Cialis is not a treatment for incontinence after prostate surgery, but it may help with a related problem
Cialis (tadalafil) does not reduce urine leakage. It works on blood vessel function and is approved by the FDA for erectile dysfunction and lower urinary tract symptoms related to benign prostate enlargement—not for incontinence itself. However, some men find it useful after prostate surgery because it can improve erectile function while they are managing incontinence separately, and in some cases it may reduce urinary urgency or frequency, which are different from leakage.
The confusion arises because prostate surgery (radical prostatectomy for cancer, or TURP for benign enlargement) can cause both incontinence and erectile dysfunction. A man recovering from surgery might take Cialis to address one problem while treating incontinence through other means. Understanding what each medication actually does prevents wasted time on the wrong approach.
Key Takeaways
- Cialis does not treat incontinence and is not approved for that purpose, though it may reduce urgency or frequency in some men.
- Incontinence after prostate surgery usually improves on its own within weeks to months, and pelvic floor exercises are the first-line treatment.
- Medications that do target incontinence include anticholinergics (oxybutynin, tolterodine) and beta-3 agonists (mirabegron), which work differently than Cialis.
- Cialis may help with erectile dysfunction that occurs alongside incontinence, addressing a separate problem at the same time.
- Talking with your surgeon or urologist about which problem is most bothersome helps determine whether Cialis is part of your recovery plan.
How Cialis works and why it does not stop leakage
Cialis relaxes smooth muscle in blood vessels and in the bladder neck and prostate tissue. This improves blood flow for erections and can reduce the urge to urinate frequently or urgently. But incontinence—involuntary urine leakage—happens because the sphincter muscles that hold urine closed are weakened or damaged during surgery. Relaxing smooth muscle does not strengthen a damaged sphincter.
The FDA approved Cialis for lower urinary tract symptoms (LUTS) in men with benign prostate hyperplasia, which includes symptoms like urgency, frequency, and weak stream. Some men with post-surgical urgency may see improvement. But the clinical trials that led to that approval did not show that Cialis reduces incontinence itself. If leakage is your main problem, Cialis alone will not solve it.
What actually happens to continence after prostate surgery
Incontinence after prostate surgery is common in the first weeks and months because the external urinary sphincter—the muscle you consciously control—is stretched or bruised during the operation. Most men regain continence gradually as the sphincter recovers, though the timeline varies. Some regain it within weeks; others take three to six months or longer.
During this recovery period, pelvic floor muscle training (Kegel exercises) is the standard first step. These exercises strengthen the sphincter and surrounding muscles. A physical therapist specializing in pelvic floor dysfunction can teach proper technique, which matters—many men do Kegels incorrectly on their own. Studies show that structured pelvic floor training reduces incontinence more effectively than waiting alone or taking medications.
Medications that actually target incontinence
If pelvic floor exercises do not fully resolve incontinence, or if urgency is severe, your urologist may prescribe medications designed to address the problem. Anticholinergic medications like oxybutynin (Ditropan) or tolterodine (Detrol) calm an overactive bladder by blocking nerve signals that trigger contractions. Mirabegron (Myrbetriq), a beta-3 agonist, works through a different mechanism and may be an option if anticholinergics cause side effects.
These medications address urgency and frequency directly. They do not strengthen the sphincter the way pelvic floor exercises do, but they reduce the urge to urinate, which can help contain leakage when the sphincter is weak. Cialis does not work this way and is not used as a first-line treatment for incontinence.
When Cialis might be part of your recovery plan
Prostate surgery often causes erectile dysfunction alongside incontinence because both involve nerves and blood vessels in the same area. If your surgeon or urologist recommends Cialis, it is usually to address erectile dysfunction while you manage incontinence through pelvic floor exercises or other means. Cialis may also reduce urinary urgency in some men, which is a side benefit but not its primary purpose.
The decision to use Cialis depends on whether erectile dysfunction is a problem for you and whether you are willing to take a medication for that specific issue. It is not a substitute for treating incontinence directly. Your urologist can discuss whether Cialis makes sense in your situation based on your symptoms and how far along you are in recovery.
Timeline and what to expect during recovery
Most men see improvement in incontinence within the first three months after prostate surgery, especially if they do pelvic floor exercises consistently. By six months, many are continent or nearly continent. Some continue to improve up to a year or longer. Nighttime incontinence (nocturia or bed-wetting) often takes longer to resolve than daytime leakage.
During this time, your urologist will monitor your progress and adjust treatment if needed. If incontinence persists beyond six months or is severe enough to affect quality of life, other options exist—including pessaries, absorbent products, or in rare cases, surgical procedures like artificial sphincter implants. Cialis does not change this timeline or these options.
Questions to ask your surgeon or urologist
Before starting Cialis or any other medication after prostate surgery, clarify what problem it is meant to solve. Ask whether your incontinence is expected to improve on its own, what role pelvic floor exercises should play, and whether medication is needed now or later. If erectile dysfunction is also a concern, ask whether Cialis is the right choice or whether other options exist.
Also ask about side effects. Cialis can cause headache, muscle aches, indigestion, and flushing. If you are taking other medications, especially nitrates for heart conditions, Cialis may not be safe. Your urologist will review your full medication list before prescribing.
Frequently Asked Questions
Can I take Cialis while doing pelvic floor exercises?
Yes. Pelvic floor exercises are the main treatment for post-surgical incontinence, and Cialis does not interfere with them. If your urologist prescribes Cialis for erectile dysfunction, continue your exercises—they address different problems and work together.
Will Cialis make my incontinence worse?
Cialis does not typically worsen incontinence, though it can increase urinary frequency in some men as a side effect. If you notice increased leakage after starting Cialis, tell your urologist. It may be coincidental, or the dose may need adjustment.
How long should I wait before trying Cialis after surgery?
Most urologists recommend waiting at least four to six weeks after surgery before starting Cialis, to allow initial healing. Your surgeon will tell you when it is safe based on your specific procedure and recovery. Do not start any new medication without checking first.
What if pelvic floor exercises are not working?
If exercises alone do not resolve incontinence after several months, your urologist may add medication—but it would be an anticholinergic or mirabegron, not Cialis. A pelvic floor physical therapist can also assess whether you are doing the exercises correctly, since improper technique is common.
Is there a surgery to fix incontinence if Cialis and exercises do not help?
Yes, though surgery is rare and usually considered only after conservative treatments have been tried for at least a year. Options include an artificial urinary sphincter or a male sling procedure. Your urologist will discuss whether you are a candidate if incontinence persists long-term.