You did what the pamphlet said. It is month three, or month six, and you are still wearing a pad. Here is what is normal, why kegels stall, and what to change.
Most men see significant improvement within three to six months. A small percentage take up to twelve. Still leaking at three months does not mean this is as good as it gets.
The line to watch is the pad count. Most men are at one to two pads a day by three months. If you are using three or more at three months, or your leaking is getting worse instead of better, it is time for someone to look.
When men tell me kegels are not working, it is almost always one of five things.
The wrong muscle. Abs, glutes, and a held breath are not a kegel. That is straining, and it pushes down on the muscle you are trying to train.
Pushing instead of lifting. If it feels like bearing down, it is backwards.
Only slow holds. Long holds build endurance. They do not catch a cough. That takes quick squeezes.
Too many. More is not better. A tired pelvic floor leaks more.
Only lying down. You do not leak lying down. You leak standing, walking, and lifting, so that is where the training has to go.
Look at when you leak. Standing up. Coughing. Lifting. Those moments are predictable.
Squeeze the pelvic floor first, then cough. Squeeze, then stand. Therapists call it the Knack, and it is the most practical skill in recovery.
Dr. Meg Cochran, DPT shows the Knack, the squeeze you do right before a cough, a sneeze, or standing up.
Lying, then sitting, then standing, then walking. Each is harder than the last. If you have done three months of kegels on your back, the next step is not more of them. It is doing them upright.
Coffee, tea, and alcohol irritate the bladder. So does drinking too little water, because concentrated urine is an irritant.
Stress, poor sleep, and being sick can all raise leaking for a few days. That is a bad week, not a lost recovery.
See a pelvic floor physical therapist if you are still at three or more pads a day after three months, if you cannot tell whether you are squeezing the right muscle, if you have pelvic pain, or if a sudden strong urge to go is a bigger problem than leaking with a cough.
Ask your urologist for a referral, and ask the clinic one question before you book: do you treat men after prostatectomy? If they hesitate, keep looking.
How to Stop Leaking After Prostate Surgery
Kegel Exercises After Prostate Surgery: How to Do Them Right
Exercises to Do Before Prostate Surgery
When Can You Exercise After Prostate Surgery? Walking, Lifting, Golf, Running
The First Week After Prostate Surgery: What to Expect
Recovery After Prostate Surgery: A Week-by-Week Guide
Pads for Men After Prostate Surgery: What to Buy and How to Leave the House
Pelvic Floor Physical Therapy After Prostate Surgery: Do You Need It?
The Stages of Incontinence After Prostatectomy
Life After Prostate Removal: What to Expect
Kegel Exercises for Men: How to Do Them Right
Your Husband Is Having Prostate Surgery: How to Help
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.
The first week after prostate surgery, written out step by step by Dr. Meg. What to do with the catheter in. What to skip. What to have in the house. Enter your email and it opens right away.
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Educational content. Not medical advice.
The Prostate Recovery Quick Start is Dr. Meg showing you the first exercises on video, from before surgery through week 4, with the two sheets to print. Open it on any phone, tablet, or computer, from anywhere. It is educational, not physical therapy.
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