A Few Drops Still Count
Dr Daniela Moise, DPT
Introduction
After a recent conversation with a urologist, I realized something important:
we are often speaking different languages when it comes to incontinence.
From a surgical perspective, patients may be told they are “doing well” as long as they are not leaking large amounts—sometimes described as “leaking a bucket.”
But from a pelvic floor perspective, any involuntary loss of urine—no matter how small—is still incontinence.
This difference in language matters, because it shapes what patients believe is normal… and what they believe can be improved.
What Happens After Prostate Surgery
During prostate surgery, part of the urinary control system is affected—especially the internal urethral sphincter, which plays a key role in maintaining continence at rest.
After surgery, the body relies more on:
- The external urethral sphincter
- The pelvic floor muscles
- The coordination between your breathing, core, and pressure system
This is not just healing.
This is adaptation and retraining of a system.
Why Even Small Leaks Matter
You may notice leakage when you:
- Cough or sneeze
- Stand up
- Walk or exercise
- Lift something
- Transition during daily movement
Many people are told this is “not real incontinence.”
But clinically, it tells us something important:
The system is not fully coordinated yet.
Even small leaks can lead to:
- Reduced confidence
- Avoidance of activity
- Compensation patterns (holding breath, gripping)
- Slower or incomplete recovery
The Body Is a System—Not Just a Muscle
At Advance Core Physical Therapy & Wellness, we don’t look at the pelvic floor in isolation.
The body is a pressure system.
When one part changes, the entire system must adapt.
After prostate surgery:
- Internal support is reduced
- The external system must take over
If that system is not trained properly—
symptoms remain, even if they seem small.
Why Pelvic Floor Therapy for Men Matters
Pelvic floor therapy is not just about doing Kegels.
It’s about:
- Timing (when muscles activate)
- Coordination (how the system works together)
- Pressure management (how you breathe and move)
With the right approach, patients can:
- Improve bladder control faster
- Reduce or eliminate leakage
- Return to activity with confidence
- Prevent long-term compensation patterns
When to Start Therapy
The best outcomes happen when therapy begins:
- Before surgery (preparation)
- Soon after surgery (guided recovery)
The earlier the system is retrained,
the better the long-term results.
Let’s Change the Conversation
Leaking after prostate surgery may be common—
but it is not something you have to accept as your new normal.
A few drops is not “fine.”
It’s a signal.
And it can be addressed.
Collaboration Matters
As we continue to align how we define and treat incontinence, there is a real opportunity for better collaboration between urology and pelvic floor therapy.
When we speak the same language, patients benefit most—recovering not just from surgery, but returning to full function and confidence.
At Advance Core Physical Therapy & Wellness, we believe pelvic floor therapy should be a natural extension of prostate surgery care—not an afterthought, but an essential part of recovery.
If You’re Experiencing Leakage—Even a Little
You’re not alone—and you don’t have to wait.
Advance Core Physical Therapy & Wellness – Chicago