Ejaculating urine after a prostatectomy is common and, oftentimes, temporary. But that doesn’t mean you have to put your sex life on hold until your symptoms resolve.
Leaking urine during ejaculation is known as climax-associated incontinence or climacturia. It’s a common side effect of prostate removal surgery.
If you or a partner are experiencing climacturia, know that you’re not alone and that your symptoms are treatable. There are many techniques you can try at home to find relief.
You can also consult with a surgeon or another healthcare professional to learn more about long-term solutions.
There are several home remedies to help manage your symptoms.
Limit fluids before sex
Climacturia often happens alongside stress urinary incontinence (SUI). SUI refers to urine leakage caused by activities that put stress on your bladder, such as exercise or coughing.
As with SIU and other causes of overactive bladder (OAB), limiting fluids before some activities can be helpful if you’re experiencing climacturia.
If you’re planning to have sex, try to limit your fluid intake for a couple of hours beforehand. This may help prevent you from ejaculating urine or, at the very least, limit the amount of urine when you climax.
Go to the bathroom before sex
Emptying your bladder and bowels before sex can help prevent or reduce leakage.
Having stool in the rectum can prevent your bladder from emptying completely when you go to the bathroom. It can also put pressure on your bladder.
Wear a condom
A condom won’t prevent you from ejaculating urine, but it can “catch” some or all of the urine that may come out during sex.
Use a variable tension penile loop
A variable tension loop is an adjustable silicone loop that’s placed around the base of the penis before sexual activity to constrict the urethra and prevent incontinence.
To use a tension loop safely:
- Place it around the base of your penis once you’re fully erect.
- Adjust it so that it’s snug but not too tight or painful.
- Avoid wearing it for more than 30 minutes at a time.
- Loosen it or remove it if you experience pain, discomfort, numbness, or swelling.
You can buy variable tension loops online, in most sex toy shops, or through retailers that sell medical or incontinent devices. Choose one that’s adjustable and stretchy, easy to put on and remove, and made of soft, medical-grade silicone.
Try pelvic floor exercises
Pelvic floor exercises may help strengthen the muscles in your pelvic floor, potentially improving incontinence and sexual function.
There’s some evidence that pelvic floor exercises may improve climacturia following prostatectomy. Still, most studies have been small or focused on pelvic floor muscle training alongside other therapies, such as biofeedback or electrical stimulation.
Contact a urologist or other healthcare professional if you’re having trouble managing symptoms or if your symptoms are affecting your mental health or relationships.
Depending on your symptoms and medical history, your clinician may recommend surgery.
If at-home techniques are unsuccessful or your symptoms persist, there are surgical procedures that can help.
Your surgeon will make an incision in your perineum — the space between your scrotum and anus — to access your urethral bulb and wrap it with mesh-like tape.
The tape constricts the urethra and repositions it while also supporting the nearby muscles. This helps keep the urethra closed during sexual activity and other physical exertion.
Artificial urethral sphincter (AUS)
Your surgeon will make an incision in your scrotum, perineum, or abdomen to implant an AUS, an inflatable medical device that can help hold your urine inside.
The device is composed of three parts: an inflatable cuff that fits around your urethra, a balloon that sits under your abdominal muscles, and a pump that relaxes the cuff to move urine.
To urinate, you squeeze the pump, which moves urine from the cuff to the balloon. Once the cuff is empty, your urethra opens to allow the urine to exit your body. The cuff then reinflates on its own.
What’s the outlook for someone with climacturia after prostatectomy?
Climacturia is usually temporary. Symptoms are typically more severe the first 12 months after surgery and improve or resolve within 2-3 years.
Many people experiencing climacturia feel embarrassed and may avoid sex because of it. If your partner is experiencing climacturia, do what you can to reassure them of your support, affection, and interest.
- Encourage them to talk about it without forcing the conversation.
- Remind them that climacturia is common, and they are not alone.
- Work together on a plan to manage symptoms and make sex more comfortable.
- Find other ways to connect and be intimate, such as doing other things you enjoy together and showing affection with hand-holding, cuddling, and kissing.
- Suggest seeing a couples counselor or sex therapist together or individually if that’s more comfortable.
Is climacturia common after a prostatectomy?
Climacturia is common after a prostatectomy, but just how common is difficult to say. Many experts believe it’s underreported.
Some research estimates that it affects as many as 93% of people who’ve had a radical prostatectomy.
What causes climacturia after a prostatectomy?
The exact cause of climacturia after prostatectomy is unknown. Some experts believe it may be caused by damage to the nerves and tissues surrounding the prostate or the sphincter during surgery.
What happens to seminal fluid after a prostatectomy?
The prostate gland and seminal vesicles, which produce seminal fluid, are removed during a radical prostatectomy, so will no longer be able to ejaculate semen.
What’s the difference between climacturia and urinary incontinence?
Climacturia is a type of urinary incontinence. Urinary incontinence refers to unintentional or uncontrollable urine leakage. Climacturia specifically refers to involuntary urine leakage during ejaculation.
What’s the difference between climacturia and erectile dysfunction?
Erectile dysfunction is the inability to develop or maintain an erection hard enough to have penetrative sex. It has nothing to do with leaking urine, though the two sometimes happen together after prostatectomy.
Climacturia is common and usually temporary. Many people can manage the symptoms at home and find it beneficial to talk with a therapist. If your symptoms persist, surgical treatments may be an option.
Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.