Managing Incontinence After Prostate Cancer

Why incontinence happens after prostate cancer treatment

Think of urination as a teamwork project between your bladder (the storage tank), your urethra (the exit ramp), and the
sphincters and pelvic floor muscles (the bouncers at the door). Prostate cancer treatments can disrupt that teamwork in a few ways:

After surgery (radical prostatectomy)

• Sphincter weakness: Removing the prostate changes support around the urethra, and the external sphincter may need time (and training) to compensate.
• Nerve irritation: Even with nerve-sparing surgery, nerves can be stunned for a while, affecting control.
• Timing matters: Leakage is often worse right after the catheter comes out, then improves gradually over weeks to months.

After radiation

Radiation can irritate the bladder and urethra. Some people notice urgency (the “I need a bathroom five minutes ago” feeling),
frequency, burning, or leakage tied to irritation rather than muscle weakness alone.

Different types of leakage (yes, it matters)

• Stress urinary incontinence: Leaks with coughing, laughing, lifting, standing up, or sneezingbasically, anything that makes your abdomen say “surprise!”
• Urge incontinence / overactive bladder: Sudden strong urges, sometimes with leakage before you get to the toilet.
• Mixed: A little of both, because bodies love complexity.

Knowing which pattern fits you helps target the right strategiespelvic floor training is great for stress leakage, while bladder training
and certain medications may be more helpful for urgency.

Start with a smart “leakage audit”

Before you try every trick in the universe, take one week to gather intel. This makes your plan more effective and gives your care team
what they need to help quickly.

Track three things for 3–7 days

• When leakage happens: coughing, walking, workouts, getting out of bed, hearing running water (your bladder may be very suggestible).
• How much: “a few drops” vs. “soaked pad.” You can even count pads per day for a practical metric.
• What you drank and when: coffee, alcohol, carbonated drinks, citrusanything that seems to correlate with urgency.

Rule out problems that need medical attention

Talk with your clinician if you have burning, fever, pelvic pain, new/worsening blood in urine, or trouble starting your streamthose can
signal infection, irritation, or other issues that should be addressed directly.

What recovery often looks like (and why patience is a strategy)

Many people see meaningful improvement over the first several months after prostate surgery, and some continue improving for up to a year or more.
That doesn’t mean you should “wait it out” with crossed fingers. It means: use the early window to train muscles, build habits, and reduce leakage
while your body is healing.

If your leakage is severe, deeply disruptive, or not improving on a reasonable timeline, that’s not a moral failingit’s a signal to step up treatment.
There are established options beyond exercises, and you deserve to hear them.

Pelvic floor muscle training (Kegels): the MVP when done correctly

Pelvic floor muscle training is often the first-line treatment for post-prostate cancer incontinence. But there’s a catch: many people do Kegels
wrong at firstusually by squeezing the wrong muscles (hello, glutes and abs) or by doing them so aggressively the pelvic floor gets tired and cranky.

How to find the right muscles

• Imagine you’re trying to stop passing gas and gently stop urine mid-stream (don’t practice mid-stream routinely; it’s just a “locate the muscles” cue).
• Your belly, butt, and thighs should stay relaxed. If your face is grimacing, you’re overpaying for this workout.

A practical Kegel routine (a common starting point)

Your clinician or pelvic floor physical therapist may customize this, but many routines build around:

• Slow holds: Gently squeeze and lift, hold 3–5 seconds, relax fully 5–10 seconds. Repeat 8–12 times.
• Quick flicks: Short squeeze-release repetitions to train rapid control (useful for cough/laugh triggers).
• Consistency: 1–3 sessions per day is commonmore is not always better if form is poor.

Upgrade: pelvic floor physical therapy (and why it’s not “extra”)

A pelvic floor physical therapist can confirm you’re using the correct muscles, adjust technique, and use tools like biofeedback when appropriate.
This can be a game-changerespecially if you’re doing the work but not seeing progress.

Timing after catheter removal

Many care teams advise starting pelvic floor training after catheter removal (and not while the catheter is still in). If you’re unsure, ask your surgeon’s
office for the exact timing for your situation.

Bladder training: teaching your bladder not to be dramatic

If urgency or frequency is part of your problem, bladder training can help reduce that “now-now-now” sensation.

Try a timed schedule

• Start by urinating on a schedule (for example, every 2 hours during the day).
• If you get an urge early, use urge-suppression tricks: sit down, breathe slowly, do a few gentle pelvic floor squeezes, and wait for the urge to pass.
• Gradually increase the interval as control improves.

Fluid strategy (not “drink nothing,” because that backfires)

• Spread fluids out: Chugging a giant bottle at once can create predictable chaos.
• Evening adjustments: If nighttime leakage is an issue, discuss safe evening fluid limits with your clinician.
• Know your triggers: Caffeine and alcohol can worsen urgency for many people; carbonated and acidic drinks may also irritate.

Constipation is a sneaky saboteur

Straining increases pressure on pelvic structures and can worsen leakage. A fiber-forward diet, adequate hydration, movement, and clinician-guided stool softeners
(when needed) can support continence recovery.

Everyday tools that make life easier (and less laundry-heavy)

Products aren’t a “defeat.” They’re just equipmentlike wearing glasses instead of squinting at road signs and hoping for the best.

Absorbent options

• Guards/pads: Often best for light-to-moderate leakage.
• Protective underwear: Useful for heavier leakage or longer outings.
• Bed protection: Washable pads can reduce stress and protect sleep (and your mattress’s dignity).

Skin care (because “rash” is not the bonus level you want)

• Change wet pads promptly when possible.
• Use a gentle cleanser and consider barrier creams if irritation develops.

Devices (for selected situations)

• Condom catheters: External collection devices that can be helpful for some men, especially for longer trips or nighttime.
• Penile clamps: Can reduce leakage for short periods (like exercise), but must be used carefully and with clinician guidance to avoid skin injury or circulation problems.
• Portable urinals: Not glamorous, but neither is sprinting in a parking lot like you’re training for the Olympics.

Travel and public-life hacks

• Carry a small kit: 1–2 spare pads, wipes, a zip bag, and underwear.
• Choose dark pants on long travel days (a strategy as old as time).
• Scout restrooms ahead of time when possibleyes, it’s annoying; yes, it helps.

Medications and medical treatments: when symptoms need extra support

Medications are most often used when urgency, frequency, or bladder overactivity is driving leakage. Your clinician may consider medications that calm bladder
spasms or reduce urgency. These can have side effects (dry mouth, constipation, or others depending on the drug), so they’re a “right patient, right time” tool.

If you’re experiencing leakage plus difficulty emptying your bladder, your team may evaluate for obstruction or retention before adding medications.

When conservative steps aren’t enough: procedures that can dramatically improve control

If you’ve worked on pelvic floor training, lifestyle strategies, and practical toolsand leakage remains significanturology can offer targeted procedures.
Evaluation may include things like a focused exam, urine testing, sometimes cystoscopy, and occasionally urodynamic testing to clarify what’s driving leakage.

Male sling

A male sling is designed primarily for stress urinary incontinence, especially mild-to-moderate leakage. The sling supports the urethra and helps resist leakage
during activity. It’s often attractive because it can be less complex to use than other devices.

Artificial urinary sphincter (AUS)

For moderate-to-severe stress incontinence, an AUS is a well-established option. It uses a cuff around the urethra connected to a pump (typically in the scrotum)
that you control to urinate. Many patients report significant improvement in leakage and quality of life when it’s the right fit.

Other options (selected cases)

• Bulking agents: Injections intended to improve urethral closure in certain situations (results can vary).
• Adjustable systems: Some procedures allow adjustment after placement in specific cases.

Timing: how long should you wait?

Many care pathways try non-surgical options first while healing progresses. But if leakage is severe and life-limiting, or if meaningful improvement isn’t happening,
your care team may discuss earlier procedural options. You don’t need to “earn” treatment by suffering quietly.

Special considerations after radiation

Post-radiation urinary issues can be driven by irritation of the bladder lining and urethra. That often looks like urgency, frequency, burning, or waking frequently at night.
Pelvic floor training can still help, but your clinician may also look for treatable inflammation or other causes.

If you notice persistent or heavy blood in your urine, worsening pain, or new difficulty urinating after radiation, contact your care team promptlythose symptoms deserve evaluation.

Mental health, intimacy, and the “nobody told me this part” part

Leakage can mess with confidence, social plans, exercise, and sexsometimes more than the cancer diagnosis itself, because it’s a daily reminder. That reaction is normal.
A few things that help:

• Talk about it early: With your clinician, with a partner, with a therapist, or with a support group. Silence adds shame; information adds options.
• Return to movement: Walking, gentle strength training, and pelvic-floor-safe exercise can help recovery and mood.
• Plan intimacy: A little preparation (emptying bladder beforehand, protective bedding if needed) can reduce anxiety and help you stay present.

The goal isn’t “pretend this never happened.” The goal is “live well anyway,” while you work toward better control.

A simple 2-week action plan

1. Track patterns: 3–7 days of triggers, pad use, and fluids.
2. Clean up the basics: Reduce caffeine/alcohol if they’re triggers, address constipation, spread fluids out.
3. Start (or refine) pelvic floor training: Focus on correct form and full relaxation between contractions.
4. Consider pelvic floor physical therapy: Especially if you’re unsure you’re doing Kegels correctly or progress is slow.
5. Choose practical gear: Pads/guards that fit your leakage level; protect skin.
6. Check in with your clinician: Bring your notes. Ask about next-step options if improvement is limited.

Real-world experiences (what many men say helps most)

The internet is full of two extremes: “You’ll be fine in a week” and “Your life is over.” Real life is usually somewhere in the middle, and it’s often surprisingly
practical. Here are experiences that prostate cancer survivors commonly sharecomposite examples meant to reflect patterns, not any one person’s story.

1) The “I did Kegels… but apparently I trained my butt” moment

A lot of men start Kegels with enthusiasm and the wrong muscle group. The tell is soreness in the glutes or abs, or feeling like you’re doing a sit-up from the inside.
Many report faster improvement once a pelvic floor therapist confirms techniqueespecially learning the underrated skill of fully relaxing between squeezes.
Several men describe it like learning to drive stick: once you stop grinding the gears, the whole thing gets smoother fast.

2) The coffee negotiation

People rarely want to quit caffeine entirely, and many don’t need to. A common compromise is “no coffee before a long drive or a meeting,” or switching to half-caf for
the first month. Men who track symptoms often spot the pattern: coffee on an empty stomach plus rushing out the door equals urgency chaos. Coffee after breakfast plus
planned bathroom breaks equals a calmer day. It’s not about being perfectit’s about being strategic.

3) The awkward (but freeing) pad learning curve

Many men say the first week of pads feels like an identity crisis. Then they discover that the right product makes life dramatically easier: thinner guards for light
leakage, more absorbent protection for workouts, and breathable underwear to protect skin. Once they stop treating pads like a secret shame and start treating them like
“temporary equipment,” anxiety dropsand ironically, urgency often improves when you’re less stressed about it.

4) The comeback happens in boring increments

Survivors often describe progress as non-linear: three good days, one bad day, then a new baseline that’s slightly better. Some men set “functional goals” instead of
“perfect dryness” goals at firstlike “one pad at home, two pads on long outings,” or “dry through dinner, protective overnight.” These small wins add up and make it
easier to keep doing the habits that actually drive improvement.

5) The day someone finally said, “You don’t have to just live with this”

Men who end up choosing procedureslike a sling or an artificial urinary sphincteroften say they wish they’d asked about options sooner. Not because surgery is
always the answer, but because knowing you have options changes your mindset. “I’m stuck like this” becomes “I’m working a plan with a backup plan.”
That psychological shift alone can be huge.

6) The quiet confidence tricks

Many men develop small routines that restore confidence: a spare-pad kit in the car, mapping bathrooms on travel days, wearing darker pants during early recovery,
and doing a few gentle pelvic floor squeezes before coughing or lifting (a “brace” strategy some therapists teach). None of these are dramatic. That’s the point.
The goal is for incontinence management to become background noiseuntil it gradually becomes no noise at all.