Incontinence after prostatectomy: kegels before and after surgery
Leaking after surgery is expected and usually improves over months. Learn kegels 4–6 weeks before, restart once the catheter is out, then go phase by phase.
Updated ·Written by the Dr. Kegel editorial team · clinical review pending
Short answer
Start pelvic floor exercises a few weeks before radical prostatectomy so you know how to do them, then restart once your catheter is out and your surgeon agrees. Leaking is expected at first. Many men gain good control within weeks to a few months; for some it takes 12–18 months. Keep training for at least three months.
Leaking after radical prostatectomy generally improves to near baseline by about 12 months, though it can persist and need treatment
Source: AUA/GURS/SUFU Guideline: Incontinence after Prostate Treatment
Why leaking happens after prostatectomy
The prostate sits just below the bladder and wraps around the urethra. It’s part of how you stay dry. When it’s removed, the bladder neck is joined directly to the urethra, and more of the work of holding urine in falls on the external urethral sphincter — a ring of muscle supported by the pelvic floor.
Right after surgery, that sphincter is often weak, bruised or not yet used to working alone. So some leaking is expected, especially when you cough, sneeze, stand up, lift, or late in the day when muscles are tired. The AUA guideline says doctors should tell men that incontinence is expected in the short term.
Pelvic floor training helps the sphincter and surrounding muscles take over that job.
What the guidelines recommend
- Before surgery: the AUA guideline says clinicians may offer pelvic floor exercises or training before radical prostatectomy (a conditional recommendation). Prostate Cancer UK suggests starting four to six weeks before surgery, partly so you can do them properly afterward.
- After surgery: the AUA says clinicians should offer pelvic floor exercises or training in the immediate post-operative period.
- If you’re leaking: NICE recommends offering supervised pelvic floor training to men with stress incontinence after prostatectomy, and continuing for at least three months before considering other options.
What recovery usually looks like
It helps to know the range before you start, so a slow week doesn’t feel like failure.
- Cleveland Clinic says many men have good control within a few weeks of the catheter coming out, most by around 6–12 weeks, but it can take up to 12–18 months to recover.
- The AUA guideline says leaking generally improves to near baseline by 12 months but may persist and need treatment.
About starting early: a 2023 meta-analysis of 12 studies (1,365 men) found that men who trained before surgery were more likely to be continent at three months, but there was no clear difference at 1, 6 or 12 months. So pre-surgery training seems to speed up early recovery rather than change the long-term end point — which still matters a lot when you’re the one wearing pads.
Phase 1: before surgery (4–6 weeks out)
This is the best time to learn. Your muscles and sensation are normal, and nothing hurts.
- Find the muscles. Squeeze as if stopping gas and stopping your urine stream at the same time. You should feel the base of the penis draw in and the testicles lift slightly. Don’t practice by stopping your pee regularly.
- Practice slow holds. Squeeze for 3–5 seconds, then fully relax for the same time. Build to 10 in a set.
- Add quick squeezes. A one-second squeeze and release, 10 in a row.
- Do it in three positions: lying, sitting and standing.
- Practice “the knack”: a quick, firm squeeze just before you cough, sneeze or stand up.
Target: three sets a day, building up to 10-second holds if you can. If you can, ask for a referral to a pelvic health physical therapist before surgery to check your technique.
Phase 2: catheter in (usually the first 1–3 weeks)
- Don’t do kegels while the catheter is in unless your team has specifically told you to.
- Focus on recovering: walking as advised, drinking what your team recommends, and avoiding constipation and straining.
- Gentle breathing and relaxing your belly and pelvic floor is fine and can help with comfort.
Phase 3: catheter out to about 6 weeks
Once the catheter is out and your team agrees, restart — gently.
| Week after catheter out | Slow holds | Quick squeezes | Sets a day | Position |
|---|---|---|---|---|
| 1 | 5 × 3 s, relax 5 s | 5 | 3 | Lying down |
| 2 | 8 × 5 s, relax 5 s | 5–10 | 3 | Lying, sitting |
| 3–4 | 10 × 5–8 s, relax 8 s | 10 | 3 | Sitting, standing |
| 5–6 | 10 × 10 s, relax 10 s | 10 | 3 | Standing, walking |
Early on, the muscles tire fast. It’s normal to leak more in the afternoon or evening. Quality beats quantity: if the squeezes become weak or you’re clenching your glutes, stop that set.
Phase 4: 6 weeks to 3 months and beyond
- Train in real life. Squeeze before you stand up, lift, cough, or get out of the car. Hold a gentle squeeze while you walk short distances.
- Keep three sets a day until you’re dry, then keep one set a day long term.
- Track pads weekly, not daily. A bladder diary shows the trend and gives your team useful data.
- Watch the triggers. Alcohol, caffeine and fizzy drinks can make leaking worse for some men.
If you’re still leaking at three months, don’t give up — many men keep improving well beyond that. But it’s a good moment to ask for supervised training with a pelvic health physical therapist, as NICE recommends, and to talk to your urologist about what else can help if you’re not improving.
After-dribble and climacturia
Two other things men notice after surgery:
- Dribbling after peeing — see our post-void dribbling guide for the urethral milking technique.
- Leaking during arousal or orgasm (climacturia) — this is common after prostatectomy. Pelvic floor training may help; raise it with your team, as there are practical options.
Erections after surgery
Erection recovery follows its own, usually longer, timeline and is often supported by a “penile rehabilitation” plan from your urologist. Pelvic floor training may play a supporting part — see pelvic floor exercises for ED — but it doesn’t replace the plan your team gives you.
Common mistakes after surgery
- Starting while the catheter is still in. Wait until it’s out and your team agrees.
- Doing too much, too soon. Hundreds of squeezes a day tire the muscles and can lead to more leaking later in the day. Stick to three good-quality sets.
- Squeezing the wrong muscles. Clenching the buttocks or tightening the belly adds pressure on the bladder. Keep them soft.
- Holding your breath. Breathe out as you squeeze.
- Stopping as soon as you’re dry. Keep one set a day long term to hold on to your progress.
- Judging progress day by day. Leaking changes with fatigue, fluids and activity. Look at the weekly trend.
Questions to ask your surgical team
- When exactly can I restart pelvic floor exercises after the catheter comes out?
- Can I see a pelvic health physical therapist before or after surgery?
- How many pads a day would you expect at 6 weeks and at 3 months for someone like me?
- What should I do if I’m not improving — and when should I call you?
- What is the plan for erection recovery?
Don’t forget to relax
Some men work so hard at squeezing that the pelvic floor stays clenched all day, leading to aching or trouble starting to pee. Finish every set with a full release and a few slow breaths. If you notice pelvic aching, add reverse kegels and tell your physical therapist.
Frequently asked questions
When should I start kegels before prostate surgery?
Prostate Cancer UK suggests starting four to six weeks before surgery. The AUA guideline says doctors may offer pelvic floor training before prostatectomy. The main benefit is learning the right technique while it's easy, so you're ready to restart once the catheter is out.
When can I start kegels after prostatectomy?
Once your catheter has been removed and your surgeon or nurse agrees. Don't do them while the catheter is in. Prostate Cancer UK notes the catheter is usually removed one to three weeks after surgery for prostate cancer.
How long does incontinence last after prostatectomy?
It varies. Cleveland Clinic says many men have good control within a few weeks of catheter removal, most by around 6–12 weeks, but full recovery can take 12–18 months. The AUA says leaking generally improves to near baseline by 12 months but can persist and need treatment.
Do kegels before surgery really help?
They seem to help early recovery. A 2023 meta-analysis of 12 studies with 1,365 men found better continence at three months with pre-surgery training, but no clear difference at 1, 6 or 12 months. Learning technique early is still worthwhile.
How many pads a day is normal after prostatectomy?
There is no single normal number. Leaking is heaviest in the first weeks after the catheter comes out and usually decreases over months. Track your pads weekly — the trend matters more than any single day. Tell your team if the number is rising.
Sources
- Incontinence after Prostate Treatment: AUA/GURS/SUFU Guideline (2019, amended 2024) — American Urological Association, 2024
- Lower urinary tract symptoms in men: management (CG97) — NICE
- Pelvic floor muscle exercises — Prostate Cancer UK
- Incontinence After Prostate Surgery — Cleveland Clinic
- Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis (Zhou et al.) — Frontiers in Public Health, 2023
This page is general education about exercise, not a diagnosis or treatment plan. Talk to a clinician about symptoms that are new, severe or getting worse.