Leakage after prostate surgery is extremely common, and for most men it improves a great deal over the following months. I am Shield, I have had the surgery, and I am back cycling to work. Here is the practical guide I wish someone had handed me, the one the discharge leaflet does not give you.
The catheter comes out and the leakage starts. For most of us the volume is far more than we expected. Nobody warned me clearly enough. My discharge notes said incontinence was common. They did not say it might be continuous, heavy, and frankly disorienting for those first few weeks. So let me say it plainly: that is normal, it is not a sign anything has gone wrong, and it gets better.
What the leaflet does not give you is the practical detail: which products to use at which stage, what pelvic floor exercises actually involve, and what a realistic timeline to dryness looks like based on the evidence.
Why Surgery Causes Leakage
During a radical prostatectomy, the prostate is removed along with the internal urethral sphincter, which sits at the base of the bladder and provides the main continence mechanism. After surgery, your continence depends entirely on the external sphincter and the surrounding pelvic floor muscles.
Nerve-sparing surgical techniques lower the risk of severe or permanent incontinence, but even with nerve sparing, the surgical trauma to the sphincter mechanism causes leakage in the immediate post-catheter period for virtually all of us. Research published in Reviews in Urology indicates that around 90% of men reach social continence (defined as zero to one pad per day) within 12 months of radical prostatectomy. That figure kept me going on the bad days.
Products: What to Use and When
The leakage volume changes as you recover, so your products should change with it. Match the product to the phase you are actually in:
- Immediately after the catheter comes out: heavy absorbency pull-up pants or tab-fastening briefs. Standard male guards are not up to this phase, do not waste money trying.
- Weeks two to eight: volume usually starts to drop. Reassess weekly. Move to a lighter product as soon as the current one is consistently underloaded.
- Three months onward: most men have moved to male guards or light absorbency products. Some are dry or close to it.
- Twelve months: around 90% of men are at zero to one pad per day.
Buy your products before the catheter is removed, not after. NHS provision varies by trust and by GP practice, and plenty of men are sent home with a supply that does not cover the first weeks. Sort it in advance so you are not scrambling.
Pelvic Floor Rehabilitation
Pelvic floor muscle training (PFMT) is the main conservative treatment for post-prostatectomy incontinence. A 2023 meta-analysis in Translational Andrology and Urology found that PFMT improved continence rates by up to 2.77 times compared to no training. This is the single most useful thing you can do, so do it properly.
The technique:
- Find the pelvic floor by imagining you are stopping the flow of urine mid-stream, or pulling the testicles upward and inward.
- Squeeze and lift. Your buttocks, thighs, and abdominal muscles should stay relaxed. If they tighten, you are using the wrong muscles.
- Hold for three seconds at first. Build up to ten seconds over the weeks.
- Relax fully between contractions.
- Aim for three sets of ten contractions a day.
The Squeezy for Men app (recommended by NHS Trusts) gives you guided pelvic floor programmes and reminders. A referral to a pelvic floor physiotherapist, available through your urology team or GP, gets you individually assessed technique correction, which is well worth asking for if you can.
Activity and Return to Normal Life
- Walking: start within days of catheter removal. Build distance and pace gradually.
- Cycling: avoid for a minimum of six to eight weeks post-surgery. When you do go back (and you can, I did), use a cutout saddle to reduce perineal pressure.
- Lifting and high-impact activity: avoid for six weeks minimum. Straining (the Valsalva manoeuvre) sharply spikes the pressure inside the bladder, which is exactly what a healing sphincter does not need.
- Swimming: usually fine from six weeks if the surgical wound has fully healed.
Recovery Timeline and Escalation
Contact your urology team or GP if:
- You are still using more than one pad per day at twelve months post-surgery
- You develop fever, pain, or blood in the urine at any point
- You experience urinary retention
- Your recovery seems to have stalled, or is going backwards after an initial improvement
None of these mean you have done something wrong. They just mean it is time for a professional to take another look.