NOTE: this is part of an ongoing series of posts about my journey with prostate cancer. So far the posts include:
1. January 30: “When Cancer Comes Calling”
2. February 16 – “Waiting in Mutual Ambush”
3. March 11 – “My Prostate is History” (on the surgery)
4. March 13 – “Letters Before Surgery” (saying goodbyes)
5. March 14 – “Cancer Prognosis: Uncertain Grace”
6. March 22 – “Post-Surgery Incontinence”
Post-Surgery Incontinence: My Story – Drip by Drip
David R. Weiss – March 20, 2025
Incontinence: it’s the gift that just keeps giving. But hopefully not forever! Still, it is one of the inevitable aftereffects of a radical prostatectomy (the complete removal of the prostate). When the alternative is giving cancer free reign in your body, it seems like a small price to pay. Then again, when you’ve just wet yourself for the tenth time in a day—before noon, you do start to ask, Really?!
Before I plunge into my tale of incontinence, a few disclaimers first. As I’ve mentioned in prior posts, I am not a urologist. I don’t even play one on my blog. I’m just a guy going through prostate cancer treatment—committed to understanding it as best I can. I try to be medically accurate, but I’m foremost writing out of my lived experience. And, as a writer, my “healing” includes processing my journey by writing about it, hence the “TMI” is part of my healing. But maybe you learn a thing or two as you listen in. Cool.
Lastly, while incontinence is considered a given after prostate surgery, it resolves on widely different timetables given a variety of factors—including (perhaps most of all) just plain luck. The fact that my incontinence seems to be resolving rather quickly is not to my credit. I’ll take dry underwear over wet any day, but there is no secret I can share. And if your journey was or is different than mine, you have my full respect for walking your own damp path with as much grace as you’re able.
Two key muscles—sphincters, as they call them: circular muscles that act like rubber bands—are crucial in continence: keeping your urine in the bladder until an opportune time. One is the internal sphincter (called the bladder neck sphincter on the diagram). Internal because it sits inside the bladder, right at the bottom where the bladder meets the prostate. The other is the external sphincter (hint: outside the bladder), which sits below the prostate. It’s embedded in the pelvic floor muscles and is the “last gate” that holds your pee back.
The internal sphincter works autonomically; it’s controlled by your body (without asking you). It’s involuntary. The external sphincter, however, is the one you have (some) control of. It normally operates in sync with the internal sphincter, usually at your subtle invitation. The swift moment of “Ahhhhh …” as you let your pee begin, that’s you telling your external sphincter, “It’s go-time.” But if you’re on the train, and your stop is 15 minutes away yet? Or if you need to desperately wait for the person before you to clear out of the bathroom? Or if you just need to stop your pee midstream because it’s spraying past the bowl? Your external sphincter is your best friend in those scenarios. It can throw an emergency brake that stops your pee right before it enters your penis, even if it’s already breeched your bladder. Except—
Each sphincter muscle sits immediately adjacent to the prostate. Or in my case, where the prostate WAS. That’s where incontinence enters the picture. Grateful as I am for the radical prostatectomy that removed my cancerous prostate, there’s inevitable collateral trauma in the neighborhood.
The neck of the bladder puckers as it meets the sphincter muscle, the way the stem of a balloon puckers at the knot. And that puckered neck, plus the internal sphincter, push right up against the prostate. Because the goal is to remove 100% of the prostate (not 98%, not 99%) that means peeling, scraping, trimming, cutting the prostate ever so carefully away from the bottom of the bladder. Bruising is inevitable. And understatement. There’s a knife involved and soon after that there’s a needle pulling a tiny barbed-wire thread through the bladder neck tissue to secure the loose end of the urethra stretched from the far side of the prostate. OUCH.
Yes, I was sound asleep for this, it isn’t hard to realize that all this is traumatic for the bladder neck and the sphincter muscle. Even the best-skilled surgeon (like mine!) cannot avoid leaving this sphincter in a royal funk (thoroughly unpuckered)—which is only heightened by the immediate insertion of a catheter, which for nine days, irritates the bladder neck and keeps the sphincter from sphinctering, all the while telling the tissue, “There, there, now, it’s all better.” Um, bullshit.
As for the external sphincter, it didn’t get the worst of it, but it did have the traumatized cut-loose end of my urethra tugged on (this is not an image I enjoy conjuring up!)—hard. That loose end, passing through the external sphincter, needed to be stretched across the gap left by my just-removed prostate and get stitched to the bladder neck. (Again, with barbed wire thread.) And then this sphincter, too, which happens to circle the narrowest bit of urethra, was also propped wide open by a catheter for nine days. Both sphincters end up with bruised egos and more—and are forbidden from sphinctering for nine days. No wonder that by the time the catheter comes out, a moment of agonized joy for me, they’re pissed. And it’s a disposition they’re only too eager to pass along … right in my pants.
Yes, this is part and parcel of the healing process. It is a step forward—toward a life less immediately threatened by cancer. (Not threat-free but doing our due diligence toward that end.) So, I’m not complaining. Still, it’s hard to feel like saying “Thank you for that drop of healing,” each time I pee myself. Perhaps a better man than I could do that. I call it good if I can get by with an eye roll, a sigh, and yet another trip to the bathroom.
So, yeah, both of these sphincters get taken for a ride and then some. And that’s in a textbook prostatectomy (which I’m told mine was). Even in that best case, these muscles don’t just bounce back and the bladder neck doesn’t just pucker up again overnight. They need time to heal. The nerve endings that carry the signals need to “wake up.” And they try. But the need to pee won’t wait. Hence, incontinence. For days, weeks, months while everything sorts itself out.
For most men (one study suggests about 70%), post-surgery incontinence lasts for six weeks to three months. A lucky 10% of men—to no credit of their own—find that it resolves sooner, in a matter of weeks. Another 10% wrestle with incontinence for three to nine months. And in the last 10% it will take up to a year to resolve. (In a very small fraction, maybe 1%, incontinence can become semi-permanent and/or require further surgery.)
I knew this only at a very general level before surgery. Mostly, just that I should “plan on being incontinent for several months.” So, I did. In the week or two before my surgery I bought a waterproof pad for my side of the bed—not wanting to soil our mattress. I picked up a package of something like “Depends”: a pull-up protective and absorbent disposable underwear; basically, an adult male diaper. And a package of men’s “Guards”—front pads to put in my underwear to catch “leaks.” I even invested in some rather pricey men’s washable underwear with sewn in absorbent pads sewn in front, so I could be “green” even while dealing with uncontrolled yellow. I wasn’t dreading the incontinence, but I didn’t really know what to expect either.
As soon as the catheter is out, both sphincters set about resuming their duties. With very mixed success. The internal sphincter has never consulted me about anything—autonomic, remember. So, as best as I can figure, it’s sphinctering in a sort of half-assed, tissue-bruised, pucker-tuckered way. Like a faucet that has a very slow drip even when turned off. It will get better as the nerves fully wake up. As the neck of the bladder gets it pucker back. And as the bruising fades (and the stitches dissolve).
Until it does, everything rests on that “last gate”—the external sphincter that closes the urethra right before it enters the penis. Literally: that tiny trickle of pee runs down my urethra until it reaches the external sphincter, the one I can clench shut. Which I’m doing these days, almost all day long. I mostly don’t have to actively think about it. Wherever I am, if not in a bathroom, my mind knows that a slight clench is my safest bet. Until it isn’t enough. Oops.
Most post-surgery incontinence—and all of mine, every last drop—has been “stress incontinence.” Or, as I like to say, multi-tasking messes. These days I can’t cough and hold my pee at the same time. Or sneeze. Or stand up. Or sit down. Or carry a plate to the sink. Or lift much of anything. Or hold the door open with my foot. Pretty much every bit of extra exertion—especially unexpected—distracts that external sphincter for just a split second. I re-clench almost immediately, but it’s too late. A dozen or so drops … drip out. And I’m wet. Damn. A dozen times a day or more. It gets worse in the evening because sphincters get tuckered and lose their pucker.
Thankfully (and to my surprise), I’ve slept dry every night. I’ve had to get up two or three times a night to empty my bladder because (thankfully) my sphincters roused me before wetting me as the need to clench disrupted my sleep. Turns out that because our sleep is usually not bothered by unexpected exertion, post-surgery stress incontinence resolves most quickly during the night. As for daytime, the first few days without a catheter I wet myself (though just barely) pretty much hourly. I never all out lost control, but drops are drops. And once you know you’ve leaked, it’s not much consolation to tell yourself, “Yeah, but the pad’s got this.” A dozen drops, a dozen times, is gross. And before long the pad smells or the underwear are undeniably damp. My only “secret”: I’ve been folding up strips of paper towel in front of my washable padded underwear. As soon as I can sense I leaked, I head to the bathroom and trade out the paper towel, which (I tell myself) lessens the dampness on the pad—and the smell. And I am getting better.
I hope (and appear) to be part of the fortunate few for whom incontinence will last less than six weeks. I’m two weeks post-surgery—barely one week catheter-free—and I’m only leaking a bit off and on during the day. Bothersome? Yes. Debilitating? Hardly. I spent five hours yesterday afternoon at the Eden Prairie public library. Other than making regular visits to the restroom to trade out paper towels, no one knew I was on a slow drip of urine leakage.
Healing happens at its own pace, and it seems that holding out some compassion and patience for my body as it heals may be helpful. And learning Kegel exercises can’t hurt—although, this is hardly a quick fix. All the evidence suggests that developing a regular routine of Kegels to strengthen your pelvic floor muscles will make a difference after four to six weeks. Fingers crossed I’ll be fully continent before then. But if not, I’ve started on Kegels: three sets of ten reps each day. Takes less than five minutes for each set. These exercises work to strengthen the pelvic floor muscles that surround and anchor the external sphincter. They don’t directly stop your pee, but they indirectly give your external sphincter all the extra support it needs to reclaim its job—and they may indirectly help tone the muscles of the sphincter itself.
Again, these are probably most important for the 70-plus percent of men who deal with post-surgery incontinence for months. By the time my Kegel routine has made my pelvic floor buff, I’ll hopefully be staying dry all the time anyway. But all that Kegeling won’t be in vain, because it will also help me recover and maintain an erection (all wistful thinking at this point in my healing) and may even provide a pleasure boost during sex. But that’s another post for another day.
Some parting thoughts on incontinence. Our bodies are wondrous. So much of what we need to happen to stay alive happens without our even thinking about it. From heartbeat to digestion, from breathing to collecting our waste, our bodies continuously grace us with life. And in those times when those processes get disrupted, we become keenly aware of how easily we take them for granted. How fragile our lives are—day in and day out. And how hard our bodies work—silent, unseen, and without seeking attention—just so that we can be.
It is humbling. It makes me appreciative of what I rarely notice happening—in me. It also invites me to embrace the awkwardness of being incontinent as one more facet of my humanity. There is no shame in it. Inconvenient? Yes. Annoying, at times? Sure. But no shame. Whether my (or your) incontinence lasts for four weeks, four months, or forever, to be cradled, however imperfectly, by our bodies is grace.
Of course, there is a much thicker conversation to be had here. Because bodies are fraught in multiple ways. Disease and injury, social conditions, environmental toxins, irresponsible behavior, and more, all impinge on our bodies’ capacities to do what bodies are designed to do. And good fortune, dumb luck, small choices, and practiced discipline, can support and enhance our bodies as well. Much could be said. But for today it enough to be clear that shame has no part in this equation. And that grace does.
Lastly, cancer is a hard-fought tutorial in the truth that we are embodied. I am not “exactly” my body. It is too little to say I “have” my body, as though it were external to me. And (in my view) it is too much to say I “am” my body, as though the limits of my body define me. It is more complicated than that. Again, a much thicker conversation to be had than in a closing couple of paragraphs. But worth opening, nonetheless.
The me that dreams, loves, hopes, hurts and so much more is inextricably—graciously—entangled with my body. My sense of self is shaped by my bodily capacities—and incapacities. The meaning I fashion for how I move through life is part of that embodied conversation. Cancer and incontinence now have a claim in my story. I can wish they did not. Or I can let them enrich the tale. Perhaps it is okay to affirm the first: I wish they had not come my way. But it is essential to affirm the second: now that they are here, let me weave them into the tapestry of who I am.
Even if they do not become central to my story (they will for some persons!—and one or both may yet lay claim to another chapter in the future of my story), it matters that I allow them to leaven the sense of self I carry. Because there is no way (at least not in this life) to be, without being embodied. And the me that I am, has to be embodied in my body, not someone else’s. And not a body that I hold in contempt.
My story—and your story—is always told by many voices. Cancer and incontinence each have a voice in mine now. But they are not me. So, as I sheepishly note the latest leak that comes alongside my healing, somewhere behind the eye roll and the sigh, there is this bedrock conviction: I am glad to be here, damp and all. And I am determined to be a force for good and a source of kindness in the world, even while I drip.
That’s my story. And, yes, it will change over time. But I intend to do all that I can to keep the gladness and the goodness and kindness front and center.
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David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” Support him in Writing into the Whirlwind at www.patreon.com/fullfrontalfaith.
