Does Urinary Incontinence After Prostate Surgery Go Away on Its Own?

This is one of the most common questions after prostate surgery (especially radical prostatectomy): “Will this get better over time, or is it permanent?”

In some men, bladder control can improve significantly over time. But it does not happen at the same pace or to the same degree for everyone. Recovery can be influenced by many factors, including the surgical technique, how severe the leakage is at the start, age, pelvic floor function and rehabilitation support.

Is urinary incontinence common in the first months after prostate surgery?

Yes. Especially in the early phase, the continence mechanism may need time to readjust after surgery. During this period, dribbling may occur with coughing, standing up, walking or physical effort.

American Urological Association guidelines state that urinary incontinence can be expected in the short term after surgery and that many men may see improvement within the first 12 months.

Can it get better on its own?

For some men, yes — especially in the early phase, bladder control can return as part of the natural healing process.

However, it is unclear how wise it is to simply wait passively for this “spontaneous recovery.” Studies show that men who receive pelvic floor muscle training can regain continence earlier, particularly in the first months. A 2024 meta-analysis reported better recovery in the exercise group at 1, 3 and 6 months.

So can it go away on its own? Yes.

Can better and faster recovery be supported? Again, yes.

Why do some men recover faster?

Several factors stand out in the research:

1. Initial severity of leakage

Recovery can take longer in men who have heavier leakage in the early phase.

2. Sphincter and pelvic floor function

How well the mechanisms that support bladder control reorganize after surgery can make a difference.

3. Starting rehabilitation early

Some studies suggest that pelvic floor training before surgery or soon after it may speed up recovery.

4. Doing the exercises with a physiotherapist

Some systematic reviews have reported that supervised exercise may be more effective than exercising alone.

When should you consider an assessment instead of “waiting”?

An assessment can be helpful if:

• The leakage is not decreasing over time
• You still clearly need pads
• You have started avoiding movement or exercise
• You do not feel meaningful progress within 6–12 months
• The symptoms affect your quality of life

The AUA guideline emphasizes that further options can be discussed for bothersome incontinence that has not improved by 6 months, and that treatment options should be actively evaluated for symptoms that persist at 1 year.

Why can pelvic floor physiotherapy matter?

Because just doing Kegel exercises and focusing only on strengthening the muscles can make symptoms worse.

For some men, what the muscles need is work on:

• Timing
• Coordination
• Pressure management
• Endurance
• Control during functional activities

rather than strength alone.

That is why a “do your Kegels and wait” approach is not always enough.

Conclusion

Urinary incontinence after prostate surgery can decrease or resolve over time in some men. However, the speed and extent of recovery vary from person to person.

The key thing to know is this: Waiting is not the only option.
The research shows that, in suitable cases, rehabilitation can support recovery, especially early recovery.

In my own clinical practice, when I work with men who have urinary incontinence after prostate surgery, I do not focus only on muscle strengthening. I address pelvic floor function, breathing and pressure management, coordination and functional control in daily life together. For some men, it is not just exercise but pelvic floor rehabilitation based on an individual assessment, and biofeedback where appropriate, that supports the recovery process. In this area, I believe it is important to use a personalized approach tailored to each person's symptoms and needs rather than a standard protocol.

References

1. American Urological Association. Incontinence after Prostate Treatment Guideline. American Urological Association.
2. European Association of Urology. EAU Guidelines on Urinary Incontinence. Arnhem: EAU Guidelines Office.
3. Hunter Wessells, et al. Incontinence after Prostate Treatment: AUA/GURS/SUFU Guideline. Journal of Urology. 2019;202(2):369-378.
4. George Milios, et al. Pelvic Floor Muscle Training and Radical Prostatectomy: A Randomized Controlled Trial. BMC Urology. 2019;19:77.
5. Zeng, Wang. Effectiveness of Pelvic Floor Muscle Training on Recovery of Urinary Continence after Radical Prostatectomy: Systematic Review and Meta-analysis. Neurourology and Urodynamics. 2024.
6. Xin, et al. Pelvic Floor Muscle Training Improves Urinary Incontinence after Radical Prostatectomy: A Systematic Review and Meta-analysis. International Urology and Nephrology. 2023.
7. Brea-Gómez, et al. Preoperative Pelvic Floor Muscle Training with Biofeedback for Urinary Incontinence after Radical Prostatectomy: Systematic Review and Meta-analysis. Urology. 2025.