Also called: Post-prostatectomy incontinence
Exercise is the main treatment
Strength
Leaking after prostate surgery, which affects most men initially. The internal sphincter is removed with the prostate, so the external sphincter and pelvic floor become the only continence mechanism left - and training them before surgery makes a measurable difference.
How common: Affects most men immediately after surgery; persists in 5-20% at 12 months
What it is
The prostate surrounds the urethra and contains the internal sphincter. Removing it leaves the external sphincter and the pelvic floor as the sole continence mechanism, and they now have to do a job they previously shared.
The single most useful finding is about timing. Pelvic floor training started before the operation - prehabilitation - shortens the time to continence compared with starting afterwards. Most men are given a leaflet at discharge and no instruction beforehand, which misses the window that matters most.
What it feels like
- Leaking immediately after the catheter is removed, often substantial
- Leaking with coughing, standing up, lifting and exertion
- Gradual improvement over months, sometimes with a plateau
- Wearing pads, and organising activity around it
- Considerable effect on confidence and mood, which is frequently unspoken
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Loss of the internal sphincter
- The internal sphincter is part of the prostate and is removed with it. The external sphincter and pelvic floor, which previously shared the job, now carry it alone.
- Surgical trauma to the external sphincter
- The external sphincter sits immediately below the prostate and can be stretched or damaged during removal. The degree varies and it is a major determinant of how long recovery takes.
- Nerve disruption
- The nerves supplying the sphincter and pelvic floor run close to the prostate. Nerve-sparing techniques preserve them better, which affects both continence and erectile function.
- Pre-existing pelvic floor weakness
- Men are rarely aware of their pelvic floor at all, let alone trained. Going into surgery with a weak floor leaves nothing in reserve.
- Bladder overactivity
- Some post-operative leaking is urgency rather than stress incontinence, and it needs bladder retraining rather than more pelvic floor squeezing. The distinction matters.
- Age
- Older men recover continence more slowly, reflecting both baseline muscle and general tissue recovery.
- Radiotherapy
- Radiotherapy before or after surgery affects tissue quality and is associated with worse continence outcomes.
- Obesity
- Higher body weight increases the pressure the sphincter must resist and is associated with slower recovery of continence.
- Not being taught before surgery
- Prehabilitation shortens time to continence, and most men are never offered it. It is the single biggest missed opportunity in this condition.
- Doing the exercises wrongly
- Without instruction, many men contract the wrong muscles or bear down instead of lifting. One session with a specialist physiotherapist to check the technique is worth months of guessing.
Who tends to get it
- Any man having a radical prostatectomy
- Older men, in whom recovery is slower
- Anyone who has had radiotherapy as well as surgery
- Men carrying extra weight
- Anyone who has not been taught pelvic floor exercises before the operation
What makes it worse, and what settles it
Makes it worse
- Heavy lifting and straining in the early weeks
- Constipation, which increases pressure on the recovering sphincter
- Doing the exercises incorrectly, which is common without instruction
- Reducing fluid intake, which concentrates urine and worsens urgency
- Caffeine and alcohol, which irritate the bladder
Settles it
- Pelvic floor training started before the operation, which measurably shortens time to continence
- Getting the technique checked by a specialist physiotherapist rather than working from a leaflet
- Continuing the training daily for months rather than weeks
- Treating constipation so straining does not load the recovering sphincter
- Building general fitness before surgery, which improves recovery overall
What actually helps
The short version: Sphincter and pelvic floor function disrupted by surgery
Strength work: Core: Pelvic Floor - start before surgery (prehabilitation) and resume immediately after
Stretching: Not primary
Massage: Not primary
Also worth doing: Fluid and bladder management
What the evidence says: Pelvic floor training started before surgery shortens time to continence. Best results come from supervised training with feedback.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routinePelvic Floor & Core Recovery
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
New pain, fever or retention after surgery needs urgent review
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Most men regain continence over three to twelve months, with the largest improvements in the first three. Pelvic floor training started before surgery shortens that timeline. A minority have persistent leaking after a year, for whom effective surgical options exist - a sling or an artificial sphincter - so it is worth pursuing rather than accepting. Getting the exercise technique checked once is one of the highest-value appointments available.
Prevalence basis: Urology outcome data
Others the same routine covers
These share the Pelvic Floor & Core Recovery routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.