Urinary incontinence after prostatectomy: what no one tells you

You've just had prostate surgery. Or the operation was several months ago, maybe even several years. And the urinary leaks are still there. Your urologist told you it was normal, that it would pass. Your physical therapist taught you how to do contractions. You're doing everything you've been told. And yet...

What no one has really explained to you is why some men recover quickly and others don't. And more importantly, what you can specifically do to speed up your recovery.

What actually happens during a prostatectomy

Radical prostatectomy involves removing the entire prostate gland, whether the procedure is performed via open surgery, laparoscopy, or robotic assistance. Today, it is the reference treatment for localized prostate cancers, with excellent long-term survival rates.

What doctors don't always have time to explain in detail is the mechanical role of the prostate in bladder control. Once removed, the external urethral sphincter, the muscle that holds urine, is left alone to ensure this control. And this muscle, if it has never been actively strengthened, is not prepared to assume this responsibility alone.

This is why most men who undergo prostate surgery experience urinary leakage in the weeks following the procedure. The real question is not whether you will have them, but how long they will last, and whether you are doing what is necessary to reduce them.

Why "it will pass on its own" is insufficient advice

In the weeks following the operation, leaks are often significant. Sometimes several pads per day. This is normal, and spontaneous improvement does occur in the first few months, particularly due to the healing of the operated tissues.

Here's what most men don't know. This spontaneous improvement has a limit. It corresponds to the natural recovery of nerves and tissues, not to the strengthening of the sphincter itself. Without active muscle work, many men stabilize at a level of leakage they consider acceptable, but which persists: one to two pads per day, urinary urgency, constant uncertainty.

After 12 to 18 months without significant improvement, many end up integrating pads as a permanent reality of their lives. This is not inevitable. It is the result of a muscle that has never been properly trained.

Kegel exercises: good idea, poor execution

Perineal rehabilitation is recommended by almost all urologists after a prostatectomy. And it's a good recommendation. The problem doesn't come from the idea, but from how it's put into practice.

When you're told "do contractions," you contract. You feel something: tension, activation. You tell yourself it's working. You continue for weeks, sometimes months. And the results don't come.

Here's why. Feeling a muscle contraction and truly strengthening a muscle are two different things. No muscle in your body has ever strengthened solely by contracting in a vacuum. The biceps needs a dumbbell. The legs need resistance. The pelvic floor is no exception.

Without external resistance, you activate the muscle. You stimulate it, you maintain a certain tone. But you don't create the progressive overload necessary for real strengthening. This fundamental principle of muscle building is missing from classic Kegels.

What research says about post-prostatectomy rehabilitation

Studies on perineal rehabilitation after prostatectomy converge on one point: men who undergo active and structured rehabilitation recover faster than those who wait for spontaneous improvement.

What separates effective rehabilitation from ineffective rehabilitation is the quality of the contractions: their intensity, their regularity, and the presence of sufficient resistance to provoke muscle adaptation.

A physiotherapist specializing in perineology knows this well. This is why supervised sessions yield better results than exercises performed alone at home. The practitioner guides the contraction, corrects the technique, and applies manual resistance to intensify muscle work.

The problem lies elsewhere. These sessions come at a cost, coverage depends on your prescription and insurance, and not all patients have a specialized practitioner nearby. The reality for many men: a few sessions, then a return to solo exercises, without the resistance that makes all the difference.

The 3 factors that determine your recovery

What no one really tells you

The truth that few doctors take the time to explain is that your recovery largely depends on what you do yourself, outside of consultations. Healthcare providers can guide you. But it's your muscle, and you're the one who has to train it.

What no one tells you either is that it's never really too late. The pelvic floor responds to training at any age, and the time elapsed since the operation does not prevent a muscle from progressing.

The condition is to give it what it needs: real resistance, regular practice, and the patience to allow muscle adaptation to occur.

You are not condemned to wear pads. Your pelvic floor is not broken. It is undertrained. And anything undertrained can improve.

In summary

• Leakage after prostatectomy is common, but it's not a permanent condition.
• Spontaneous improvement has a limit. Without active training, you stabilize at a level of leakage that you eventually accept.
• Kegels alone are insufficient: without resistance, the muscle activates but does not strengthen.
• The 3 key factors: consistency, resistance, neuromuscular connection.
• It's never too late to start. The muscle responds to training at any age.

To understand the basics of perineal strengthening, consult our complete guide to Kegel exercises.