Post-Prostatectomy Incontinence (PPI) refers to involuntary urine leakage following surgical treatment of the prostate, most commonly after radical prostatectomy for prostate cancer. It occurs due to disruption of the urinary sphincter mechanism, pelvic floor muscles, and supporting nerves during surgery.

While some degree of leakage is common in the early weeks following surgery, ongoing incontinence can significantly affect confidence, social participation, physical activity, and quality of life. The good news is that most men improve with time, and targeted pelvic rehabilitation plays a central role in recovery.

How Common is Post-Prostatectomy Incontinence?

Urinary leakage is a well-recognised and common consequence of prostate surgery.

  • Immediately after catheter removal, the majority of men experience some level of incontinence.
  • By 3–6 months post-surgery, many men see substantial improvement.
  • At 12 months, persistent incontinence affects a smaller but significant proportion of men, particularly those with pre-existing pelvic floor weakness, older age, or more extensive surgery.

The severity and duration of symptoms vary widely and depend on surgical technique, nerve preservation, baseline pelvic floor function, and post-operative rehabilitation.

Symptoms of Post-Prostatectomy Incontinence

Symptoms range from mild to more functionally limiting and may include:

  • Leakage with coughing, sneezing or laughing
  • Leakage during standing, walking or exercise
  • Dribbling after voiding
  • Difficulty delaying urination
  • Needing pads or continence aids
  • Reduced confidence leaving the house or exercising
  • Avoidance of social or physical activities

Some men experience urgency-related leakage, while others notice stress-related leakage associated with movement or load.

How Post-Prostatectomy Incontinence is Assessed

Assessment focuses on pelvic floor function, urinary patterns, and contributing musculoskeletal or behavioural factors. A men’s pelvic health assessment may include:

  • Review of surgical history and recovery timeline
  • Pelvic floor muscle strength, endurance and coordination testing
  • Assessment of pelvic floor relaxation and overactivity
  • Evaluation of abdominal, hip and postural control
  • Bladder habits, voiding patterns and fluid intake review
  • Screening for post-void dribble or urgency components
  • Consideration of scar tissue or radiation-related changes (if relevant)

Medical review may be recommended if leakage is severe, worsening, or associated with pain, blood in the urine, or recurrent infections.

Treatment & Recovery

Recovery from PPI is highly responsive to targeted, conservative care. Early and appropriate rehabilitation improves continence outcomes and supports a faster return to normal activity.

Pelvic Floor Muscle Training

Pelvic floor rehabilitation is the cornerstone of PPI management. Treatment focuses on restoring strength, coordination and timing of the muscles responsible for urinary control. Training may include:

  • Strengthening of the external urinary sphincter
  • Endurance holds to support sustained continence
  • Quick contractions to manage sudden pressure changes
  • Coordination training during movement and transitions
  • Relaxation strategies when overactivity is present

Correct technique is essential. Over-bracing or excessive tightening can delay recovery.

Neuromuscular Electrical Stimulation (NMES) / HIFEM

NMES and High-Intensity Focused Electromagnetic (HIFEM) therapies may be used to support pelvic floor activation. These therapies are most helpful when voluntary pelvic floor contraction is weak, delayed, or difficult to coordinate. NMES / HIFEM may assist by:

  • Improving recruitment of pelvic floor and sphincter muscles
  • Enhancing muscle strength and endurance when activation is poor
  • Supporting early re-engagement of pelvic floor function post-surgery
  • Reducing reliance on compensatory abdominal bracing
  • Assisting men who struggle to feel or isolate pelvic floor contractions

Devices such as PelviTone (NMES) and EMSELLA (HIFEM chair) provide repeated, supramaximal pelvic floor contractions to help stimulate neuromuscular pathways.

Functional Continence Retraining

Beyond isolated exercises, continence recovery requires retraining the pelvic floor during real-world tasks. This may include:

  • Standing, walking and sit-to-stand control
  • Lifting and load management strategies
  • Breath coordination to reduce abdominal pressure
  • Gradual return to exercise and daily activities
  • Reducing compensatory patterns that worsen leakage

This approach helps translate pelvic floor strength into functional continence.

Bladder & Behavioural Strategies

Simple changes can significantly improve symptoms:

  • Timed voiding and bladder retraining
  • Avoiding “just in case” urination
  • Managing constipation and straining
  • Optimising hydration
  • Reducing bladder irritants when appropriate

Education and reassurance are key parts of recovery.

Manual Therapy & Scar Management

Hands-on therapy may be used to address contributing factors such as:

  • Pelvic and abdominal soft tissue tension
  • Reduced mobility around surgical scars
  • Restrictions affecting pelvic floor coordination
  • Postural or movement compensations

Manual therapy supports comfort, mobility and optimal muscle function during recovery.

Low-Level Laser Therapy (LLLT)

LLLT (904 nm) may be used as an adjunct to rehabilitation following prostate surgery. Potential benefits include:

  • Supporting tissue healing after surgery
  • Improving local circulation
  • Assisting nerve recovery
  • Reducing discomfort or sensitivity around scar tissue

LLLT is gentle, non-invasive, and used alongside active rehabilitation.

When to Seek Help

Book an assessment if you experience:

  • Ongoing leakage beyond the early post-operative period
  • Difficulty returning to normal activity due to incontinence
  • Leakage that worsens rather than improves
  • Night-time leakage or urgency
  • Reduced confidence, avoidance or distress related to symptoms

Early intervention improves outcomes and reduces long-term reliance on continence aids.

Get Support

The Athlete’s Guild provides personalised, evidence-informed support for men recovering from prostate surgery, including:

  • Pelvic floor muscle rehabilitation
  • Functional continence retraining
  • Manual therapy and scar management
  • Low-Level Laser Therapy (LLLT)
  • Exercise guidance during recovery
  • Support following prostate cancer treatment

Book with Trent Renshaw at Coffs Coast Sports Physiotherapy for respectful, goal-focused care aimed at restoring continence, confidence and quality of life.

Book Now at Coffs Coast Sports Physiotherapy

Key Takeaways

  • Post-prostatectomy incontinence is common and expected early after surgery.
  • Most men improve significantly with time and targeted rehabilitation.
  • Pelvic floor training is the foundation of recovery.
  • Functional retraining is essential for real-world continence.
  • Early assessment leads to better and faster outcomes.