Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 16 July 2026
Urinary incontinence in men is more common than most people realise, yet it remains under-discussed due to embarrassment. Whether related to prostate surgery, an overactive bladder, or an enlarged prostate, effective treatments exist for almost every type and severity of male incontinence. This guide explains the causes, how incontinence is assessed, and the full range of treatment options.
Types of Male Urinary Incontinence
Stress Incontinence
Stress incontinence is leakage of urine with physical exertion — coughing, sneezing, lifting or exercise — caused by weakness of the muscles supporting the urethra. In men, this is most commonly a consequence of prostate surgery (particularly radical prostatectomy), which can affect the external urinary sphincter.
Urge Incontinence (Overactive Bladder)
Urge incontinence is a sudden, strong need to urinate followed by involuntary leakage, often related to an overactive bladder muscle. This can occur independently or alongside bladder outlet obstruction from an enlarged prostate.
Overflow Incontinence
Overflow incontinence occurs when the bladder does not empty properly and becomes overdistended, leading to frequent dribbling. This is commonly related to bladder outlet obstruction from BPH or, less commonly, neurological conditions affecting bladder function.
Causes
- Prostate surgery — radical prostatectomy for cancer, or occasionally HoLEP/TURP for BPH
- Overactive bladder — often idiopathic, but can be exacerbated by caffeine, alcohol or excess fluid intake
- Benign prostatic hyperplasia (BPH) — chronic obstruction can lead to overflow symptoms
- Neurological conditions — including Parkinson's disease, stroke, or spinal cord injury
- Urethral stricture — narrowing of the urethra affecting normal voiding
Assessment
Assessment begins with a detailed history and a bladder diary to characterise the type and severity of leakage. A physical examination, urine test, and often urodynamic testing (which measures bladder pressure and function during filling and voiding) help confirm the type of incontinence and guide treatment. Cystoscopy may be used to exclude structural causes such as urethral stricture.
Treatment Options
Pelvic Floor Physiotherapy
For most men with mild to moderate stress incontinence — especially in the first 12 months after prostate surgery — pelvic floor physiotherapy is the appropriate first step. A specialist physiotherapist teaches targeted exercises to strengthen the muscles supporting the urethra, and outcomes are best when exercises begin before or immediately after surgery.
Lifestyle and Behavioural Measures
Reducing caffeine and alcohol intake, timed voiding, fluid management, and weight loss (where relevant) can meaningfully improve both stress and urge incontinence.
Medications
For urge incontinence, medications that relax the bladder muscle (antimuscarinics or beta-3 agonists) can reduce urgency and leakage episodes. These are not effective for pure stress incontinence.
Male Sling
For men with mild to moderate stress incontinence that persists beyond 12 months despite physiotherapy, a male sling is an effective option. This is a supportive mesh tape placed under the urethra via a small perineal incision, repositioning and compressing the urethra to improve continence. It is a day-case or overnight procedure with a relatively quick recovery.
Artificial Urinary Sphincter
For moderate to severe stress incontinence, particularly after radiation therapy or in men who have not responded to a sling, an artificial urinary sphincter (AUS) remains the gold-standard treatment. This implantable device consists of an inflatable cuff around the urethra, a pressure-regulating balloon, and a pump placed in the scrotum, allowing the patient to control voiding by deflating the cuff when needed. Long-term continence rates with AUS are excellent, with high patient satisfaction.
Comparing Surgical Options
| Factor | Male Sling | Artificial Urinary Sphincter |
|---|---|---|
| Best For | Mild–moderate stress incontinence | Moderate–severe stress incontinence |
| Mechanism | Passive urethral support/compression | Active, patient-controlled cuff |
| After Radiation | Less effective | Preferred option |
Dr Dias' Approach
Dr Brendan Dias offers a full assessment and treatment pathway for male urinary incontinence, including coordination with pelvic floor physiotherapists and, when required, surgical management with male sling or artificial urinary sphincter surgery. Treatment is tailored to the type and severity of incontinence and the individual's goals.
Frequently Asked Questions
Is male urinary incontinence common?
Yes. Male urinary incontinence is most commonly seen after prostate surgery (particularly radical prostatectomy) but can also occur with an overactive bladder, neurological conditions, or an enlarged prostate. It is under-reported because many men are reluctant to discuss it.
How long does incontinence last after prostate surgery?
Most men regain continence progressively over 3–6 months after robotic radical prostatectomy, with continued gradual improvement for up to 12 months. Pelvic floor exercises started early significantly speed recovery for most men.
What is a male sling?
A male sling is a surgical mesh device placed under the urethra to provide support and compression, used for mild to moderate stress incontinence, most commonly after prostate surgery, in men who have not responded to pelvic floor physiotherapy.
What is an artificial urinary sphincter?
An artificial urinary sphincter (AUS) is a implantable device with a cuff around the urethra, a pressure-regulating balloon, and a scrotal pump, used for moderate to severe stress incontinence. It remains the gold-standard surgical treatment for significant post-prostatectomy incontinence.
Can incontinence be treated without surgery?
Yes. Pelvic floor physiotherapy is the first-line treatment for most men and can significantly improve or resolve mild incontinence. Lifestyle changes (fluid timing, reducing caffeine and alcohol) and, for urge incontinence, medications can also help.
Does Dr Dias treat urinary incontinence in Melbourne?
Yes. Dr Brendan Dias assesses and treats male urinary incontinence in Melbourne, including coordinating pelvic floor physiotherapy and performing surgical options such as male sling and artificial urinary sphincter surgery for men who need it.
The Bottom Line
Male urinary incontinence is a treatable condition, not something to simply live with. Most men improve significantly with pelvic floor physiotherapy alone, and for those who don't, effective surgical options such as the male sling and artificial urinary sphincter offer excellent long-term results. Speaking to a urologist is the first step toward regaining confidence and quality of life.