The surgery is done. The cancer is gone – a huge relief. But bladder leakage after prostate surgery is one of the most common things men struggle with next, alongside changes to erectile function.
Bladder leakage and changes to sexual function are among the most common concerns men bring to us after prostate surgery. They’re also the things men are least likely to talk about. If you’re dealing with either of these right now, read on. We’ll explain what’s happening, what to expect, and how pelvic floor physiotherapy can make a genuine difference.
What causes bladder leakage after a prostate surgery?
During a prostatectomy, the surgeon must carefully separate the sphincter muscle from the prostate before reattaching it to the bladder. This causes a period of weakness. Once the catheter comes out, leakage is often occurring.
Around 80% of men experience some degree of urinary leakage immediately after removal of the prostate. Most see significant improvement within the first three months. Others take longer – particularly if they had pre-existing urinary symptoms or a more complex surgery.
This isn’t something you just have to wait out.
What about erectile dysfunction?
ED is a very common side effect of prostatectomy – and it’s an issue men often feel less comfortable raising. The nerves responsible for erection run close to the prostate. Surgery can affect them even when the surgical team is able to leave the nerves intact.
Most men experience some degree of erectile difficulty after surgery, at least in the short term. Recovery varies considerably. It tends to go better for younger men and those who had nerve-sparing surgery.
What help is available:
Here’s something many men don’t know: pelvic floor physios can help you with advice on how to maintain the integrity and blood flow of the erectile tissues, until you get your function back. We can guide you through self-help strategies to aid the return of erectile function over time. The Prostate Cancer Foundation also has helpful information on managing side effects after prostate surgery.”
These are conversations we have regularly. You won’t be the first man to bring them up.
What does recovery look like in the first weeks?
Once the catheter comes out, leakage is usually at its worst. You may notice it when you stand up, cough, sneeze, lift something, or move quickly. This is stress urinary incontinence – the pelvic floor muscles aren’t yet strong enough to compensate for the weakened sphincter.
Pads: Use pads designed specifically for men. They fit male anatomy correctly and absorb in the right places. We can guide you on appropriate choices. As your control improves, you’ll need less padding.
Movement: Start walking early. Even ten to fifteen minutes a day in the first few weeks helps circulation, supports recovery, and gently activates the muscles you need. Build up gradually. Avoid heavy lifting, straining, and high-impact activity in the early weeks – these increase pressure on a pelvic floor that’s already working hard.
Where does pelvic floor physiotherapy come in?
Your pelvic floor is a group of muscles at the base of your pelvis. They work with the sphincter to help keep you continent. After a prostatectomy, these muscles need to take on extra work.
A good physiotherapy programme includes:
- Finding and activating the right muscles – many men attempt pelvic floor exercises but don’t engage the correct muscles. We assess this directly and give you clear feedback from day one.
- A progressive training programme – building strength and endurance at the right pace for your recovery.
- Practical strategies – learning to brace correctly before you cough, sneeze, or lift, to reduce leakage in everyday situations.
- Guidance on returning to exercise – knowing when and how to safely build back up to the activities you want to do.
- Support for erectile recovery – self-help strategies that work alongside any medical treatment you’re receiving.
The best time to start is before surgery
We’d love to see you before your operation. Four to six weeks beforehand is ideal – but even one appointment a week or two out makes a difference.
Coming in before surgery means you learn to activate your pelvic floor correctly while everything still works normally. When the catheter comes out, you’ll already know what to do. You can start your recovery straight away instead of learning new skills when you’re sore, tired, and dealing with leakage for the first time.
Research shows pre-operative pelvic floor training reduces both the severity of post-surgery leakage and the time it takes to regain continence. Most men tell us they wish someone had mentioned it sooner.
What if I’ve already had surgery?
It’s not too late. Many men come to us weeks or months after surgery. Some didn’t know physio was an option. Others assumed the leakage would resolve on its own.
Starting a pelvic floor programme at any point post-surgery still makes a real difference – both in how much you leak and how quickly you recover. The same applies to erectile function. Starting rehabilitation is worthwhile even if time has passed since your surgery.
You don’t have to just get on with it
Leaking after prostate surgery feels demoralising. Many men stop going to the gym, avoid social situations, or put their lives on hold waiting for things to improve. That’s understandable – but it doesn’t have to be that way.
We work with men referred by local urologists and oncology teams, and we have particular experience supporting recovery after radical prostatectomy. If you’re in the Wellington region, we’d love to help.
You can self-refer – no GP or specialist referral needed. Get in touch and let’s talk about where you are at and what we can do.
You might also find our blogs on pelvic pain in men and men’s pelvic floor and bladder problems helpful.
Frequently asked questions
How long does bladder leakage last after prostate surgery? Most men see significant improvement within three months of the catheter coming out. Some recover sooner. Others take up to twelve months, particularly with pre-existing urinary symptoms or a more complex surgery. Starting pelvic floor physiotherapy early – ideally before surgery – shortens this timeline.
Will my erectile function come back after a prostatectomy? For many men, yes. Recovery depends on age, overall health, and whether nerve-sparing surgery was possible. Initial healing takes six to eight weeks. Full nerve recovery can take six to twelve months, or even longer. Pelvic physiotherapy rehabilitation supports this process. Starting early gives you the best chance – and it’s never too late to begin.
Do I really need to see a physio before my prostate surgery? We strongly recommend it. You’ll learn to activate your pelvic floor correctly before surgery, so you’re ready to start your recovery programme the moment the catheter comes out. Research shows pre-operative training reduces the severity of post-surgery leakage and speeds up continence recovery.
What kind of pads should I use after a prostatectomy? Use pads designed specifically for men. They fit correctly and absorb in the right places. Aim to need less padding over time as your control improves.
Can I exercise after prostate surgery? Yes – start gentle walking early and build gradually. Avoid heavy lifting, straining, and high-impact activities in the early weeks. These increase abdominal pressure and can worsen leakage. Your physiotherapist will guide you on returning safely to the activities you enjoy.
Do I need a referral to see a pelvic health physiotherapist? No. You can self-refer and book directly. Your urologist or oncologist may refer you, but you’re welcome to get in touch yourself at any point – before or after surgery.
What happens at the first physiotherapy appointment? The first appointment is an hour long. We take a thorough history, explain what we think is going on, and build a treatment plan with you. We check whether you’re activating your pelvic floor correctly – many men aren’t – and give you a personalised exercise programme to take away. You may like to read our section on what to expect at your first appointment.
At Pelvic Health Physiotherapy Wellington, we see men with a wide range of pelvic health concerns. Our clinicians have specialist training in men’s pelvic floor rehabilitation and are experienced at making these conversations feel comfortable and straightforward. Call us or book online at pelvicphysio.co.nz
