Following prostate surgery, it is common to experience some urine leakage (urinary incontinence). This tends to occur more often after a radical prostatectomy for prostate cancer but can also occur after surgery for benign prostatic hypertrophy (BPH). 

The amount of leakage tends to lessen over time and usually by the six-week post-surgery follow up visit most men will have reasonable control over their bladder most of the time. 

Why may it happen? 

The urethra (bladder tube) passes from the bladder to the outside. There is a tight ring of muscles (urethral sphincter muscles) that act to hold urine in the bladder until it is ready to be emptied via the urethra. Despite advances in surgical techniques it is not always possible to avoid damage to these sphincter muscles or the nerves that supply them during prostate surgery, particularly if a prostate cancer tumour is in this area.  This can then lead to weakening of the pelvic floor muscles.  

What causes leakage?

Leakage occurs when the squeeze pressure of the urethral sphincter or the pelvic floor muscles are unable to withstand the pressure exerted on the bladder. Leakage can also occur if the bladder is contracting and the urethral sphincter is not strong enough to resist this pressure, resulting in leakage. 

How much leakage occurs?

The amount of leakage occurring after radical prostatectomy surgery can vary from one man to the next. Some will have little if any leakage, whereas others can find that they have little control initially and this generally improves after several weeks. 

Is the leaking continual? 

Many men describe having no leakage when they are lying in bed or sitting in a chair and watching TV. However, when they stand up they get a sudden, urgent sensation to go to the toilet. Some men find they are not able to reach the toilet in time when this happens. This symptom also tends to lessen after several weeks, particularly if the man is performing pelvic floor muscles exercises correctly. 

Will I leak less if I drink less? 

It is very tempting to cut back on drinking water during this time in an attempt to reduce the amount of leakage that occurs, however this can actually make things worse. 

Poor fluid intake can make the urine more concentrated, causing it to irritate the bladder. Insufficient fluid can also result in constipation and straining, which can further weaken the pelvic floor muscles 

Drinks containing caffeine such as tea, coffee and cola may irritate the bladder, as can alcohol. It is often helpful to limit these drinks and drink more water. 

What can I do?

It is advisable to see a continence physiotherapist, preferably before having surgery to learn how to train your pelvic floor muscles. Many physiotherapists use a real-time ultrasound as this can show you how your pelvic floor muscles are contracting. You will also be taught how to contract the muscles effectively and how to brace the muscles when you cough or sneeze, get up from a chair or other activities that may result in leakage (stress urinary incontinence).  

Do they make incontinence pads for men? 

There is a range of styles of incontinence pads and pants designed for men that will absorb the urine, keeping you drier and more comfortable, and protecting your clothing from wet patches. 

Are there any other options rather than pants and pads? 

Some men may prefer to use a uridome or condom drainage system or a penile clamp. See our section on Incontinence aids and products for men for more information or contact us

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Kylie – parent of a child that wets the bed 

Kylie rang our service as she was concerned about her five-year-old daughter, Mia, who was wetting the bed. Kylie had tried limiting Mia’s drinks in the late afternoon and evening and was also getting up at night to wake Mia and take her to the toilet.

Our advisor explained that it may take children until they around 5 ½ years old before they gain bladder control during sleep. Kylie was advised to encourage Mia to drink well throughout the day and was cautioned against cutting out drinks in the afternoon and early evening. Kylie was discouraged from waking Mia at night to take her to the toilet. Kylie was provided with information on obtaining a referral from Mia’s doctor to a bedwetting clinic if Mia continues to wet the bed past 5 ½ years of age.

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Anastasiya’s story

“As a mum of two young children, I have experienced the joys of two pregnancies and postpartum recoveries. I was shocked after the birth of my first child to discover that my pelvic floor muscles had become weak. I sought advice from Bladder and Bowel Health Australia and learnt the importance of exercising these muscles. This knowledge helped, and because I was better informed second time around, I have now fully restored the dignity of my body and truly enjoyed the changes - and my motherhood. Thank you, Bladder and Bowel Health Australia, for informing young families about bladder and bowel health issues.” 

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Doreen – carer of her husband who has dementia 

Doreen was becoming exhausted caring for her husband Tom, who has dementia. Tom was not always making it to the toilet on time and needed his trousers to be changed several times a day. Every day Doreen was also washing bedlinen and the four towels that Tom was laying on at night as he was soaking through his pull-up pants. 

Tom was receiving a high-level Home Care Package, and Doreen was able to arrange with their provider for some of Tom’s package to be allocated to funding continence assessment and management.  

Our advisor went to Tom’s home and conducted a thorough continence assessment. A continence management plan was developed with input from Doreen, and appropriate incontinence aids and linen protection were organised. Doreen is relieved that Tom’s incontinence has reduced, and her washing load has lessened. Doreen is now confident that she can continue caring for Tom in their home. 

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Gary – experiencing leakage after his recent prostate surgery 

Gary met with one of our Bladder and Bowel Health advisors, as he was concerned about his urine leakage that was persisting after his radical prostatectomy five weeks earlier.   

Gary discussed his concerns with the advisor and was reassured that he was making good progress towards regaining bladder control. This reinforced the information he had received from his urologist. Gary was encouraged to switch to a smaller incontinence pad rather than continuing to wear the pull- up incontinence pants he had worn since his surgery. The advisor arranged some smaller pads for him to trial and provided details on where he could buy them close to his home. 

Gary was encouraged to drink plenty of fluid (particularly water) and to increase his fruit and vegetable intake to avoid constipation. Gary was uncertain if his pelvic floor muscles were working properly and he was referred to a pelvic floor physiotherapist. Gary left the clinic in a brighter frame of mind, confident that he was improving and had clear strategies to further support his recovery.