Urinary Incontinence After Prostate Cancer Surgery

Leaking urine after prostate surgery is expected, not a sign that something went wrong. The National Cancer Institute lists "leakage of urine from the bladder" among the possible problems after surgery for prostate cancer. Most men leak at first. Most improve. And there is real, specific work you can do to speed that up, which many men are never offered.

A catheter drains your bladder while you heal. It "usually stays in place for about 1 to 2 weeks while you are healing." When it comes out, leakage is common straight away, and it can be heavy for the first days.

The most common pattern after this surgery is stress incontinence: "urine might leak when coughing, laughing, sneezing, or exercising." Two other patterns show up less often. Overflow incontinence, where "the bladder may not empty completely," is "usually caused by blockage or narrowing of the bladder outlet by scar tissue." Urge incontinence, "a sudden need to urinate," is "less common after surgery than after having radiation therapy." Losing all control of urine is described as very rare after surgery.

Knowing which pattern you have matters, because the treatments differ. Tell your team exactly when you leak, not just that you leak.

"After surgery for prostate cancer, bladder control usually improves slowly over several weeks or months." Slowly is the operative word. Progress is uneven, and a bad day after a long walk does not mean you have gone backwards.

Age plays a part: "older men tend to have more incontinence problems than younger men." So does where you were treated, with better results generally reported at high-volume centres.

This is the part worth pushing for. Strong pelvic floor muscles hold in urine better than weak ones, and the exercises are free, private, and doable anywhere.

Finding the right muscles first: "imagine you are trying to stop passing gas. Squeeze the muscles you would use." Then the exercise itself. "Find and squeeze your pelvic floor muscles. Try to hold the squeeze for 3 seconds. Release the muscles and fully relax your pelvic floor." Build up toward "10 to 15 repetitions each time you exercise," and exercise "at least three times a day," practising lying down, sitting, and standing.

Two cautions. Do not practise by stopping your urine midstream during normal urination, because it can increase the risk of bladder infection. And "be careful not to tighten your stomach, thighs, or other muscles" — squeezing everything at once is the most common mistake.

Give it time: "you may not feel your bladder control improve until after 3 to 6 weeks."

If you are unsure you are squeezing the right muscles, get checked rather than guessing for months. "First, ask your doctor for a referral to a pelvic floor therapist. Cancer treatment centers often have pelvic floor therapists who specialize in helping patients." A pelvic floor therapist will ask about your diagnosis and treatment, examine the muscles, and build a plan that may include strengthening, stretching, bladder and toilet habits, biofeedback, or electrostimulation.

Biofeedback "uses special sensors to measure muscle contractions that control urination," so you can see whether you are doing it right instead of hoping. Ask directly: "Can you refer me to pelvic floor physical therapy?" See pelvic floor rehabilitation after cancer treatment for what those sessions involve.

Products exist because leaking is common. "Absorbent, washable incontinence underwear" and "disposable incontinence briefs" are standard ways of coping while control returns. Using them is not giving up; it is what lets you leave the house and stay active.

Bladder training can help too: urinating on a schedule, tracking it in a bladder diary, and gradually lengthening the gaps. Cutting back on caffeine — "chocolate, tea, coffee, and carbonated beverages" — and on "alcoholic drinks, which can increase how much urine your body makes," may reduce leaks.

If leaking is not improving on the expected timeline, say so rather than waiting for the next scheduled visit. "It's important for all prostate cancer survivors to tell their health care team about any new symptoms or problems." Persistent stress incontinence has surgical options, including "the male sling" or "an artificial urinary sphincter," and overflow caused by narrowing may need surgery to remove the blockage.

Bring it up at every follow-up appointment, alongside other effects such as erection changes.

Get urgent help — "call 911 or go to the emergency room" — if you have new confusion, blood in your urine, or you have not been able to urinate for 24 hours or more.

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Treatments for Bladder Control Problems (Urinary Incontinence)
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Kegel Exercises
• National Cancer Institute (NCI): Prostate Cancer Treatment (PDQ) — Patient Version
• American Cancer Society: Surgery for Prostate Cancer
• American Cancer Society: Bladder Incontinence
• American Cancer Society: How Pelvic Floor Therapy Can Help During Cancer

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