Urinary incontinence after prostatectomy is one of the most commonly listed complications and one of the least commonly discussed before surgery. The patient is told it “usually passes”, goes home with pads and waits.
Waiting is the worst possible strategy.
Why it happens
Continence in men depends on two mechanisms: the internal sphincter, located near the bladder neck, and the external sphincter together with the pelvic floor muscles. Removing the prostate disturbs the first — and the whole burden of holding urine falls on the second.
That second mechanism can be trained. You just have to know you have it and be able to activate it consciously.
The best time is before the operation
Training started before surgery — prehabilitation — is more effective than the same training started afterwards. The reason is prosaic: before the operation you can learn a correct contraction calmly, without pain, without a catheter and without pressure.
After the procedure, a man who trained beforehand is not learning a new movement. He is only recovering one.
If you have a date for surgery, a sensible time for a first visit is a few weeks earlier. If the operation has already happened, we start now, after consulting your urologist and usually once the catheter has been removed.
Is it too late after a year?
No. Results come more slowly than in the first months, but they come. I see men in the practice who wore pads for two years, convinced that was permanent, and after a few months of consistent work go down to one pad as insurance, or stop using them altogether.
What therapy involves
- History and a bladder diary — when, how much, during what activity. This reveals a pattern the patient usually cannot see himself.
- Functional examination — whether the contraction goes in the right direction. A great many men squeeze their buttocks and abdomen while convinced they are training the pelvic floor.
- Pelvic floor training — individually designed, separating fast fibres (the response to a cough, a sneeze, standing up) from slow ones (endurance).
- Manual therapy and scar work after the operation.
- Re-learning habits — the amount and type of fluids, caffeine, the rhythm of using the toilet.
What not to do
Do not train a pattern you have not checked, “just in case”. Do not stop the flow of urine as a training method — it disturbs bladder emptying. Do not drastically restrict drinking in the hope that less fluid means less trouble; concentrated urine irritates the bladder and the symptoms get worse.
A word about embarrassment
Men come to pelvic floor physiotherapy far later than women, and usually only when somebody tells them plainly that such therapy exists. There is nothing embarrassing about it — it is training for a specific group of muscles, delivered as matter-of-factly as rehabilitation for a shoulder.
- mens health
- prostate
- incontinence