Men's Health · Pelvic Floor — Urinary Leaks After Prostate Surgery: What Nobody Tells You

Reading time: 7 min | Men's Health · Pelvic Floor

You've just had prostate surgery, or it was months ago — maybe even a few years. And the leaks are still there. Your urologist told you it was normal, that it would pass. Your physiotherapist taught you how to do contractions. You've done everything you were told. And yet.

What nobody has really explained to you is why some men recover quickly and others don't — and above all, what you can concretely do to accelerate your recovery.

What actually happens during a prostatectomy

A radical prostatectomy — whether performed by open surgery, laparoscopy, or robotic assistance — consists of completely removing the prostate gland. This procedure is today the reference treatment for localised prostate cancers, with excellent long-term survival rates.

But what doctors don't always have time to explain in detail is that the prostate plays a mechanical role in controlling urination. By removing it, the external urethral sphincter — the muscle that holds back urine — finds itself alone in ensuring this control. And if this muscle has never been actively strengthened, it's not prepared to assume this responsibility alone.

That's why virtually every man who has prostate surgery experiences urinary leaks in the weeks following the procedure. The question isn't whether you'll have them, but how long they'll last — and above all, whether you're doing what's needed to reduce them.

Why "it'll sort itself out" is insufficient advice

In the weeks following surgery, leaks are often significant — sometimes several pads per day. This is normal, and spontaneous improvement does occur in the first months, notably thanks to the healing of operated tissue.

But here's what most men don't know: this spontaneous improvement has a limit. It corresponds to the natural recovery of nerves and tissue — not to the strengthening of the sphincter itself. Without active muscle work, many men stabilise at a level of "acceptable" but persistent leaks — 1 to 2 pads per day, constant urinary urgency, permanent uncertainty.

After 12 to 18 months without notable improvement, many end up integrating pads as a permanent reality of their life. It's not inevitable. It's simply the result of a muscle that has never been properly trained.

"I did Kegel exercises for over a year after my surgery with little improvement. I wasn't convinced at first. Five weeks later, I went from 4 pads a day to zero."
— David R., 61

Kegel exercises: good idea, poor execution

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

When you're told "do contractions," you contract. You feel something — a tension, an activation. You're told it's working. You continue for weeks, sometimes months. And the results aren't there.

Here's why: feeling a muscular contraction and actually strengthening a muscle are two fundamentally different things. No muscle in your body has ever been strengthened solely by contractions in a vacuum. Biceps need a dumbbell. 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 it to actually strengthen. This is the fundamental principle of strength training that's absent from classic Kegels.

What research says about post-prostatectomy rehabilitation

Studies on perineal rehabilitation after prostatectomy are clear on one point: men who practise active, structured rehabilitation recover significantly faster than those who wait for spontaneous improvement.

What makes the difference between effective rehabilitation and ineffective rehabilitation is precisely the quality of contractions — their intensity, their regularity, and above all the presence of sufficient resistance to trigger muscle adaptation.

A physiotherapist specialised in pelvic floor health knows this — it's why professional rehabilitation sessions deliver far better results than exercises done alone at home. The physiotherapist guides the contraction, corrects technique, and applies manual resistance to intensify the muscle work.

The problem: professional rehabilitation typically costs $90 to $140 CAD per session in Canada, isn't always fully covered by private insurance or provincial health plans, and isn't geographically accessible to everyone. The reality for many men is a few sessions then a return to exercises alone — without the resistance that makes all the difference.

The 3 factors that determine your recovery

1. Consistency

Muscle strengthening requires constancy. 5 minutes every day delivers far better results than 30 minutes once a week. Consistency is the number one factor — before intensity.

2. Resistance

Without resistance, no real strengthening. This is the principle of progressive overload — valid for every muscle, including the urethral sphincter. The more progressive and adapted the resistance, the more the muscle develops.

3. The neuromuscular connection

After a prostatectomy, certain nerves can be temporarily affected. Active rehabilitation helps rebuild the connection between the brain and the muscle — something passive electrostimulation devices don't do, since they contract the muscle for you without your brain being involved.

What nobody actually tells you

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

What nobody tells you either is that it's never truly "too late." Men operated on 3, 4, or 5 years ago who had accepted pads as a permanent reality have regained significant control in just a few weeks of adapted training.

The pelvic floor muscle responds to training at any age. The condition is to give it what it needs: real resistance, regular practice, and the patience to let muscle adaptation occur.

You are not condemned to wearing pads. Your pelvic floor isn't broken. It's simply undertrained — and everything that's undertrained can progress.

"After my prostate operation, I tried doing Kegel exercises alone for two years with no real result. I thought I'd have to wear pads for life. In four weeks, I went from five pads a day to zero."
— Robert T., 68

In summary

• Leaks after prostatectomy are common but are not a permanent inevitability
• Spontaneous improvement has a limit — without active training, you stabilise at an "acceptable" level of leaks
• Kegels alone are insufficient: without resistance, the muscle activates but doesn't strengthen
• The 3 key factors are consistency, resistance, and the neuromuscular connection
• It's never too late to start — the muscle responds to training at any age

Tags: men's health Canada, pelvic floor, prostate surgery, urinary leaks, rehabilitation, FlowStop