Prostatectomy And Incontinence: When can I expect it to improve?

@edinmaryland @jeffmarc

That is 100% true and we were so lucky that UCSF provided all of the above even before surgery.

My husband literary got prescription for a pump and the address of a pharmacy of where to go. Prescription for Cialis was also given before surgery. Nurse would call for followups lol , no messing around by not doing what is necessary to promote healing.

PT was available before surgery too. Incontinence was openly discussed and explained by surgeon and also all the factors that could possibly effect final results beside the RARP technique.

Now that he needs RT for BCR we were informed beforehand that it can effect continence and that it is really good that he has full continence before RT started since RT can effect continence in negative way in general (as well as ED).

I can not understand how some doctors can have a practice and never go through all of this with their patients ? Even before some banal procedures such as a tooth extraction one gets full list of possible complications and has to sign a paper that all was explained and understood. How are they not afraid of lawsuits etc. ? 😳

@surftohealth88 - all of that (and more) was explained before, day of, and after my surgery as well. I’d assume it’s just standard procedure to do so.

However, I do know that with my first two biopsies, those were done with my local urologist, and he was pretty scant on his discharge instructions, especially compared to the COE cancer that did my third biopsy.

@anosmic1 I am with you. I had surgery 27 months ago and still use a pad. I am like you; it is a small price to pay to be cancer free. I have a great life.

Two weeks after surgery is still very early, so I would not be too concerned about incontinence at this point. For most men, continence gradually improves over the following months, and many become fully or almost fully continent by around the one-year mark.

Doing pelvic-floor physical therapy under the guidance of a good physical therapist can help with recovery. That said, recovery varies considerably from person to person. Age, the exact type of prostate surgery, individual anatomy, and the condition of the urinary sphincter can all affect the outcome. A small percentage of men continue to have significant incontinence even a year after surgery despite diligent pelvic-floor exercises—and unfortunately, I am one of them.

I had my prostatectomy on September 3rd, and I am still incontinent despite being very diligent with PT and pelvic-floor exercises. So I certainly understand the frustration. But at only two weeks, you have a lot of time for improvement.

I hope you are one of the large majority of men who gradually regain continence. And if you happen to be among those who continue to struggle with it, there are several effective options, including clamps and, for more significant incontinence, procedures such as an artificial urinary sphincter (AUS).

I may consider an AUS myself at some point, but at this stage I am not physically or emotionally ready for another invasive procedure. In the meantime, I am managing reasonably well with pads at night and a clamp during the day. So there are ways to manage the situation while you give your body time to recover and decide what, if anything, you want to do in the longer term.

Wishing you a smooth recovery!

As many others have shared, try to remain positive and patient. I am 16 months out from a NS robotic prostatectomy at a center of excellence and had a very similar experience with incontinence to what you shared. Unlike some of my friends and acquaintances who literally experienced no incontinence, I was filling diapers from the moment my catheter came out. However overtime and with the assistance of a very good PT, I am happy to report that I am probably 95-98% continent and typically only experience incontinence after a surprise sneeze or too many beers! In fact, I typically don’t wear any sort of protection when I’m around the house and mostly find my very light pad “unsoiled” after I going out. Again, be patient and positive and find yourself a good PT who specializes in male incontinence. The data clearly supports that most ment with be close to or fully continent within one year.

Sorry to hear of the issue, but "welcome to the club." You "should have" received both "pre-op" and "post-op" 'WHAT TO EXPECT" instructions and information to include info on urinary incontinence. You mention that your surgery was just two weeks ago, therefore I assume that you "just" had your catheter removed. I would say that it is safe to offer that only the luckiest of post-op men restore their urinary continence within a month. I would also say that most men are incontinent for at least three months, and maybe 50% are incontinent for 6 - 9 months, but with lots of improvement. A smaller percentage never regain their continence.

There will be a logical progression from wearing full jockey-style diaper briefs ("Depends" or Tena) for a month, maybe two months, followed by using "pads" in jockey-style or boxer-brief-style underwear (to hold the pad in place). I was personally a boxers guy, so adjusting to jockey-style and boxer briefs was uncomfortable for a while. Then...after a couple months of wearing that thicker pad in your underwear, you will progress to wearing thin "Shields" for the dribbles and occasional squirts, until you have finally regained control of your one remaining urinary sphincter. Remember: your surgery also removed the strongest, more important urinary sphincter, so you must retrain your one remaining, weaker sphincter to do the job of two. That brings me to my final comment:

If your urologist did not already write a Rx for you to have Pelvic Floor Physical Therapy ("PFPT"), have them do it TODAY. This is a very specific subspecialty of physical therapy...a lot of women have leakage problems as part of everyday life, as well as in their postpartum situations. Your insurance company will likely approve only two sessions out of the eight that the doctor orders, but...the therapist will write a simple justification to your insurance company, and the full eight sessions should be approved. You have likely heard of Kegel exercises, but PFPT exercises go well beyond Kegel's (but do include Kegel's). It even gets down to how you breathe while doing those exercises because your entire abdomen below your diaphragm, down to your groin, is a giant "air chamber" subject to pressure with each sequence of breathing: inspire/expire. That actually works with and affects the functional pressure on your bladder and how you learn to control it all. It is rather amazing. But I encourage you: MAKE SURE you tell (not "ask"..."tell") your urologist that you want PFPT. I don't know why urologists don't automatically write the order for it. You have to find out about PFPT by accident, or in a place like this blog, to find out that it exists - as I did. If you are in between your "every-three-months-post-surgical doctor office visits, CALL YOUR DOCTOR to get he order for the PFPT, because you need it "now", not in three more months when you see him again.

Bottom line: be patient. Jockey-style diapers are your "present" reality for the next 2 -3 months, followed by "pads" for 2 - 4 months. You should have regained 95% or more of your continence by 6 months, hopefully less. All of the guys on this blog will chime in as to how long it took them to regain their continence. For me...I am 17 months post-op (April 2025). For "cautionary" protection, I still wear the thin Depends "Shields" for those unexpected squirts and dribbles. BTW - one of the things your PFPT therapist will tell you, that I offer now, is that you will need to change your pattern and form of liquid consumption. Right now: No caffeine (coffee, tea, sodas, or energy drinks). No acidic drinks like orange juice. No alcohol of any kind. And drink only 8 ounces of any liquid at a time (only water for now). Apologies for the pun here, but like my PFPT therapist said: "Your bladder is 'pissed off'...angry right now. It was just assaulted during the surgery. The surgery removed its #1 gatekeeper sphincter, and it is not happy. It needs time to recover from the surgery and re-learn how to do what it always could do before, but now it can't. Patience...be patient. Good luck to you.

So much good advice from those who have gone through this experience. There is an APP called Easy Kegel for Apple products that have been a tremendous help for me. I have it set for three or four sets/day, 10 slow reps of 10 sec hold and 10 sec release, and 10 fast reps of 1 sec hold and release. After 10 weeks, I am nearly accident free. I found the most rapid improvement when I stopped doing standing kegels to doing them in a recliner with legs akimbo. I read somewhere that this keeps the muscles elevated—not sure of the science, but it has worked for me. My sudden movements continue to be thoughtfully executed, but it has been a while now where no release of more than a drop or two. Best of luck to you. Be patient with yourself. You have already been through a lot. Now is the road to gradual recovery.