Prostate surgery for cancer often disrupts urinary control. Here’s how incontinence develops, why it occurs, and evidence-based strategies for recovery and long-term solutions.
Sarah Jenkins
Executive Director, National Association for Continence
Prostate cancer is one of the most common cancers among men, with 1 in 9 U.S. men expected to be diagnosed, and those chances become 1 in 7 for Black men. While treatments like surgery and radiation are highly effective, they can bring about side effects. One of the most common and distressing is urinary incontinence, especially following prostatectomy (removal of the prostate). Understanding why incontinence occurs and how to manage it can improve both physical recovery and emotional well-being.
Why incontinence happens
The prostate sits below the bladder and surrounds the urethra. When it’s removed, structures that help control urine flow, including the internal urinary sphincter and nearby nerves, are often damaged or removed, compromising control. Although another sphincter remains, it may not be strong enough to prevent leaks.
Surgery can also weaken pelvic floor muscles and temporarily reduce the bladder’s function. Radiation therapy, though less invasive, can irritate the bladder or cause scarring, leading to urge incontinence, a sudden, uncontrollable need to urinate.
How common is it?
Nearly all men experience some degree of incontinence after surgery, particularly after catheter removal. Many regain control within six months, but about 6-8% continue to experience significant leakage one year later. Recovery varies by age, overall health, surgical approach, and dedication to rehabilitation.
Types of incontinence
- Stress Incontinence — Leakage during activity, coughing, or laughing
- Urge Incontinence — A sudden, strong urge to urinate
- Overflow Incontinence — Less common; results from incomplete bladder emptying
Managing and treating incontinence
A combination of exercises, lifestyle changes, medication, and, if needed, surgery can improve bladder control and quality of life.
- Pelvic Floor Exercises (Kegels): Strengthen muscles around the bladder and urethra. Doing them before and after surgery can speed recovery. Guided pelvic floor therapy is often beneficial.
- Lifestyle Changes: Stay at a healthy weight, avoid heavy lifting, limit caffeine and alcohol, and try bladder training techniques.
- Medications: Drugs like alpha-blockers or antimuscarinics may relieve symptoms, especially urge incontinence.
- Surgical Options: If incontinence continues after 6-12 months:
- Male Sling — A mesh sling supports the urethra, ideal for mild to moderate stress incontinence.
- Artificial Urinary Sphincter (AUS) — An implanted device with a pump in the scrotum allows control of urination. It is highly effective for moderate to severe incontinence.
Moving forward with confidence
Urinary incontinence is common after prostate cancer treatment, but it’s often temporary. With the right approach, most men regain control and return to active, fulfilling lives.
Many men are caught off guard by the reality of urinary incontinence after prostate cancer treatment. It’s not just a physical issue; it impacts confidence, relationships, and daily life. That’s why it’s so important to educate and prepare men before treatment begins. When men know what to expect and are equipped with tools and support, they’re empowered to take control of their recovery and quality of life.
The National Association for Continence recommends early screening and open communication with your care team, which can reduce side effects and lead to better outcomes. You are not alone, and with time, support, and treatment, recovery is possible.
For more, visit The National Association For Continence at nafc.org.
