Part of Men's pelvic health: pelvic floor dysfunction in men, and where to start
Incontinence after prostate surgery: how long it lasts and when to get help
Warning signs, and when to get help
How long does incontinence last after prostate surgery?
Weeks to months for most men, and no honest page can be more precise than that about you.
The reason matters more than another confident number would. The encouraging percentage you will meet most often online has no study behind it that we could trace to a population, a procedure and a date, so it is not repeated here even to argue with. Two trial figures further down this page do come with a denominator, and neither of them is yours: one was measured in men whose leaking had already failed to settle six weeks after the operation, so it describes a harder group than every man leaving hospital. The other followed every man a British trial sent for surgery, which is the closer thing to the question you came with, and it is still a group average. Putting numbers from different groups of men side by side as though they answered one question is how a man ends up either falsely reassured or unnecessarily frightened.
What is published and traceable is the direction. A Cochrane review of 50 trials and 4,717 men reported that men's symptoms improved over time irrespective of management (Anderson 2015). The improvement is real and it happens in the control groups too, which is a genuinely important thing to understand before you judge your own progress or anybody's program.
One British trial does give the shape of the years, even though it cannot give you the weeks. ProtecT picked up prostate cancer through PSA testing in the community between 1999 and 2009 and randomized 1,643 of those men between monitoring, surgery and radiotherapy, 553 of them to have the prostate removed; the median age in the trial was 62. Questionnaires went out to all of them before treatment, at six months, at a year and once a year after that (Lane 2016). Among the men randomized to the operation, the proportion using one or more absorbent pads a day was 1 percent before treatment, 46 percent at six months, 26 percent at a year, 21 percent at two years, 20 percent at three years and 17 percent at six years (Donovan 2016). That is all 553 men who were sent for surgery rather than just the ones whose leaking had failed to settle, which is the denominator usually missing from a number like this.
Read it as the direction in a group of men rather than as your own odds, and take the small print with it. What was counted is each man's own answer about pads on a questionnaire, not a dry test and not the three-day pad count this page asks you for further down, so the two do not line up. The first measurement is at six months, so it says nothing about the weeks most of this page is about. And the surgery is dated: of the 553 men, 324 had an open retropubic operation and 25 a robot-assisted one, and the authors say in the paper that the field has moved on since the trial started. If you are having keyhole or robot-assisted surgery now, you are not having the operation most of those men had.
The other trial figure, the one you will meet most often, is British too, and its population has to travel with it. MAPS randomized 391 men whose leaking had not settled six weeks after a radical prostatectomy. A year later, 76 percent of the men given four one-to-one therapy sessions and 77 percent of those who were not were still incontinent (Glazener 2011). What was counted there was each man's own report of leaking on a postal questionnaire, so it means any leaking at all rather than still being wet or still in pads.
Read the entry condition twice: these were men whose leaking had already not settled by six weeks. MAPS ran the same design a second time in men still leaking six weeks after a TURP, where 65 percent of the therapy group and 62 percent of the others still reported leaking at a year, so a man after that operation has his own figure rather than this one. The authors themselves described the high rates of persisting incontinence after twelve months as evidence of a substantial unmet need, which is an argument for being seen, not for giving up.
Why it happens, in plain words
The prostate sits below the bladder, and the tube that carries urine out of the body, the urethra, runs through it.
POGP's leaflet for men sets out the mechanism in two parts. Urine is held in by valves, one at the base of the bladder and one underneath the prostate gland, and the pelvic floor muscle wraps around them so it can help hold them shut. Taking the gland out takes part of that arrangement away, and the operation can affect both the muscles and the nerves that supply them. POGP names pelvic radiotherapy as having similar effects, which matters because many men have had both.
Two different operations end up on this page, and they do different things to the tissue. In a radical prostatectomy the whole gland is removed and the bladder is then joined directly to the urethra, so the valve at the base of the bladder goes with it and the join itself has to heal. In an operation for an enlarged prostate, such as a TURP or a laser enucleation, the gland stays where it is and the channel through it is opened out, which can bruise or nick the valve below. That difference is why the risk is so different for the two. The AUA and SUFU guideline for American urologists puts it in one sentence: most men who have a radical prostatectomy, and some men who have radiotherapy or surgery for an enlarged prostate, will leak afterwards (Sandhu 2019).
So the muscle that is left is being asked to cover more of the job than it used to. That is the whole logic of the exercise program, and it is also why the leak that remains is usually the effort kind: standing up, lifting, coughing, the first few steps after sitting still for a while.
Nothing about that mechanism is a failure of the operation or of you. It is what the anatomy predicts.
What the first weeks usually look like
The first landmark is not the operation, it is the catheter coming out. Leaking usually starts in earnest at that point. If you have had prostate or other urological surgery, Continence Health Australia's advice is to wait until your surgeon has checked your healing before starting pelvic floor exercises, and the timings and the program come from the team that operated. The only specific timing we could find anywhere in a guideline sits in the body text of the European guideline rather than in its recommendation, which carries no date at all, and it is set out with that caveat on pelvic floor exercises after prostate surgery.
While the catheter is in it is doing a job, and the job explains the rules you were sent home with. After a radical prostatectomy the bladder has been stitched to the urethra, and the catheter sits across that join while it seals. That is why your team puts limits on lifting and straining for the first weeks, and it is also why those limits have to come from them rather than from a page. They differ between surgeons, between the two operations and between men, and this page does not know yours. If you were not given them in writing, ring the ward and ask.
After that, say it plainly: no document we were able to read gives a week-by-week curve for this. That absence is the finding, and it explains why this search leads to forums. Nobody with authority has written the week-by-week page, so men write it for each other out of their own experience, which is generous and is not evidence.
What you can use instead is a direction and two checkpoints. The direction is what physios see in clinic rather than a measured curve: leaks become smaller and take a bigger effort to produce before they stop altogether, and the efforts you cannot prepare for, a sneeze or a stumble, are usually the last to go. The first checkpoint is six weeks, which is the point at which a UK trial judged leaking persistent enough to recruit on, so if you are still leaking then you are in a well-populated group rather than a worrying minority. The second is around twelve months, which is the point most trials measure, and it is the horizon for a conversation about what else is available.
Between those two, the useful question is not how much you leak but which way the line is going. Months, not days, is the unit.
One thing that can happen in those months is the opposite of leaking, and it is easy to mistake for progress. Where the bladder was joined to the urethra, the join can narrow as it heals, and after an operation for an enlarged prostate the channel can scar in the same way. What that looks like is a stream that gets weaker or more stop-start, having to strain or wait for it to start, and a feeling that you have not emptied.
After a prostatectomy the narrowing usually shows itself within the first six months and becomes much less likely after two years (Rosenbaum 2020). It is not a pelvic floor problem, squeezing does not treat it, and finding it takes a look inside with a camera rather than an examination. It is on the warning list at the foot of this page as its own item, going to the team that operated.
Square one thing away before you read the warning list at the foot of this page. Leaking once the catheter is out is expected, and the list still tells you to treat a sudden, total loss of bladder or bowel control as an emergency. Those two are not the same picture. The one on the list arrives with numbness or altered feeling around your genitals or back passage, or with not being able to feel yourself peeing at all, or alongside back pain or symptoms down a leg. If you cannot tell which of the two you have, use the list rather than this paragraph.
Pads, and what they tell you
Pads are a measurement instrument that happens to also keep you dry, and most men throw the measurement away.
Count them. Use the same brand and count honestly for three days, starting this week rather than waiting for an appointment, and write down what you were doing each time you changed one. That single sheet of paper tells a continence service more than the first ten minutes of questions, and it gives you something better than memory, which smooths out exactly the trend you are trying to see.
One count on its own cannot show a direction, and the direction is what you want to know. Do it again the same way about once a month, keep the sheets together, and take the most recent one to any appointment. Two or three of them side by side answer the question a single count cannot: which way the line is going, and how fast.
No document we read sets a number of pads that is too many, so this page does not invent one. What matters is the slope. A count that is slowly falling is the recovery doing what it does. A count that has stopped falling over a couple of months, or one that is rising, is the thing to take back to the team.
A word about the research, because it bears on how much to trust any one measure. The trials counted leaking both by what men reported and by pad tests, and the two did not always agree: the Cochrane review found a benefit in one comparison that its own pad test data did not support, and said so (Anderson 2015). An umbrella review of 18 reviews covering 29,925 patients described the included studies as all of critically low methodological quality (Yang 2023). So your own three-day count is not a poor substitute for science here. It is roughly the same instrument.
What helps besides the exercises
This is the section most men have never been told about, and it comes straight out of a UK recommendation.
NICE says that people with prostate cancer who have troublesome urinary symptoms after treatment should have access to specialist continence services for assessment, diagnosis and conservative treatment, and it names what that could include: "coping strategies, pelvic floor muscle re-education, bladder retraining and pharmacotherapy". That is an entitlement, not a favor, and it is worth asking for by name. The recommendation carries a 2008 stamp in the guideline, so it is best used as a pathway and an access right rather than as a current evidence summary.
Three of those four are somebody else's department and this page will not pretend otherwise. Medicines are a prescribing decision for your doctor or urologist. Bladder retraining is the answer when the problem is urgency rather than effort, and the different types of incontinence and how bladder training works are set out on urinary incontinence and pelvic floor training, which is written for women and is where those definitions live on this site. Read it for the definitions and for the bladder training, and take your own squeeze numbers from the program page below rather than from that one, because its doses are written for a woman who has not had an operation. Coping strategies are the practical half: pad choice, what you take with you, and knowing where the toilets are on a route you have not done since the operation.
The fourth one is ours, and it has its own page. Straining on the toilet loads the same muscles from above, so constipation is worth treating properly rather than working around, and pelvic floor weakness, constipation and bowel control covers that side.
What happens if it does not settle?
There is a surgical pathway, and the numbers behind it deserve to be shown as they were published.
NICE's recommendation is that a man whose stress incontinence proves intractable goes to a specialist surgeon, who weighs up an artificial urinary sphincter. It also says bulking agents should not be injected into the distal urinary sphincter in men with prostate cancer. Both recommendations are stamped 2008.
A network meta-analysis of 11 studies and 1,116 participants compared the options against no treatment for achieving continence, in men leaking after surgery for either an enlarged prostate or prostate cancer (Park 2023). Before the four numbers, hold on to one thing: each is that option measured against no treatment, so they cannot be lined up against each other, and not one of them is a measured difference between one operation and another. The artificial urinary sphincter came out with a pooled odds ratio of 3.31, with a 95 percent credible interval from 0.749 to 15.710; the adjustable sling 2.97, from 0.412 to 16.000; the non-adjustable sling 2.33, from 0.559 to 8.290; and bulking agent injection 0.26, from 0.025 to 2.500. The authors concluded that only the artificial sphincter had a statistically significant effect and ranked it first.
Those two sentences do not sit comfortably together, and that is the point of printing both. Every one of those credible intervals crosses 1, which usually means the result could be chance, so the authors' conclusion and their own interval are pulling in different directions. The reading we would take to a clinic is that the artificial sphincter is the option with the most evidence behind it and the best ranking in this analysis, and that the size of its effect is much less certain than the ranking makes it look. That is a conversation with a surgeon who can see your own situation, not a decision from a page.
Three more things about those four numbers, because a man reading them will take them for a league table and they are not one. First, every one of them is a comparison with no treatment, not with each other: the analysis did not show that a sphincter beats a sling, and the ranking it reports is a probability of coming first rather than a measured difference between the options. Second, the 0.26 against bulking agents is not evidence that an injection makes a man worse, because its interval crosses 1 in the same way the others do; it is an unconvincing result rather than a harmful one. Third, none of the four tells you which one suits you, because that is decided by how much you leak and by what has already been done to the tissue.
Where there is a head-to-head trial, it is British and it is worth more to you than the ranking. MASTER randomized 380 men with stress leaking after prostate surgery, 190 to a sling and 190 to an artificial sphincter, and found the sling non-inferior to the sphincter for continence at twelve months: an absolute difference of 3.4 percentage points in the sphincter's favor, with a confidence interval running from 11.7 points in the sphincter's favor to 4.8 points in the sling's. Symptoms and quality of life improved in both groups and satisfaction was high in both. Where the secondary measures separated them they favored the sphincter, and there were more serious adverse events in the sphincter group, 15 against 8 (Constable 2022).
Read MASTER as two reasonable operations rather than a winner and a loser. Note also who the trial would not take: men whose bladder neck or urethra had narrowed and not yet been dealt with were excluded, which is one more reason the narrowing described earlier on this page gets sorted out before anything else.
What each of those four operations actually is
The names tell you almost nothing, and the four commit you to very different lives. What follows is what each one does and what it asks of you, from the European Association of Urology's 2024 guideline on male lower urinary tract symptoms.
A non-adjustable sling is a strip placed under the urethra, usually through a small cut between the legs. Its tension is set during the operation and cannot be changed afterwards. There is no device to operate and nothing to learn. European guidance offers it for mild to moderate leaking, at a Weak strength rating, and in the next line asks that men be told severe leaking, previous pelvic radiotherapy or previous surgery up the water pipe may make the result worse.
An adjustable sling is the same idea with a port left under the skin so the tension can be changed after the operation. European guidance makes no recommendation either way on these, because the randomized trials do not exist, and it records that more of them end up being taken out than fixed slings do.
An artificial urinary sphincter is a device in three parts: a cuff around the urethra, a small pressure-regulating balloon, and a pump placed in the scrotum. It is not automatic. The cuff holds the urethra closed, and every time you want to pee you squeeze the pump to open it.
European guidance recommends the artificial sphincter for moderate to severe stress leaking, at a Strong strength rating, and three things it says in the same section deserve reading twice. It should only be implanted in expert centers. Men should be warned, again at a Strong rating, that although a cure can be achieved there is a high risk of complications, of mechanical failure, and of the device having to be taken out. And it has a limited lifespan, so further operations to maintain it are common in the long run and are not counted as complications. All of that rests on being able to work the pump, which is why the guideline tells surgeons to think ahead about a man who may lose his memory or the use of his hands.
A bulking agent is an injection to pad out the damaged sphincter zone. European guidance says not to offer it to men with leaking after prostate surgery, and that there is very limited evidence it works at all. NICE's 2008 recommendation was narrower, against injecting bulking agents in men with prostate cancer. The European one is both newer and wider, so it is the one to go by.
When a surgical opinion becomes reasonable
There are two clocks here and they are easy to confuse. Asking for a continence service or a pelvic health physiotherapist is the early conversation, and the trigger for it is on the warning list and further down this page: leaking that has stopped improving over a couple of months, is getting worse, or is deciding what you do. The year that comes next in this section belongs to the surgical conversation only, and it is not a reason to wait before asking for the earlier one.
Surgery is the later conversation, and the American guideline is the one that puts a figure on it. Its own summary says that men who remain incontinent a year after the procedure, or who have severe incontinence at six months, may elect to undergo surgical treatment, and that before any such operation the risks, the benefits, the alternatives and the further procedures that are likely should be discussed (Sandhu 2019). "May elect" is the right phrase and worth keeping. It is not a deadline, it is not a push, and reaching a year without being dry is not a failure on your part.
Surgeons differ on when they will consider operating and on which operation they offer, so your own surgeon's timing is the one that counts. What the figure is good for is this: it tells you that a referral at twelve months is a normal request and not an impatient one.
If you already have a sling or an artificial sphincter, there is one more thing to know. The leaking it was done for coming back, or new pain or new bleeding, is on the warning list at the foot of this page as its own item, and it goes back to the surgical team rather than into more squeezing.
The reason that line matters is that a device giving way is usually not dramatic. In a published series of men whose sphincter cuff had worn through into the urethra, what brought most of them in was simply that the leaking had come back or had got worse; some had pain on peeing or blood in the urine, and several had no other symptom at all (Shumaker 2023). So leaking that returns months or years after a device was fitted is not something to work harder at and not something to save for your next routine review. It needs the team and a look inside.
Two practical things that go with having a device, and both of them are about where it sits. The warning list speaks of pain or swelling "around the operation site". For an artificial sphincter that site includes your scrotum, because the pump is in it, and the area between your legs, because that is where the cuff was put on. Redness, heat, swelling or new pain in either of those places counts, and a device that becomes infected usually has to be removed, so it is a same-day question and not a wait-and-see one.
The second is a sentence to memorize. Anybody who is about to pass a catheter into your bladder has to be told you have an artificial sphincter, the device with a pump in your scrotum that you squeeze when you want to pee, because the cuff must be deactivated first. A catheter pushed past a closed cuff presses the urethra against it, and that is one of the known ways a cuff erodes (Shumaker 2023). Say it in an emergency department, say it before any operation of any kind, and if you were given a card or a letter about the device, keep it where you will have it with you and show it. If you are not sure you have been understood, ask for a urologist or the urology team on call to be involved before any catheter goes in, which is the one request that does not need you to win an argument with the person in front of you.
What to tell your surgical team, and when
For the first weeks the team that operated is your first call, ahead of a physiotherapist and ahead of this page. They have your operation notes and nobody else does. Months later, when the ward is no longer a number you can ring, the urology or cancer nurse specialist looking after you is the route, and your own doctor can make the same referral.
Go back to them, or ask for the referral, if your leaking has stopped improving over a couple of months, if it is getting worse, if it is deciding where you go and what you do, or if nobody has yet offered you a pelvic health physiotherapist or a continence service. Ask for the specialist continence service by name, using the NICE wording above if it helps. Take the three-day pad count with you.
Then there is the list that does not wait for any of this. Everything in the warning signs at the foot of this page is a separate question from your recovery, and several lines on it are written specifically for a man in the weeks after a pelvic operation: a same-day route for a fever, a wound that is oozing or coming apart, heavy bleeding or pelvic pain that is new or quickly worsening; an emergency route for severe or sudden pain, a wound that opens, or bleeding that suddenly becomes much heavier; a same-day line for a newly swollen or painful calf or thigh, because surgery in the pelvis raises the risk of a blood clot; and the lines for blood in your urine and for a bladder you cannot empty at all. Red flags in physiotherapy explains why we keep that list apart from the advice.
Where the exercise program is
Not here, deliberately, and the split is worth knowing so you can find things fast.
Pelvic floor exercises after prostate surgery is the program: when it starts, the two published doses, the staged progression from lying to sitting to standing, and the whole evidence picture including the European recommendation and its Weak strength rating. If any two pages seem to give you different numbers, that is the one to follow, because it is the one written for a man who has just had this operation. Pelvic floor exercises for men is the technique: how to find the muscle, the perineum and mirror checks, the mistakes, and what the exercises are and are not claimed to do.
If pain rather than leaking is now your main problem, that is a different pattern again and squeezing is the wrong instruction for it. Male pelvic pain covers it, and men's pelvic health is the map for this whole topic. Anything about the cancer itself, monitoring or what comes next in your treatment belongs with your urologist or your cancer team, and no page here touches it.
Warning signs
Get emergency help now
- Emergency: you cannot pee at all, especially if your lower tummy feels full and painful. Call emergency services or go to an emergency department straight away, and do not drive yourself.
- Emergency: if you have an artificial urinary sphincter, the device with a pump in your scrotum that you squeeze when you want to pee, and you cannot pee at all, call emergency services or go to an emergency department straight away, and do not drive yourself. Say that you have an artificial urinary sphincter as soon as you arrive, and say it again before anyone passes a tube (catheter) into your bladder for any reason, because the cuff around the tube that carries your urine out (the urethra) has to be switched off first. Passing a catheter through a cuff that is still closed is one of the recognized causes of the cuff wearing through that tube (erosion), and the staff in front of you will not know the device is there unless you tell them. If you were given a card or a letter about the device, show it, and if you are not sure you have been understood, ask for a urologist or the urology team on call to be involved before any catheter goes in, because a catheter placed by someone not trained in the device is one of the listed risks for that erosion.
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you suddenly cannot control your bladder or bowels at all. The same applies to new leaking of pee or poo, new trouble starting to pee, not being able to feel yourself peeing, not noticing when you need to poo, a new change in how your genitals feel during sex, new trouble getting or keeping an erection, new trouble ejaculating, or new trouble reaching orgasm, if it comes with back pain, sciatica, or pain, tingling, numbness or weakness in one or both legs. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can also be signs of cauda equina syndrome.
- Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away, and do not drive yourself.
- Emergency: since any operation in your pelvis, including an operation for prolapse or for leaking, removal of the womb (hysterectomy) or removal of the prostate gland, you have pain in your tummy or pelvis that is severe or came on suddenly, a wound from the operation that opens up, bleeding that suddenly becomes much heavier or that soaks a pad within an hour, or you feel faint, dizzy or breathless, your heart is pounding, or you feel very unwell. Stop your pelvic floor exercises and call emergency services or go to an emergency department straight away, and do not drive yourself.
- Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or you have new or worsening pain spreading down an arm or leg, weakness, numbness, pins and needles or a loss of feeling in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Those symptoms count on their own, with or without back or neck pain. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through, and do not drive yourself. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
- Emergency: leaking that starts suddenly in an older person who is also newly confused or agitated, very drowsy, or has trouble speaking. Call emergency services or go to an emergency department straight away. This can be a sign of a serious infection or another illness that needs urgent treatment.
Get help today
- Same day: you still have your catheter and it has stopped draining, or urine is leaking around it, or you are passing blood or clots down it, or you have cramping pain low down. Get it dealt with the same day: ring the ward you went home from, your community nurse or the team that operated, and if you cannot reach any of them get medical help the same day anyway. A catheter that is not draining lets the bladder fill against a join that is still healing. If your lower tummy becomes full and painful, call emergency services or go to an emergency department straight away, and do not drive yourself.
- Pain or burning when you pee together with a high or very low temperature, feeling hot or cold and shivery, or pain in your back just under the ribs. Get medical advice the same day, as this can be a kidney infection. If you also become confused, very drowsy or have trouble speaking, call emergency services or go to an emergency department straight away.
- Same day: since an operation for leaking, such as a sling or an artificial urinary sphincter, you have a fever or feel hot, cold or shivery, bleeding or a discharge that smells from the wound, a wound from the operation that is oozing or whose edges are coming apart, new or worsening pain or swelling around the operation site, including in your scrotum, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding from the repair. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: you have an artificial urinary sphincter or a sling, and the skin over it is red, hot, swollen or newly painful, whether that is in your scrotum, where the pump sits, between your legs, where the cuff or the sling was put on, or at the wound. This is the same-day line above with the places named, because a man often does not count his scrotum as part of the operation site. Stop your pelvic floor exercises and get medical advice the same day, from the team that fitted the device or from the ward you went home from, and if you cannot reach them get medical help the same day anyway. A device that becomes infected usually has to be taken out, and that is a decision better made early than late.
- Same day: since an operation in your pelvis for any other reason, for example removal of the womb (hysterectomy) or removal of the prostate gland, you have a fever or feel hot, cold or shivery, heavy bleeding, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: since any operation in your pelvis, a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness. Stop your pelvic floor exercises and get medical advice the same day, because surgery in the pelvis raises the risk of a blood clot (deep vein thrombosis). If you are also short of breath or have chest pain, call emergency services.
- Blood in your pee, which may look pink, red or dark brown, even a small amount, even once, and even with no pain. Get medical advice the same day. It needs checking even if it goes away.
- Same day: leaking that starts suddenly or gets much worse over a few days in an older person, without any of the signs above. Get medical advice the same day, as this can be caused by a urine infection or a medicine.
- Same day: new back, hip or pelvic pain and you have had cancer, now or in the past. Get medical advice the same day and mention your cancer history. If you are being treated for cancer now, contact your cancer team the same day.
- Pain at night or at rest that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
- Same day: pain at night or at rest that keeps getting worse. If you have had cancer, now or in the past, get medical advice the same day and mention it, even if the pain is not getting worse. Do the same if you have back, hip or pelvic pain and are losing weight without trying, even if it does not hurt at night.
Book an appointment
- Pain at night or at rest that keeps getting worse. See your doctor within a few days.
- Routine: since an operation for leaking, such as a sling or an artificial urinary sphincter, the leaking you had it done for has come back or is getting worse, or you have new pain, new bleeding, or new trouble peeing or pooing. Stop your pelvic floor exercises and book an appointment with your surgical team rather than waiting for your next routine review. A repair can give way and a device can stop working, and after mesh surgery these are also the symptoms a specialist checks the mesh for. Which of those it is takes an examination, and it is not something this page or a physiotherapist can tell you.
- Routine: new trouble emptying your bladder or your bowels, a weak or stop-start stream, dribbling after you think you have finished, or a feeling that you have not emptied. Book an appointment with your doctor rather than doing more pelvic floor squeezes, because a flow or emptying problem has its own causes. If you are passing only small amounts and your lower tummy feels full or swollen, or you are leaking all the time without feeling the need to go, get medical advice the same day.
- Routine: in the first six months after the operation in particular, a stream that has become weaker or more stop-start, straining or waiting for it to start, or a feeling that you have not emptied. This is the line above with the surgical reason attached: where the bladder was joined to the urethra the join can narrow while it heals, and after an operation for an enlarged prostate the channel can scar. Book an appointment with the team that operated rather than with a physiotherapist, because finding a narrowing takes a look inside with a camera and pelvic floor squeezes do not treat it. If you cannot pass urine at all and your lower tummy feels full and painful, use the first line on this list instead.
- Routine: your leaking has stopped improving over a couple of months, is getting worse, or is deciding where you go and what you do. Book an appointment with the team that operated, or ask them for a referral to a specialist continence service or a pelvic health physiotherapist, rather than waiting for your next routine review.
- Routine: pain in your pelvis, perineum, testicles or back passage that squeezing brings on or makes worse, or a feeling that you can never fully let go down there. Stop the squeezes and book an appointment with a pelvic health physiotherapist or your doctor, because an overactive pelvic floor needs the opposite treatment from a weak one.
Common questions
Is it normal to leak as soon as the catheter comes out?
Leaking at that point is usual and it is what the pelvic floor program is for. Removing the prostate removes part of what was holding urine in, so the muscle that is left has to cover more of the job, and that takes practice and time rather than days. What is not part of a normal recovery is a fever, a wound that is oozing or opening, blood in your urine, severe or sudden pelvic pain, or a bladder you cannot empty at all. Those are on the warning list on this page, each with how fast to act.
How many pads is too many?
No document we could read sets a number, so this page does not invent one. What a pad count is good for is direction: the same brand, counted honestly for three days and repeated the same way about once a month, tells you and your continence service whether things are moving, which is more than memory can do. One count on its own cannot show you a direction. A count that has stopped falling over a couple of months, or one that is rising, is the thing to take back to the team rather than a particular total. If you are using more pads because leaking suddenly got worse, that is a same-day question rather than a supply question.
Why is the leaking worse later in the day or when I stand up?
No source written for men measures that pattern, so nobody can honestly tell you why it happens to you. Both of them do describe the leak after this operation as the effort kind, the sort that arrives with standing, lifting, coughing or the first steps after sitting, which is why the program works through lying, then sitting, then standing, before it tackles the movement that catches you out. Leaking that is heading the wrong way over days, rather than slowly easing, is a question for the team that operated rather than a reason to add repetitions.
What happens if the leaking never settles?
There is a route for that, and it is worth knowing now rather than years later. In the UK, NICE sends a man whose stress leaking will not settle on to a specialist surgeon, to weigh up an artificial urinary sphincter, and it rules out injecting bulking agents in men with prostate cancer. Both of those recommendations carry a 2008 stamp in the guideline, so read them as a referral route and an entitlement rather than as an up-to-date reading of the evidence. The European guideline of 2024 goes further on the bulking agents, telling surgeons not to offer them to any man with leaking after prostate surgery, and it also recommends the artificial sphincter for moderate to severe leaking and a sling for mild to moderate. Which of those fits you depends on how much you leak and on whether you have had radiotherapy, not on a ranking. The American guideline is the one that puts a time on it: still incontinent at a year, or severe at six months, is when a man may elect surgery. All of that is set out further up this page, and the decision itself belongs with your surgeon.
Does erectile dysfunction after the operation belong on this page?
No, and it has its own route. NICE's prostate cancer guideline covers access to specialist erectile dysfunction services, then phosphodiesterase type 5 inhibitors, and then vacuum devices, intraurethral inserts, penile injections or penile prostheses for men for whom the tablets do not work or cannot be used. That is a medical pathway and this page gives no advice about any of it: ask the team that operated or your urologist to start it. If new trouble getting an erection or ejaculating arrives alongside back pain, leg symptoms or numbness around the genitals and back passage, read the first two lines of the warning list on this page now.
References
- National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management (NG131). Recommendations 1.3.36 to 1.3.41, stamped 2008, with 1.3.36 amended 2014. https://www.nice.org.uk/guidance/ng131/chapter/Recommendations
- Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CM. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews. 2015;1(1):CD001843. doi:10.1002/14651858.CD001843.pub5
- Glazener C, Boachie C, Buckley B, et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Lancet. 2011;378(9788):328-337. doi:10.1016/S0140-6736(11)60751-4
- Donovan JL, Hamdy FC, Lane JA, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. New England Journal of Medicine. 2016;375(15):1425-1437. doi:10.1056/NEJMoa1606221. Pad use figures read from the full author manuscript in PubMed Central, PMC5134995.
- Lane A, Metcalfe C, Young GJ, et al. Patient-reported outcomes in the ProtecT randomized trial of clinically localized prostate cancer treatments: study design, and baseline urinary, bowel and sexual function and quality of life. BJU International. 2016;118(6):869-879. doi:10.1111/bju.13582
- Park JJ, Hong Y, Kwon A, Shim SR, Kim JH. Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis. International Journal of Surgery. 2023;109(3):401-411. doi:10.1097/JS9.0000000000000170
- Yang JM, Ye H, Long Y, et al. Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: an umbrella review of meta-analysis and systematic review. Clinical Rehabilitation. 2023;37(4):494-515. doi:10.1177/02692155221136046
- European Association of Urology. EAU Guidelines on Management of Non-neurogenic Male LUTS. Update April 2024, section 5.6.3.2.3 for pelvic floor muscle training and section 5.6.5 for the surgical treatment of stress urinary incontinence in men. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-Neurogenic-Male-LUTS-2024.pdf
- Sandhu JS, Breyer B, Comiter C, et al. Incontinence after Prostate Treatment: AUA/SUFU Guideline. Journal of Urology. 2019;202(2):369-378. doi:10.1097/JU.0000000000000314. The full guideline is behind a paywall, so it is used here only for the two statements its published summary carries in full: who gets incontinence after which prostate treatment, and the one-year and severe-at-six-months point at which a man may elect surgery.
- Constable L, Abrams P, Cooper D, et al. Synthetic sling or artificial urinary sphincter for men with urodynamic stress incontinence after prostate surgery: the MASTER non-inferiority RCT. Health Technology Assessment. 2022;26(36):1-152. doi:10.3310/TBFZ0277
- Rosenbaum CM, Fisch M, Vetterlein MW. Contemporary management of vesico-urethral anastomotic stenosis after radical prostatectomy. Frontiers in Surgery. 2020;7:587271. doi:10.3389/fsurg.2020.587271
- Shumaker LA, Compher TR, Selph JP. Delayed management of artificial urinary sphincter cuff erosion: a case series. Translational Andrology and Urology. 2023;12(5):944-948. doi:10.21037/tau-22-809
- Martins FE, Bernal J, Tryfonyuk L, Holm HV. Artificial urinary sphincter and stricture disease: surgical principles in management. Translational Andrology and Urology. 2024;13(8):1717-1728. doi:10.21037/tau-23-16
- Kosuru S, Ozcelik C, Wong TR, Mordukhovich I, Khanmammadova N, Isali I. Comparative analysis of male stress urinary incontinence treatments: a review of efficacy, safety, and clinical outcomes. Current Urology. 2026;20(3):155-164. doi:10.1097/CU9.0000000000000321
- NHS. Urinary catheter: living with. Page last reviewed 3 February 2023. https://www.nhs.uk/tests-and-treatments/urinary-catheters/living-with/
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscle exercises and advice for men. 2021. https://thepogp.co.uk/Resources/122/pelvic_floor_muscle_exercises_for_men/
- Continence Health Australia. Pelvic floor exercises for men. https://www.continence.org.au/living-with-incontinence/pelvic-floor-exercises/pelvic-floor-exercises-for-men/
- NHS. Back pain. Page last reviewed 5 March 2026. https://www.nhs.uk/conditions/back-pain/
- NHS. Sciatica. Page last reviewed 3 December 2024. https://www.nhs.uk/conditions/sciatica/
- NHS. Slipped disc. Page last reviewed 24 April 2024. https://www.nhs.uk/conditions/slipped-disc/
Written and checked by the PocketPhysio editorial team. Last updated 2026-11-03.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.