer was the part everyone prepared them for, and this part was not.
You stand up from the recliner and you leak. You cough and you leak.
Nobody warned you that you would be buying pads at 68 years old after beating prostate cancer, and there is a particular kind of quiet that settles in when that happens.
Here is the part that gets buried. This is expected, it has a name, and there is a treatment that major urology guidelines say your clinician should be offering you.
If you are the spouse or the adult child of a man who came through surgery fine and then went strangely quiet about how he is doing, this is often what the silence is about.
Quick Answer
Urine leakage after prostate surgery is called post-prostatectomy incontinence, and the first-line treatment is pelvic floor muscle training. The American Urological Association guideline on incontinence after prostate treatment states that in patients seeking treatment for incontinence after radical prostatectomy, clinicians should offer pelvic floor muscle exercises or pelvic floor muscle training.
The same guideline tells clinicians to inform men that incontinence is expected in the short term and generally improves to near baseline by 12 months, though it can persist and need treatment. Cleveland Clinic puts the typical recovery at less than three months for most people.
Do not start the exercises while the catheter is still in.
Memorial Sloan Kettering is direct about that one. Wait until the catheter is out, then begin.
Why Prostate Surgery Causes Leaking in the First Place
Men have two valves that hold urine in. This is the single most useful fact in this entire article, and almost nobody gets told it before surgery.
Cleveland Clinic explains it plainly. The internal urine valve sits inside the prostate, so when the prostate is removed for cancer, that valve comes out with it.
That leaves the external valve doing a job that two valves used to share.
The external valve is skeletal muscle, which means it is trainable the same way a quadriceps or a calf is trainable. That is the whole logic behind pelvic floor muscle training after a prostatectomy, and it reframes the exercises from wishful thinking into what they actually are.
You are asking one muscle to take over for two.
Surgery for an enlarged prostate is a different situation
Not every prostate operation is cancer surgery. Plenty of men over 60 have a procedure for benign prostatic hyperplasia instead, most commonly a transurethral resection.
The National Institute of Diabetes and Digestive and Kidney Diseases lists temporary urinary incontinence, urgency, and frequency among the things that can follow that kind of surgery. The word doing the work there is temporary.
There is one more group worth naming, because these men tend to get the least warning of anyone. The AUA guideline specifically tells clinicians to inform patients having a radical prostatectomy or a transurethral resection after radiation therapy about the high rate of incontinence following those procedures.
The Timeline, Honestly
Two numbers matter more than any others here, and knowing both of them changes how the first year feels.
The first is three months. Cleveland Clinic states that the average time it takes most people to regain control of urination is less than three months, which is far shorter than the open-ended stretch most men brace themselves for.
The second is twelve months. That is the AUA’s marker for when continence has generally returned to near baseline, and it is also the point at which the guideline stops waiting.
In between those two numbers, progress is rarely a straight line. Cleveland Clinic notes that nerve regeneration after this surgery can take anywhere from at least six months up to two years, which is part of why a good week can be followed by a frustrating one.
Recovery also tends to come back in an order rather than all at once. Dry sitting still comes before dry walking, dry walking comes before dry through the night, and dry through a cough or a lift usually comes last.
Counting pads is the most useful thing you can do during this stretch. Going from six pads a day to two is real progress even when it does not feel like it, and it is the kind of number a urologist can actually act on.
Caregivers, this is where you can genuinely help. Keeping the pad count on a calendar on the fridge takes the tracking off a man who is already tired of thinking about it, and it turns a vague “I think it’s a bit better” into something worth bringing to an appointment.
One thing worth sorting out separately is the overnight trips. Getting up repeatedly at night is not the same problem as leaking, and frequent nighttime urination has its own list of causes that deserve their own look.
What the Research Actually Says, Including the Uncomfortable Part
Most pages on this topic tell you pelvic floor exercises work and leave it there. The real evidence picture is more interesting than that, and you deserve the whole thing.
Start with the guideline, because it is unambiguous. The AUA, together with the Genitourinary Reconstructive Surgeons and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, makes three separate recommendations about this training.
- Before a radical prostatectomy, clinicians may offer pelvic floor muscle exercises or training. This one is a conditional recommendation, graded C.
- In the immediate post-operative period after a radical prostatectomy, clinicians should offer it. Moderate recommendation, graded B.
- For men actively seeking treatment for incontinence after a radical prostatectomy, clinicians should offer it. Also a moderate recommendation, graded B.
Now the uncomfortable part.
A 2023 Cochrane systematic review by Johnson, Mamoulakis, Stoniute, Omar and Sinha looked at conservative treatments for urinary incontinence after prostate surgery. It pulled together 25 trials covering 3,079 men, and it concluded that the value of these interventions, alone or combined, remains uncertain.
That is not a typo and it is not a reason to skip the exercises. It is a statement about the quality of the trials, not a verdict that the muscle does not matter.
The Cochrane authors said so themselves, calling for larger and better-designed trials with consistent training protocols. Read the trials and the problem jumps out: no two of them define the exercise program the same way, and many never confirmed that the men in the study were contracting the correct muscle at all.
In my practice, that last point is the one that explains almost everything. When a patient tells me the exercises did nothing, I ask him to show me, and a large share of the time what actually tightens is the buttocks and the belly while the pelvic floor sits still.
A trial full of men squeezing the wrong muscle will not show a benefit. Neither will six months of diligent home practice built on the same mistake.
So the honest summary is this. Guidelines recommend it, the trial evidence is messier than the hospital brochures suggest, and the single biggest variable in whether it works for you is whether someone confirmed you are doing it right before you spent months doing it.
Finding the Right Muscle, Which Is Harder Than It Sounds
NIDDK gives men a blunt self-check for this. Insert a finger into the anus and squeeze as if you were holding in urine, and if you feel tightness against the finger, those are the right muscles.
It is not a dignified instruction. It is also the only way most men can verify this on their own without equipment.
The mental cues that work best are stopping the flow of urine, or holding back gas in a room full of people. Use those as a mental picture only, and do not make a habit of actually stopping your stream partway through as an exercise.
Watch what else moves. NIDDK cautions against tightening the stomach, thighs, or other muscles, because squeezing the wrong ones puts more pressure on the bladder and makes leaking easier rather than harder.
If you cannot tell whether anything is happening, that is the moment to get hands-on guidance rather than push through another month of guessing. Biofeedback puts your muscle activity on a screen, and Cleveland Clinic lists it as something often paired with the exercises for exactly this reason.
The Actual Exercise Program
Two reputable sources publish specific dosages for this, and they differ slightly. That is normal, and either is a reasonable starting point until a clinician tailors it to you.
The Memorial Sloan Kettering version
Hold the squeeze for 5 seconds, then relax completely for 5 seconds. Repeat that 10 times, at least 3 times every day.
Each week, add a little to both the hold and the rest until you are working at 10 seconds on and 10 seconds off.
The NIDDK version
Squeeze for about 3 seconds, then release and let the muscle fully relax. Build up to 10 to 15 repetitions per session, at least three times a day, practiced lying down, sitting, and standing.
Standing is the position men skip and the one that matters most, because standing is where the leaking actually happens.
The skill that changes daily life fastest
Strength is only half of it. The other half is timing, and it is the half that shows up in real life first.
Memorial Sloan Kettering recommends squeezing deliberately right before the moments that cause leaks: standing up, starting to walk, coughing, sneezing, and laughing. You brace the muscle a half second before the pressure arrives instead of chasing it afterward.
Practice it on purpose ten or fifteen times a day attached to something you already do. Every time you get out of a chair for a week, squeeze first.
When to expect something to change
NIDDK sets a realistic marker: you may not feel your bladder control improve until after 3 to 6 weeks. That number is worth writing down somewhere, because week two is when most men quietly decide this is not working.
The relaxation half of every repetition is not padding either. A pelvic floor that never fully lets go becomes its own problem, and more squeezing makes that version worse instead of better.
What Not to Do
A handful of well-meant moves actively slow this down.
- Do not exercise with the catheter in. Memorial Sloan Kettering states this directly, warning that it can be painful and cause bladder spasms. Wait until it is out.
- Do not hold your breath. Cleveland Clinic points out that holding your breath raises the pressure inside your abdomen, which can make you leak more, not less.
- Do not do hundreds a day. NIDDK warns that overdoing these exercises leads to straining with urination and bowel movements, and Cleveland Clinic notes that over-exercising can leave you with pelvic pain from a muscle that will not release.
- Do not cut back on water to leak less. Concentrated urine irritates the bladder, and dehydration causes its own trouble in older adults.
- Do not sit out the whole first year assuming it will sort itself out. The AUA opens the door to treatment as early as six months if things are not improving.
- Do not let a pad be the only plan. Pads are practical and there is no shame in using them, but they manage the symptom and change nothing about the muscle.
What a Doctor or Physical Therapist Will Typically Check
The AUA treats evaluation as a clinical principle, directing clinicians to use history, physical exam, and appropriate testing to categorize the type and severity of incontinence along with how much it is bothering you. That last piece is not a courtesy question, since bother is part of what determines the treatment path.
Here is what an evaluation usually covers.
- Pad count and pad weight. How many you use in 24 hours, and sometimes a weighed pad test to measure the actual volume rather than relying on your impression of it.
- A bladder diary, usually three days of what you drank, when you went, roughly how much, and what you were doing each time you leaked.
- Which type it is. Cleveland Clinic separates stress incontinence, the cough-sneeze-lift kind that is more common after the prostate is removed, from urge incontinence, the sudden-need kind that is more common after radiation. They are not treated the same way.
- A confirmed pelvic floor contraction, checked by exam or biofeedback rather than assumed from your description of it.
- A postvoid residual, which measures how much urine stays behind after you go and helps rule out a bladder that never fully empties.
- Urinalysis to rule out infection, which can cause sudden leaking on its own at any point in recovery.
- Hip, trunk, and walking assessment. A physical therapist will often time a Timed Up and Go test and count how many times you can rise from a chair in 30 seconds, because getting to the bathroom quickly is part of staying dry.
- A medication review, since diuretics and several other common prescriptions change bladder behavior.
There is one more question worth raising yourself if nobody raises it for you. The AUA guideline gives a strong recommendation that clinicians counsel patients about sexual arousal incontinence and climacturia, which is leakage during arousal or orgasm after prostate cancer treatment.
It is common, it is recognized in the guideline, and it is treatable. It also goes unmentioned in a lot of follow-up appointments because neither side wants to bring it up first.
If you are a caregiver attending the appointment, specifics beat impressions every time. “Four pads on Tuesday, two on Saturday, and the leaks happen when he stands up rather than on the way to the bathroom” is far more useful than “he seems about the same.”
The Part Men Do Not Say Out Loud
Bladder leakage carries a specific weight for men that has very little to do with urine. It lands somewhere near independence and dignity, and it arrives right after a stretch of months where a man has already had very little control over what happens to his body.
So it gets hidden rather than reported.
What you tend to see instead are the edits. The golf foursome he stops joining, the aisle seat every single time, the dark trousers, the coat kept on indoors, the sudden lack of interest in a long drive to see the grandchildren.
Caregivers, the trap here is leading with the evidence. Naming the laundry or the pads in the bathroom bin is the fastest way to guarantee this never gets discussed again.
Aim at the thing he gave up instead of the leaking. “You used to love Thursday golf, what happened there” opens a door, and the answer often arrives without you ever having to say the word.
If you are the one dealing with it, you do not need a graceful phrase for the urologist. “I am leaking and I want to know what my options are” said in the first two minutes of the appointment does the entire job.
In a urology clinic this is a Tuesday. It is one of the most common reasons men are sitting in that waiting room, whatever the silence in the room suggests.
When to Stop Waiting and Ask for More
The guideline gives you two dates, and knowing them keeps you from drifting.
At six months, if bothersome stress incontinence is not improving despite conservative treatment, the AUA says clinicians may offer surgery. That is a conditional recommendation, which means it is a conversation rather than an automatic step.
At one year, the language hardens. For bothersome stress incontinence persisting despite conservative treatment, the guideline says clinicians should offer surgical treatment, and that one carries a strong recommendation.
Cleveland Clinic describes the two usual options, a urethral sling or an artificial urinary sphincter, for symptoms persisting somewhere between six months and a year.
None of that means the muscle training was wasted. A documented, properly supervised trial of pelvic floor work is exactly what a urologist wants to see before moving on, and it makes the next conversation a much better informed one.
Separately, anything sudden deserves a call regardless of where you are in the timeline. Blood in the urine, fever with burning, or a bladder that will not empty are not part of normal recovery.
Getting Evaluated, and What to Ask When You Call
Pelvic health is a physical therapy specialty with its own training, and not every clinic offers it. Ask that question directly when you call rather than assuming either way, and ask specifically whether the therapist works with men after prostate surgery, since a clinic can offer pelvic health and still see mostly women.
Your urologist’s office is usually the fastest route to a name. They refer men for this constantly.
The rest of recovery is far more widely available, and it matters more than most men expect. Post-surgical rehabilitation, leg and trunk strength, walking speed, and the plain ability to get out of a low chair quickly all feed into whether you make it to the bathroom in time, and a general geriatric physical therapist handles all of that.
That mobility side is worth taking seriously for a second reason. Hurrying across a room with a full bladder, often at night and half asleep, is one of the most common setups for a fall in an older adult, and the strength and walking work in structured programs like the Otago Exercise Program is associated with a 35 to 40 percent reduction in fall risk for qualifying seniors.
In Salem, HWYPT works out of Center 50+ at 2615 Portland Rd NE and offers free 15-minute screenings, free virtual consultations, and in-home visits for men who are still not driving after surgery. We are in network with Medicare Part B, United Healthcare, Wellcare, and Aetna Medicare Advantage, and our Pay What You Can program exists so that cost is not what stops someone from being evaluated.
Call and ask what we do and do not treat, and if pelvic floor work specifically is what you need and it is outside our scope, we will tell you that and help you find it. If you are not sure whether physical therapy is even the right next step, it is worth reading through how to tell whether you need physical therapy before you make any calls.
Frequently Asked Questions
How long will I leak after prostate surgery?
Cleveland Clinic puts the average at less than three months for most people to regain control. The AUA frames the longer arc, telling clinicians to inform men that incontinence is expected short-term and generally improves to near baseline by 12 months, though it can persist and need treatment.
Your own number depends on your age, your bladder control before surgery, and what kind of procedure you had.
Do pelvic floor exercises really work for men, or is that a women’s thing?
Men have the same muscle group, and the AUA guideline recommends offering pelvic floor muscle training to men both immediately after a radical prostatectomy and later if they seek treatment for leaking. The idea that this is a women’s issue is a marketing artifact, not a medical one.
The honest caveat is the one covered above. Trial evidence is mixed, and technique appears to be a large part of why.
Should I start before the surgery?
The AUA says clinicians may offer pelvic floor muscle exercises prior to radical prostatectomy, which is a conditional recommendation rather than a firm one.
There is a practical argument for it regardless of the grade. Learning to reliably find and contract the right muscle is much easier before surgery than in the raw weeks after a catheter comes out, so at minimum you arrive already knowing what you are looking for.
Is this the same thing my wife did for her bladder?
The muscle group and many of the exercises overlap, but the reason behind the leak is different. Hers most likely involves pregnancy, menopause, or long-term load on the pelvic floor, while yours involves a valve that was surgically removed.
If you want the broader picture of how this treatment works across both, our guide to non-surgical treatment for urinary incontinence covers the general version, the different types of leakage, and what a first appointment looks like.
Does Medicare cover physical therapy for this?
Medicare Part B covers medically necessary outpatient physical therapy, and coverage depends on documented functional limitation rather than the diagnosis label by itself. Ask any clinic to check your specific plan before the first visit.
My father had this surgery and will not discuss it. What can I do?
Ask his urology office to raise bladder control as a routine follow-up question at the next appointment, which takes the whole burden off you. You can also leave a printed page about pelvic floor training somewhere he will find it alone, since men on this topic are far more likely to act on information they discovered themselves than on a conversation they were pulled into.
Final Thoughts for Adults Over 50
A man who has just come through prostate cancer treatment has spent months being told what is going to happen to him. Pelvic floor training is one of the first things in that whole stretch that he actually does himself, and that matters more than the mechanics of it.
The work itself is unremarkable. Ten squeezes, three times a day, one confirmed correct muscle, and a squeeze before you stand up.
Give it three to six weeks before you judge it, and count pads rather than trusting your memory of last week.
If you are the spouse or the adult child, your most useful contribution is not encouragement. It is getting him seen by someone who will confirm he is contracting the right muscle, because everything else in this article depends on that one thing being true.
And if six months goes by without real change, that is a signal, not a failure. The guideline has a next step written down for exactly that situation, and it is a conversation worth having on time rather than late.
Medical Disclaimer
This article is for general education and does not replace personalized medical advice. Talk with your urologist, surgeon, or a licensed physical therapist before starting pelvic floor muscle training, particularly in the weeks following prostate surgery.
Do not perform pelvic floor exercises while a urinary catheter is in place. Seek prompt medical care for blood in the urine, fever with painful urination, inability to empty the bladder, or new leakage accompanied by leg weakness or numbness.
You Might Also Be Wondering
- What electrical stimulation therapy actually does in physical therapy, useful background if biofeedback or e-stim has been suggested to you.
- Why constipation puts extra strain on the pelvic floor, which is worth sorting out while you are retraining these muscles.
- How to stick with a home exercise program past the first two weeks, since this one only works if you keep doing it.
Medical References
- American Urological Association / GURS / SUFU. Incontinence after Prostate Treatment Guideline (2019; amended 2024).
- Johnson EE, Mamoulakis C, Stoniute A, Omar MI, Sinha S. Conservative interventions for managing urinary incontinence after prostate surgery. Cochrane Database of Systematic Reviews, 2023, Issue 4. Art. No.: CD014799.
- Cleveland Clinic. Incontinence After Prostate Surgery.
- Cleveland Clinic Health Essentials. Importance of Kegel Exercises After Prostate Surgery.
- Memorial Sloan Kettering Cancer Center. Pelvic Floor Muscle (Kegel) Exercises for Males.
- Memorial Sloan Kettering Cancer Center. Managing Urinary Incontinence After Prostate Treatment.
- National Institute of Diabetes and Digestive and Kidney Diseases. Kegel Exercises.
- National Institute of Diabetes and Digestive and Kidney Diseases. Prostate Enlargement (Benign Prostatic Hyperplasia).
