Prostate cancer is the 2nd most common form of cancer in men (behind skin cancer, for those who are curious). One of the most common treatments is prostatectomy, which is the removal of part or all of the prostate gland. It is a common procedure, with hundreds of thousands of these surgeries occurring each year in the US.
There are a number of best practices for both preparing ahead of time and optimizing recovery after the surgery. This article is going to look at some best practices (in particular, Kegel exercise – which is recommended by urologists both before and after prostatectomy). Let’s start on the front side with preparations.
Pre-prostatectomy preparation tips
Your doctor will give you a full run-down of how to prepare, but if you are curious about what to expect, there are both short- and long-term considerations. First, some longer term concerns:
- Pelvic floor exercises (Kegels): many doctors recommend Kegels before the beginning of prostate cancer treatment, so that you can strengthen the pelvic floor muscles ahead of time and have the strongest possible foundation in place before treatment, which can weaken the pelvic floor and thus cause issues with bladder control and/or sexual dysfunction.
- Tell your doctors about any medications you take: this includes both prescription and also over-the-counter (OTC) medicines, even including supplements / vitamins. It’s especially important if you take blood-thinners, but OTC painkillers like Advil, Motrin, Aleve and other medications can also matter. Your doctor may have you change your normal routine to reduce risk of bleeding during and after the surgery.
As you approach the day of the surgery, late-stage considerations may include:
- Fasting: your doctor may ask you to avoid eating and drinking (other than water, since you do want to stay hydrated) on the day of the procedure and perhaps part of the day before.
- Bowel / waste preparation: the doctor may also ask you to empty out your bowels ahead of time that day, perhaps using an enema kit.
The recovery trajectory for prostatectomy can vary considerably depending on your procedure – for instance, whether you had open vs. minimally invasive / laparoscopic surgery, or whether you had radical prostatectomy (full removal of the prostate) vs. simple prostatectomy (partial removal). With that said, there are still a few recommendations that pretty much always hold. The surgery usually involves an overnight stay at the hospital but often you’ll be able to return home the next day (generally with a catheter still in place, which often remains for 7-10 days).
Once you get home, there are a number of things to keep in mind that can help keep you moving along the road to recovery at top speed:
- Listen to your doctor: this is the golden rule; your doctor will be the most knowledgeable about your individual situation and what’s best for you.
- Ramp up your activity gradually (but do be active): as with any surgery, take it easy and don’t push yourself too hard, especially at the beginning. It often takes up to 2 weeks to resume normal activities and a month to return to full activity levels. But with that said, it’s not good to be totally sedentary, either – trying to make sure you walk around a little bit at least five times per day is a good target even early on.
- Stay on top of bowel function: you’ll be at particularly high risk of constipation following surgery for a variety of reasons (for instance, anesthesia and post-surgery pain meds, and reduced activity levels). Make sure you hydrate regularly and eat lots of fiber, fruits and veggies. Overall you’ll definitely want to avoid having to strain when pooping.
- It can take a while for sexual function to return to normal. Especially if you had a radical prostatectomy (full removal of the prostate, as opposed to partial removal), it can take upwards of a year for some men to get back to normal erectile function. Talk to your doctor about how to minimize the impact (pelvic floor exercises may be able to help, and of course there are pharmaceutical options like Viagra for ED). But don’t get discouraged; erectile and sexual function more broadly does usually return, even if it takes a while.
- Expect bladder control challenges: urinary incontinence is extremely common following prostatectomy. It often resolves within 3 months, but it can take longer in some cases. Absorbent pads can be helpful in managing leakage symptoms while you work on addressing the underlying causes.
- Pelvic floor exercises (Kegels): speaking of addressing the underlying causes, the previous bullet leads straight into this one… one of the main reasons that incontinence often follows prostatectomy is that the surgery can damage your pelvic floor (which consists of muscles, ligaments and other tissues that play a large role in controlling urination). And this goes double for open surgery (as opposed to laparoscopic or minimally invasive procedures). But the good news is that this means that a consistent Kegel exercise regimen can strengthen your pelvic floor and speed the return of your bladder control / continence. One important note: don’t do Kegels if you still have a catheter in.
Pelvic floor exercise (Kegels)
You may have noticed that pelvic floor, or Kegel, exercise was the one thing that came up as both part of pre-prostatectomy preparation and post-prostatectomy recovery.
If you haven’t already, you’ll almost certainly hear about them from your urologist as part of the prostatectomy process. There’s a whole article about Kegels for men that you can check out here if you want more details. Long story short, though, pelvic floor muscle strengthening is well-established to have beneficial effects for both urinary incontinence and sexual function after prostatectomy.
But one of the things that sometimes gets lost about Kegels is that, like any other type of exercise, they can only help if you actually do them consistently. And that is particularly challenging for Kegels because the pelvic floor is essentially invisible, and because doing Kegels is actually quite boring. That’s why a Kegel trainer for men, like the kGoal Boost, can help: it provides biofeedback (to help you know whether you’re doing the exercises correctly), exercise history data (to quantify and track your progress) and guided workouts / games (to help you get a balanced workout that isn’t boring). And, in contrast to many of the other options, Boost does not use a rectal/anal probe to measure your pelvic floor muscle activity – you just place it on a chair and sit on top like a bicycle seat, with clothes left on. Easy!
The Bottom Line
Prostatectomy is a common procedure and outcomes are generally quite good, especially as more and more surgeries move from open to minimally invasive. But there is still room for the actions taken by the patient to have a significant impact on how smoothly the recovery period goes. Talk to your doctor, be patient and do your best to stay on top of the right exercise, diet and activity regimens after surgery (including Kegels) and you’ll be putting yourself on the road to an optimal recovery.