Leaking after prostate surgery is a training problem. One muscle is now doing a job two used to share. Here is how you train it, in the order that works.
You stop leaking by training the one sphincter you still control. Find it. Use it right before the moments that make you leak. Build its strength and its speed. Then train it in the positions where you actually leak.
Waiting helps a little. Swelling settles and nerves heal on their own. The muscle does not get stronger on its own. That part is yours.
Two sphincters used to keep you dry. The internal one sat right where the prostate was, and surgery damages or removes it. The external one is part of your pelvic floor, the muscle group you can control.
After surgery the external sphincter works alone. It has not caught up yet. That is why you leak. Not because something is broken forever.
Most men squeeze the wrong thing. Abs. Glutes. Breath held. That is straining, not a pelvic floor contraction.
A real one is small and internal. Imagine stopping the flow of urine, or holding back gas. You should feel a gentle squeeze and lift deep in the pelvis. Your belly stays soft. You keep breathing. Use the urine cue as a picture only. Do not practice by stopping your stream on the toilet.
If you feel yourself pushing down or out, you are doing it backwards. Think lift, not push.
Notice when you leak. Standing up. Coughing. Sneezing. Lifting. Those are pressure moments, and they are predictable.
So brace first. Squeeze the pelvic floor, then stand. Squeeze, then cough. Squeeze, then lift. Pelvic floor therapists call this the Knack. It is the most practical skill in recovery, because every pressure moment in your day becomes practice.
Dr. Meg Cochran, DPT shows the Knack, the squeeze you do right before a cough, a sneeze, or standing up.
Your pelvic floor does two jobs. It holds steady through a long walk, and it reacts fast to a sneeze. Those are different muscle fibers and they need different training.
Slow holds build endurance. Quick squeezes and releases build speed. Doing only one leaves a gap. Men who only do long holds still get caught by a cough.
Lying down is the easiest position. Gravity is on your side. Most men are dry on their back long before they are dry on their feet.
So the work has to move. Lying, then sitting, then standing, then walking. Each one is harder than the last. Each one is closer to real life.
Use male guards, not women's pads. They are shaped for where men leak. Keep a spare and a plastic bag with you when you go out.
Keep drinking water. Cutting back makes urine more concentrated, which irritates the bladder and makes urgency worse. Ease up on coffee, tea, and alcohol for now. All of them irritate the bladder.
Do not do more repetitions than your plan calls for. A tired pelvic floor is a weak pelvic floor.
See a pelvic floor physical therapist or call your urologist if you cannot tell whether you are squeezing the right muscle, if nothing has changed after several weeks of steady work, if leaking is getting worse, or if you have pain, burning, fever, or blood.
None of those mean you failed. They mean it is time for someone to look.
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Dr. Meg Cochran is a licensed Doctor of Physical Therapy specializing in pelvic floor rehabilitation, and treats men after prostate surgery through Where You Are Physical Therapy in Oxford, Mississippi.
This article is educational and is not medical advice, a diagnosis, or a substitute for in-person care. Follow your surgical team's instructions. If you have urgent symptoms including severe pain, fever, unexpected bleeding, or a sudden change in function, contact your healthcare provider.
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