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One side effect of a prostatectomy — surgery to remove all or part of the prostate gland — is urinary incontinence. In other words, you may leak some urine after the surgery. That can cause embarrassment, discomfort, and other emotional and social problems.

How much urine you leak and for how long can vary. Here’s what you need to know about urinary incontinence after prostatectomy.

What a Prostatectomy Entails

A prostatectomy is the partial or full removal of the prostate gland. It is a common treatment for prostate cancer that hasn’t spread outside the prostate. Men with benign prostatic hyperplasia, a non-cancerous enlarged prostate, may also have this surgery.

The prostate sits just below the bladder. The urethra — the tube that carries urine out of the body — runs directly through the prostate. Pressure from the prostate helps hold urine in the bladder.

By removing the prostate, that pressure lessens. The surgery may also cause damage to the delicate nerves and muscles of the bladder and urethra. Surgery can also damage the sphincter, the muscle that controls the flow of urine out of the bladder.

The result is a lack of control over urine flow, or incontinence. In general, older men have more problems than younger men with incontinence after prostatectomy.

What to Expect After a Prostatectomy

Leaking urine may prove an unpleasant surprise after prostatectomy. But the good news is that most men do regain bladder control after prostatectomy. It typically takes six to 12 months to regain complete bladder control.

Types of incontinence after prostatectomy

There are different types and stages of incontinence after prostatectomy. The degree of incontinence can range from a small dribble to a complete lack of bladder control. The incontinence tends to worsen right after surgery and gets better with time.

Types of incontinence after prostatectomy are:

• Stress incontinence, which means leaking urine when you sneeze, cough, or exercise. It’s the most common type of incontinence after prostate surgery. This is because a prostatectomy may damage the muscles and nerves that keep urine in the bladder.
• Urge incontinence is a sudden “gotta go” feeling. Urge incontinence happens when the bladder muscles squeeze without warning, allowing urine to escape. It’s more common in men who’ve had radiation treatment instead of surgery for prostate cancer.
• Overflow incontinence is when you have trouble emptying your bladder, or your urine comes out in a slow, dribbling stream. It can happen after prostatectomy if scar tissue blocks or narrows the outlet from the bladder.
• Continuous incontinence is when you lose all control over your bladder. It’s rare for it to happen after a prostatectomy.

Most men recover bladder control within six months to a year after prostatectomy. If you are still having problems more than a year after surgery, you may need additional treatment.

Treatment for Incontinence After Prostatectomy

There are several ways to cope with incontinence after prostatectomy.

Wearing an absorbent undergarment

It may not sound appealing, but wearing absorbent underpants or incontinence pads for a while after surgery can help. You can switch to a thinner pad as leaks diminish.

Pelvic floor exercises

Your doctor may recommend exercises called Kegels to regain strength in your pelvic floor. During Kegels, you repeatedly tighten and relax the muscles that stop the flow of urine. A physical therapist may use biofeedback to help you learn how to do Kegels.

Bladder training

Scheduling bathroom breaks — and gradually drawing out the time between them — can help strengthen your bladder after surgery.

Surgery

If other treatments and therapies don’t work after about a year, your doctor may recommend surgery to treat your incontinence. The possible procedures are:

• Urethral sling procedure. In this surgery, doctors implant mesh tape to support the urethra. Many men have good results and less leakage.
• Artificial urinary sphincter. This device is for men who have severe incontinence problems. The artificial urinary sphincter is a metal ring that helps close the bladder.

As always, talk to your doctor about the treatment that’s right for you.