Prostate cancer is the most commonly diagnosed cancer among American men, and while surgery—specifically radical prostatectomy—offers a strong chance at cure, the aftermath can feel like trading one crisis for another. Urinary leakage following prostatectomy is not a fringe side effect; according to the American Urological Association (AUA), the majority of men will experience some degree of stress urinary incontinence in the weeks and months after surgery. What most men aren't told in the pre-operative rush is that there is a proven, structured path back to continence—and it starts before the surgeon ever makes an incision.
We sat down with Dr. Marcus Webb, DPT, a men's pelvic health specialist based in Denver, Colorado, with over a decade of clinical experience helping men navigate urinary recovery after prostatectomy. His protocol blends evidence-based pelvic floor rehabilitation with real-world practicality, and his patients consistently outperform national continence recovery benchmarks. What follows is a candid, detailed conversation about what works, what doesn't, and what every man facing prostatectomy deserves to know before he ever wakes up from anesthesia.
The Problem Nobody Warned Him About
Dr. Webb's passion for men's pelvic health didn't emerge from a textbook. He describes the turning point in his career as a single patient encounter—a 64-year-old retired firefighter named Gerald who arrived at his clinic eight months post-surgery wearing a thick adult diaper, refusing to leave the house, and quietly falling apart.
"Gerald had been told by his urologist that leakage was 'normal' and to 'give it time,'" Dr. Webb recounts, leaning forward in his chair. "Nobody had referred him to pelvic floor PT. Nobody had explained what was happening to his body. He thought he was broken. He'd stopped going to his grandson's baseball games. He was eating dinner at home every night because he was afraid of leaking in public. That kind of isolation—it's not a urinary problem anymore. It's a quality-of-life emergency."
Gerald's story is, unfortunately, common. The National Association for Continence (NAFC) estimates that millions of American men live with urinary incontinence and never seek treatment, often because of shame, a lack of information, or simply not knowing that effective treatment exists. For post-prostatectomy patients specifically, that silence can add months of unnecessary suffering.
Starting Before Surgery: The Case for Pre-Habilitation
"The biggest mistake I see is waiting," Dr. Webb says flatly. "Men come to me at six months post-op, frustrated and demoralized. My first question is always: did anyone talk to you about pelvic floor PT before surgery? The answer is almost always no."
Pre-habilitation—or "pre-hab"—refers to beginning pelvic floor physical therapy before the surgical procedure takes place. The logic is straightforward: if a man already knows how to correctly contract and relax his pelvic floor muscles before they are traumatized by surgery, his recovery trajectory is meaningfully better.
"During a radical prostatectomy, the external urethral sphincter—the muscle that gives you voluntary control over urination—gets stressed, stretched, and sometimes partially disrupted," Dr. Webb explains. "If a patient already has neuromuscular awareness of that muscle group before we go in, his brain can reconnect to it much faster afterward. It's the difference between relearning something and learning it from scratch."
The AUA's clinical guidelines on the management of non-neurogenic male lower urinary tract symptoms support the use of pelvic floor muscle training (PFMT) as a first-line conservative intervention, noting that structured exercise programs consistently improve outcomes compared to watchful waiting. Dr. Webb cites these guidelines often with his patients because, as he puts it, "men respond to data. When I show them the evidence, they stop thinking of PT as something soft and start treating it like training."
His standard pre-hab protocol begins four to eight weeks before the scheduled surgery date. Sessions involve internal pelvic floor assessment (with the patient's informed consent), instruction in correct Kegel mechanics, and education about the anatomy of the post-prostatectomy pelvic floor. "Most men have no idea where their pelvic floor is," he says with a laugh. "They think they're doing a Kegel and they're squeezing their glutes, holding their breath, or tightening their abdomen. All of that is counterproductive."
Post-Op: When to Start and What That First Week Looks Like
"The catheter comes out—typically at seven to ten days post-op—and I want to see my patient within 48 to 72 hours," Dr. Webb says. "Not because we're going to do anything heroic in that first visit, but because we need to establish a baseline, manage expectations, and prevent compensatory patterns from taking root."
Those compensatory patterns are a key concern. Men who leak will instinctively begin holding tension in the wrong muscle groups—gripping the abdomen, over-squeezing the thighs, hiking the hips—in a misguided attempt to suppress urine loss. "Those habits become hard to unlearn," Dr. Webb warns. "And they actually make the underlying problem worse by increasing intra-abdominal pressure."
In the first two weeks post-catheter removal, the protocol is intentionally gentle. The focus is on diaphragmatic breathing, low-load pelvic floor activation, and education about fluid management. "I tell my patients: drink your water. A lot of men with leakage try to solve it by not drinking. That concentrates the urine, irritates the bladder, and makes everything worse. It's one of the most counterproductive things you can do." The Mayo Clinic echoes this guidance, noting that adequate hydration is essential for bladder health even when managing urinary incontinence.
This is also the point in his narrative where Dr. Webb mentions practical management strategies—not as a defeat, but as part of the protocol. "Managing leakage while you recover is not optional—it's part of the plan. I've had patients miss therapy sessions because they were too embarrassed to leave the house. That's not acceptable. You need reliable, dignified protection so you can show up and do the work." For many of his patients, he notes, finding a product that doesn't feel clinical or infantilizing is itself a meaningful step. Orykas washable incontinence underwear, he mentions, has come up organically in patient conversations because the underwear looks and feels like regular underwear—a detail that sounds minor until you realize how profoundly it affects whether a man will wear protection at all rather than simply staying home.
Progression: Weeks Three Through Twelve and Beyond
"Pelvic floor therapy after prostatectomy is not one-size-fits-all, but there is a general arc," Dr. Webb explains. By weeks three through six, patients who are responding well begin adding endurance holds to their Kegel practice, progressing from quick flicks (fast-twitch fiber activation) to sustained contractions of eight to ten seconds. They also begin functional integration—practicing pelvic floor engagement during transitions like sitting to standing, walking, and eventually stair climbing.
"The pelvic floor doesn't exist in isolation," he emphasizes. "It works in concert with the diaphragm, the deep abdominals, and the hip musculature. A lot of what we do in weeks four through eight is about restoring that whole-system coordination." Research published through NIH's National Library of Medicine supports integrated core rehabilitation approaches for post-prostatectomy recovery, showing improvements not only in continence outcomes but in overall pelvic pain and sexual function—outcomes that matter deeply to this patient population but are rarely discussed openly.
By week twelve, the majority of Dr. Webb's patients who began pre-hab have achieved either full continence or a level of leakage that is minimal and manageable. For those who began therapy only post-operatively, the timeline extends, but the trajectory is still positive. "I've seen men regain full continence at fourteen, sixteen, even twenty months post-op. The pelvic floor is remarkably adaptable if you give it consistent, intelligent training."
The Role of Biofeedback
"Biofeedback changed my practice," Dr. Webb says simply. Biofeedback uses real-time physiological data—typically surface electromyography (sEMG)—to give patients visual or auditory feedback about their muscle activity. For men who struggle to isolate the correct muscles, it removes the guesswork entirely.
"I use biofeedback routinely with post-prostatectomy patients, especially in the first four to six weeks. When a man can see on a screen that he's over-recruiting his abdomen instead of his pelvic floor, something clicks. The visual feedback bypasses all the noise in his head about whether he's doing it right." Multiple studies, including systematic reviews available through NIH's PubMed database, confirm that biofeedback-assisted PFMT produces faster and more robust continence outcomes than verbal instruction alone, particularly in early post-operative recovery.
Realistic Expectations: What Men Actually Need to Hear
"Every man who sits across from me wants to know: will I be completely dry? And I have to be honest with them," Dr. Webb says. "The majority—yes. But it takes time. And the work has to be consistent."
The AUA notes that continence rates following radical prostatectomy vary significantly depending on surgical technique, patient age, pre-operative continence status, and whether nerve-sparing procedures were performed. At one year post-surgery, continence rates in academic centers range from roughly 85 to 95 percent—but that's not where most men start, and the road there requires patience.
"The men who struggle most are the ones who white-knuckle it alone—who refuse to get help, won't use appropriate protection, and measure their progress in shame rather than centimeters," Dr. Webb observes. "The men who do best show up to their appointments, do their home program every day, and treat this like a physical recovery—which it is. No different from ACL rehab."
For those managing moderate leakage during recovery, he's seen how much difference comfortable, washable protection makes in maintaining engagement. Orykas incontinence underwear, designed specifically to be discreet and reusable, lets men participate in the activities—walks, PT sessions, social outings—that are themselves therapeutic. "Isolation is the enemy of recovery," Dr. Webb says. "Anything that gets a man out of the house and back into his life is clinically valuable."
Life After the Turning Point
Gerald—the retired firefighter who couldn't attend his grandson's baseball games—completed Dr. Webb's full rehabilitation protocol over six months. At the eight-month mark, he was continent during the day and managing mild nighttime leakage with a light liner. At fourteen months post-surgery, he sent Dr. Webb a photo from the bleachers at a Little League game, giving a thumbs-up.
"That photo is on my office wall," Dr. Webb says quietly. "That's why I do this work. Not the discharge summary. Not the outcomes data. That photo."
The message he wants every man facing prostatectomy to receive is direct: urinary leakage after prostate surgery is common, it is treatable, and you do not have to endure it alone or in silence. Ask your urologist for a referral to a pelvic floor physical therapist before your surgery. Start the conversation early. Accept appropriate support—practical and clinical—during recovery. And keep showing up.
"Your pelvic floor is a muscle," Dr. Webb says, standing to close the interview. "And muscles, when trained correctly, respond. That's not hope. That's physiology."
Frequently Asked Questions
How soon after prostatectomy should I start pelvic floor physical therapy?
Ideally, pelvic floor therapy after prostatectomy begins before surgery—four to eight weeks pre-operatively if your schedule allows. Post-operatively, most pelvic floor PTs recommend an initial evaluation within 48 to 72 hours of catheter removal, typically seven to ten days after surgery. Early intervention helps prevent compensatory muscle habits and establishes a structured recovery plan from the outset.
Are Kegel exercises the same as pelvic floor physical therapy?
Kegel exercises—voluntary contractions of the pelvic floor muscles—are one component of pelvic floor physical therapy, but PT is far more comprehensive. A qualified DPT specializing in men's pelvic health will assess your individual muscle function, correct faulty mechanics, use biofeedback to optimize neuromuscular activation, and integrate pelvic floor training with breathing, core, and hip rehabilitation. Doing Kegels incorrectly (a very common problem) can actually slow recovery.
What does the AUA say about pelvic floor therapy for post-prostatectomy incontinence?
The American Urological Association (AUA) recommends pelvic floor muscle training (PFMT) as a first-line conservative management approach for post-prostatectomy urinary incontinence. Their clinical guidelines emphasize that structured, supervised PFMT produces significantly better outcomes than unsupervised exercise or watchful waiting, and they support early referral to qualified pelvic floor specialists as part of standard post-surgical care.
How long does it take to regain continence after prostatectomy?
Recovery timelines vary based on surgical technique, patient age, pre-operative continence, and whether nerve-sparing procedures were performed. Many men who complete pre-hab and begin immediate post-operative PT achieve significant continence within three to six months. Those who begin therapy only after surgery may take six to twelve months or longer. Some men continue to see improvement up to eighteen to twenty-four months post-operatively. Consistent, guided effort is the strongest predictor of outcome.
What should I use to manage leakage while I'm in recovery?
Managing leakage with appropriate protection during rehabilitation is clinically important—it allows men to attend therapy, stay active, and avoid the isolation that impedes recovery. Look for options that are discreet, comfortable, and don't compromise your dignity. Washable incontinence underwear like those from Orykas are designed to look and feel like regular underwear, making it easier for men to stay engaged in daily activities and therapy appointments throughout recovery.
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