Incontinence After Robotic Prostatectomy: What to Expect, Week by Week

Two structures keep you continent: an internal sphincter mechanism that runs through the prostate, and an external sphincter muscle just below it. When the prostate is removed for cancer, the internal mechanism goes with it. The external muscle, which used to play a supporting role, now has to do the job on its own.

Leakage after surgery is therefore not a complication. It is an expected transition period while that muscle adapts to its new role, and adaptation takes time.

For a few days after the catheter is removed, there may be very little control. Leakage can happen when you stand up, when you cough, or for no obvious reason at all. Pads are needed during this period — something to plan for, not something to be embarrassed about.

Heavy leakage in the first days does not mean that recovery will go badly. There is no direct link between the two.

Most men see clear improvement during this period. Dryness at night usually comes first, because pressure inside the abdomen is low when you are lying down. Control during the day, while you are still, comes next.

What recovers last is usually control during effort: coughing, sneezing, lifting and climbing stairs. Knowing this order matters. Once you are dry at night, recovery is on the right track — even if you are still using pads during the day.

Recovery continues, more slowly, through this period. Many men reach a point around three months where leakage no longer limits daily life, but the process does not stop there; control can keep improving for up to a year.

Not being completely dry at three months is therefore not a sign of failure. The right approach is to keep up the exercises and wait, rather than make a hasty decision.

Yes — provided you are working the right muscle. The most common mistake is to squeeze the abdominal, buttock or thigh muscles, which does nothing useful. The right muscle is the one you tighten when you try to stop the flow of urine.

The exercises are much easier to learn before surgery than after it. If you are travelling for your operation, learn the technique before you travel, while there is time to get it right.

Several short sets spread through the day work better than long, infrequent sessions. Overdoing it is also a mistake: an exhausted muscle does not hold well.

Avoid constipation. Straining increases pressure on the pelvic floor, so fibre and adequate fluids matter.

Excess weight raises pressure inside the abdomen and makes leakage worse. Losing weight during this period makes a measurable difference.

Restricting fluids is a mistake. Drinking too little concentrates the urine, irritates the bladder and makes symptoms worse. Cutting down on caffeine and fizzy drinks, on the other hand, can help.

The catheter is removed here, but the weeks and months in which continence returns are spent at home. The plan for that period matters as much as the operation.

Pack enough pads for the journey home, and more than you think you will need. A flight or a long transfer is not the moment to run short.

If you can, arrange to see a pelvic floor physiotherapist near home. A specialist can check that you are contracting the right muscle — the single thing that most often goes wrong — and adjust your programme as you improve.

Agree before you leave how your progress will be reviewed, and by whom. A named contact who knows your case is worth more than a general promise of support.

If leakage still limits daily life at the end of a year, it is assessed separately. That assessment looks at the type and amount of leakage and at how the bladder behaves.

There are options at that stage, and they are reserved for the exceptions. Trying to decide early, out of worry about what will happen if things do not improve, is unnecessary.

Some symptoms are not part of normal recovery and should be reported straight away: fever, burning when passing urine, being unable to pass urine at all, abdominal swelling, and pain that keeps getting worse. If you are already home, do not wait for a reply to an email — seek care locally.

How quickly control returns varies from man to man. Age, bladder function before surgery, the bladder itself and other medical conditions all play a part. Comparing yourself with another patient's timetable is misleading.

Be cautious of any approach that promises you a definite timescale or a definite outcome. What helps is knowing the expected course and following your own progress against it.

This article is general information and does not replace medical advice. For your own situation, speak to the team that performed your operation.