How Can Men Manage Incontinence After Prostate Cancer Treatment?

Continence nurse specialist Jane Simpson on what men with prostate cancer need to know about incontinence

Continence nurse specialist Jane Simpson, author of the Pelvic Floor Bible, joins OnFocus to discuss what men with prostate cancer need to know about incontinence and what they can do about it.

The interview

Continence nurse specialist Jane Simpson, author of the Pelvic Floor Bible, joins OnFocus to discuss what men with prostate cancer need to know about incontinence and what they can do about it.

What Is Post-Prostate Cancer Incontinence and How Common Is It?

Urinary incontinence — the involuntary leaking of urine — can occur after prostate cancer treatment, particularly following radical prostatectomy. It is usually temporary, with most men regaining bladder control through pelvic floor rehabilitation. The type of treatment you choose significantly affects your risk: in The Focal Therapy Clinic’s audit of 265 patients, 97% of men maintained full urinary continence after focal therapy.

Continence nurse specialist Jane Simpson, author of The Pelvic Floor Bible and a specialist at The London Clinic for over 22 years, shares her expert guidance on managing incontinence after prostate cancer treatment in this interview for the OnFocus podcast.

Why Does Incontinence Happen After Prostate Cancer Treatment?

Stress incontinence — leaking urine when coughing, sneezing, or during physical activity — is the most common type of incontinence men experience after prostate cancer surgery. It occurs because the pelvic floor muscles, which support the bladder and help maintain continence, can be weakened or bruised during treatment such as radical prostatectomy.

Jane Simpson, who has treated thousands of men at The London Clinic over 22 years, explains that incontinence is usually temporary. Most men regain bladder control with consistent pelvic floor rehabilitation. The risk varies significantly by treatment type — focal therapies such as HIFU (NICE IPG424) carry less than a 2% risk of urinary incontinence (FTC audit, n=265), compared to higher rates following radical prostatectomy.

How Do Pelvic Floor Exercises Help After Prostate Surgery?

Pelvic floor exercises are the single most effective non-surgical intervention for managing post-treatment incontinence. Current evidence shows that men who understand their pelvic floor and begin exercises before treatment recover continence faster after surgery. Jane Simpson recommends a structured programme that starts pre-treatment and continues throughout recovery.

Key elements of pelvic floor rehabilitation include:

• Pre-treatment preparation — learning to identify and activate the pelvic floor muscles before surgery improves post-operative recovery
• Consistent daily practice — regular exercises strengthen the hammock of muscles running from the pubic bone to the coccyx that support bladder control
• Avoiding high-impact activity too soon — activities like tennis or running put downward pressure on a recovering pelvic floor and can delay progress
• Electrical stimulation options — for men whose incontinence doesn’t improve with exercises alone, devices such as Innovo shorts can boost pelvic floor tone

Where Can Men Get Professional Help for Post-Treatment Incontinence?

Specialist continence nurses and pelvic floor physiotherapists provide personalised rehabilitation programmes that go beyond generic advice. Jane Simpson, who runs a dedicated continence practice at The London Clinic in Harley Street, explains that a specialist can assess your individual pelvic floor strength, tailor an exercise programme, and monitor progress to ensure recovery stays on track.

Professional support options include:

• Continence nurse specialists — assess pelvic floor function, prescribe targeted exercises, and advise on pad selection and management strategies
• Pelvic floor physiotherapists — provide hands-on rehabilitation and biofeedback to improve muscle activation and strength
• Your urological surgeon — can advise on whether further intervention is needed if incontinence persists beyond the expected recovery window

At The Focal Therapy Clinic, patients receive prehabilitation and rehabilitation support as part of their treatment pathway, helping to optimise outcomes before and after the procedure.

What Lifestyle Changes Reduce Incontinence Symptoms?

Jane Simpson emphasises that lifestyle optimisation is a crucial part of incontinence management and recovery. Simple, evidence-based changes can make a meaningful difference to bladder control — and ideally these should begin before treatment, not after symptoms appear.

• Reduce caffeine and alcohol — both are bladder irritants that increase urgency and frequency; switching to decaffeinated drinks can reduce symptoms significantly
• Monitor fluid intake — aim for 1.5 to 2 litres of water daily; too little concentrates urine (irritating the bladder), too much increases volume and frequency
• Maintain a healthy weight — excess weight puts additional downward pressure on the pelvic floor, worsening stress incontinence
• Address constipation — straining during bowel movements weakens the pelvic floor; the bowel and bladder share the same muscle support system
• Schedule bathroom visits — timed voiding every 2-3 hours helps retrain the bladder and reduces urgency episodes

How Does Incontinence Affect Men Emotionally and Socially?

Incontinence can have a profound emotional and social impact on men who have never experienced bladder problems before. Jane Simpson describes it as “a brave new world” — men who have controlled their bladder their entire lives suddenly face wearing pads, worrying about leakage at work, and navigating practical challenges that women are more familiar with from menstruation and childbirth.

Specific challenges men report include:

• Workplace anxiety — fear of leaking through clothing at work or in meetings
• Practical obstacles — men’s public toilets rarely have disposal bins for incontinence pads, and many public toilets have closed
• Communication gap — female incontinence is discussed openly on television and social media, but male incontinence remains largely taboo
• Relationship impact — incontinence combined with erectile dysfunction can significantly affect intimate relationships and family life

Jane encourages men to discuss their concerns openly with their healthcare team and to connect with prostate cancer support groups where shared experience can reduce isolation.

How Does Treatment Choice Affect Incontinence Risk?

The type of prostate cancer treatment you choose has a significant impact on your risk of experiencing incontinence. Focal therapies such as HIFU (NICE IPG424) and NanoKnife IRE (NICE IPG768) target only the cancerous tissue within the prostate, preserving the surrounding structures — including the urinary sphincter and pelvic floor muscles — that are essential for continence.

Source: FTC one-year outcome audit (n=265) and published literature

“Not every patient is suitable for focal therapy, and we’re transparent about that. We assess every referral carefully with mpMRI and targeted biopsy before recommending treatment.”

Discussing all available treatment options with your medical team ensures you make an informed decision that aligns with your cancer stage, personal health goals, and quality-of-life priorities. To learn more about whether focal therapy may be suitable for you, book a consultation or call 0207 036 8870.

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