Deep Dive

Incontinence and Intimacy After Prostate Surgery

For many men, the most unexpected part of prostate cancer treatment isn’t the cancer – it’s what comes after.

You’re told the surgery was a success. 

The cancer is gone. Be grateful. And yet – there it is: the leaking. 

The smell. The fear of leaving the house without a pad. The hesitation before sex.

No one told you that beating cancer might come with needing a backup pair of underwear.

Urinary incontinence can chip away at your identity. It’s not just about control – it’s about confidence, privacy, intimacy. 

And while it’s incredibly common, it’s also fixable.

Why It Happens

The prostate sits just below the bladder and wraps around the urethra. 

When it’s removed, the sphincter muscles and nerves that help control urine flow can be stretched, weakened, or disrupted.

In the first weeks, almost every man leaks. For many, it improves within 3–6 months. 

But some men continue to leak when they cough, sneeze, stand up – or during sex.

What You Can Do

• Pelvic floor therapy: Work with a pelvic floor physical therapist – not just a general PT. These specialists are trained to help men retrain the deep muscles that control continence.
  

• Bladder timing: Empty before intimacy or activity to reduce pressure and urgency
  

• Surgical options: If incontinence is persistent, talk to a urologist who specializes in prosthetics or reconstructive urology. Male slings or artificial urinary sphincters are effective long-term solutions for many men
  

• Smart daily tools: In the meantime, high-absorbency pads or leak-proof underwear can help you feel more secure out in the world. No shame – just smart backup.

Yes, That Too: Leaking During Sex

It has a name: climacturia – urine leakage with orgasm. 

It happens to nearly 1 in 5 men after prostate surgery. It can be a few drops or more. 

It can feel shocking, embarrassing, and like yet another blow to your sexual confidence.

Here’s the truth: the urine is sterile. It’s not dirty. 

It doesn’t mean you’re broken. 

But it does take an open mind – and a bit of planning – to navigate.

If You’re Leaking During Sex (Climacturia)

If climacturia is your main concern, you’re not alone – and you’re not without options.

• Try a constriction band (also known as a cock ring): These soft bands can be worn at the base of the penis during sex to limit urine loss at the time of climax. They’re widely available online or at most adult stores.
  
  Word to the wise: when you search online, cover your eyes – and maybe don’t use your family Amazon account.
  

• Pelvic floor therapy: Timing and voluntary contraction strategies can help reduce leakage during intimacy
  

• Use protective bedding or towels: For peace of mind, not shame
  

• Talk with your doctor: Especially if it’s persistent – there may be personalized strategies based on your anatomy and recovery stage

Some men are otherwise dry but only leak during sex. 

I’ve performed sling surgery for several of these men – with excellent results. 

In those cases, the erections had returned, confidence was high, but the last missing piece was control. 

Completing that recovery has been one of the most rewarding parts of my work.

It may take up to a year to fully recover continence after surgery, so don’t give up. 

Keep doing the work. Keep asking questions. There’s always another step.

Navigating It as a Couple

• Talk about it – before it happens: “This might happen. I’m working on it.”
  

• Plan without pressure: Towels, dim lights, humor. It helps.
  

• Remember what matters: Most partners care more about closeness than perfection.

This doesn’t have to be the end of sex – it might be the beginning of a new kind.

Big Picture: It’s About More Than Leaks

Incontinence touches everything – your sense of control, desirability, freedom. It’s okay to feel frustrated. It’s okay to feel like no one warned you.

But you’re not stuck. And you’re definitely not alone.

With rehab, realistic timelines, and honest conversations, most men improve dramatically. 

Many return to sex lives that feel grounded, intimate, even better – because they’ve stopped avoiding, and started engaging.

You deserve that too.

And it starts by talking about it.