After TURP Surgery: Why Urinary Leaks Happen and How PFPT Can Help

Urinary leaking after surgery is something many men don’t expect, and even fewer feel comfortable talking about. But after a transurethral resection of the prostate (TURP)—a ca common procedure for treating enlarged prostate—changes in bladder control can happen. The good news is that for most men, leaking improves over time, and pelvic floor physical therapy (PFPT) can help speed recovery. 

Even though TURP removes the part of the prostate causing blockage, the way the bladder and sphincter muscles behave afterward can change. Research shows that the biggest cause of urinary leaking after TURP is detrusor instability, also called detrusor overactivity. The detrusor is the muscle of the bladder wall that squeezes when you urinate. 

Two major studies found that: 

• 54% of men who have urinary problems after TURP show detrusor instability on urodynamic testing. 

• Among men whose main complaint is urine leakage, 75% have detrusor instability, while only 20% have sphincter weakness. 

This means that most leaking after TURP is not because the sphincter was damaged. Instead, the bladder muscle becomes overly active, squeezing when it shouldn’t. 

If you have detrusor overactivity, you may notice: 

• Sudden urges to urinate 

• Leaking before you make it to the bathroom 

• Frequent trips to the toilet 

• A feeling that the bladder “jumps” or “spasms” 

These symptoms are called urgency urinary incontinence, which is the most common type after TURP. 

Although detrusor overactivity is the main cause, other bladder and sphincter issues also play a role. 

1. Sphincteric Insufficiency:  

This means the urinary sphincter doesn’t fully close. It is less common than detrusor problems but still important.  Reaseach shows that around 20% of men with post-TURP leakage have sphincteric insufficiency. 

2. Poor Bladder Compliance 

Some bladders do not stretch well or become stiff over time. Men who already had poor bladder compliance before TURP have higher rates of postoperative leaking and worse urinary symptoms. 

3. Nerve and Muscle Changes 

If the bladder has been overactive for years due to prostate obstruction, it may take time to “retrain” itself after surgery. The bladder muscle and nerves do not always recover right away. 

Leaking is fairly common early on, but it improves for most men. 

• At 3 months, about 38% of men report some level of incontinence. 

• By 6–12 months, this drops to around 12%. 

• At 12 months, about 10% still have leakage, and only 4% have leaking severe enough to need pads regularly. 

Urodynamic studies show that 86% of men with post-TURP urinary problems have at least one abnormal finding. But incontinence caused by bladder dysfunction alone is rare—only about 3% of cases. 

Even though leaking after TURP is often due to detrusor overactivity, pelvic floor physical therapy can still help in important ways. Physical therapy strengthens the pelvic floor muscles, improves sphincter control, and helps retrain the bladder.  Pelvic floor muscles help keep the urethra closed during activity. Even when the bladder is overactive, stronger pelvic floor muscles can help stop leaks. 

Studies show that after just 4 weeks of pelvic floor exercises: 

• Muscle strength improves significantly (from a grade of 2.8 to 3.8). 

• Men have fewer leaking episodes and less post-urination dribbling. 

These gains often appear quickly—especially within the first month after surgery. 

Pelvic floor therapy also supports overall bladder function. Research shows that men who perform PFPT: 

• Improve their urine flow rate (16.41 mL/sec vs. 12.41 mL/sec at 12 weeks) 

• Experience larger reductions in urinary symptom scores 

• Report better quality of life (from a score of 5.5 to 1.5) 

This means therapy helps more than just leakage—it improves overall urinary health. 

Studies consistently show that the earlier PFPT begins, the better the outcomes. The most effective programs begin immediately after the catheter is removed or within the first week after surgery. Men who start early experience less leaking and fewer dribbling episodes and better bladder control overall. 

Large trials show supervised PFPT is more effective than doing exercises alone. Unsupervised exercises often work no better than doing nothing.  This is likely because many men don’t activate the pelvic floor muscles correctly without guidance.  A 2025 systematic review confirmed that structured, therapist-guided programs with confirmed muscle activation lead to better continence outcomes. 

RUSI is a tool physical therapists use to show real-time images of pelvic floor muscles during contraction. This helps men learn to contract the right muscles and avoid substituting with the glutes, abdominals, or thighs. 

Studies show: 

• Ultrasound visual feedback is more effective than verbal or tactile instruction for teaching correct pelvic floor contractions. 

• Men who can improve the shortening of the urethral sphincter on ultrasound are much more likely to regain continence earlier. 

• The degree of leaking at baseline predicts how fast men recover, and RUSI helps therapists tailor the program based on each man’s starting point. 

Urinary leaking after TURP is common, especially in the first few months. Most cases are caused by detrusor instability, not sphincter damage. Fortunately, the majority of men improve within a year. 

Pelvic floor physical therapy—with early start, supervised sessions, and tools like ultrasound—can help men recover bladder control faster and improve daily comfort and confidence. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.