After prostate cancer surgery, you’ll have a catheter in place for one or two weeks to drain urine while your bladder heals from the procedure. This requires some care, cleaning, and management on your part. By working with your cancer care team, slowly increasing your activity level, staying on top of catheter maintenance, and managing side effects, you can empower yourself to navigate recovery as smoothly as possible.
1. Master Your Catheter Care
Getting used to a catheter is a large part of adjusting to postsurgical life at home. “I think the most jarring thing for most patients after a prostatectomy is using a Foley catheter,” says Jamie Petrancosta, a physician assistant at Memorial Sloan Kettering Cancer Center in New York City. “Most patients require the catheter for about seven days, and before surgery, most don’t have experience with them, so it’s definitely an adjustment period.”
To avoid infection, Petrancosta recommends regular cleaning. This involves washing the penis and whole catheter tube. Start at the tip of the penis and wipe downward to the area around the anus. This helps prevent the spread of germs and infection. “Clean the area at least once a day, as well as washing the drainage bags daily,” Petrancosta says. “A regular, plain, unscented soap like Dove soap is fine to avoid irritation. Always wash your hands before handling the area, and ensure the area is fully dry afterward.”
Make sure that the bag is below the bladder or hip level at all times and avoid lying flat with it on. This can lead to urine backflow, which can cause a bladder infection.
To prevent the tubing from pulling, Petrancosta recommends using catheter tape to attach the tube to your leg. Different bags are available for use at different times. “You’ll usually get two bags,” she says, “a smaller one for the day and a larger overnight bag so you don’t have to wake up as often to empty it.”
Some people experience irritation while using a catheter. “We sometimes provide lubrication gel for the tip of the penis to help with irritation,” Petrancosta says. “Don’t be alarmed to see a little bit of blood in the urine right after surgery. It’s normal.”
- Urine leaking around the catheter
- A sudden or complete drop in urine output
- A lot of blood or bright red blood with clots in the urine
- New onset of pain in the pelvic area or abdomen
2. Prioritize Pelvic Floor Exercises (Kegels)
“When we think of the pelvic floor, we typically think of women. But guess what? Men also have a pelvic floor, and it plays a very important role in both erectile function and urinary continence,” says Justin Dubin, MD, a urologist and the director of men’s sexual health at Miami Cancer Institute in Florida.
Performing a Kegel correctly involves isolating the right muscles, according to Sandip M. Prasad, MD, the surgical director of genitourinary oncology at Atlantic Health in New Jersey. “Imagine that you are holding in a bowel movement or squeezing a finger performing a prostate exam,” he says. Dr. Prasad emphasizes breathing normally and lifting the muscle up, rather than pushing it down, without tightening your abdomen, thighs, or buttocks. He also notes that starting pelvic floor strengthening exercises like Kegels before a planned prostatectomy can help shorten the time of urinary incontinence after the operation.
Just make sure not to do Kegels until your Foley catheter is removed, Petrancosta says.
She recommends the following steps once your doctor clears you to start practicing Kegels:
- Start by holding your pelvic floor muscles for about 5 seconds without holding your breath.
- Relax for 5 seconds.
- Do this at least 10 times in a row, three times a day.
Make sure that you aren’t using your legs or stomach; only use the pelvic floor muscles. You can slowly build up to 10-second holds.
If you’re struggling with continence, both Dr. Dubin and Prasad emphasize the value of seeing a specialist. “The best way to learn and perform Kegel exercises optimally is for men to engage a pelvic floor physical therapist to guide and optimize their technique,” says Prasad.
Dubin echoes this advice, adding, “Pelvic floor physical therapists are one of the most underused providers in the men’s health space and are incredibly valuable in helping men restore their quality of life after prostate cancer surgery.”
3. Walk a Little More Each Day
“The best thing you can do is get moving,” Dubin says. “Early walking after surgery, even in the hospital, is helpful to prevent clots, get your bowels moving, and improve your postoperative recovery.”
Petrancosta advises trying to walk every hour or two, even if it’s just a lap around the block. “The eventual goal is to build up to a couple of miles per day,” she says.
Prasad says that there are no limitations on walking, and he encourages patients to get up and move immediately after surgery to prevent the risk of blood clots and pneumonia.
While increased movement can support recovery, avoid heavy lifting. “During this time, it is very important that you limit all heavy lifting greater than 10 pounds and avoid straining yourself or doing any other strenuous activity,” Dubin says.
Prasad asks patients to avoid all nonwalking exercise and sports for four weeks to reduce the risk of a hernia. He also recommends that people pace themselves. “Patients should remember that they feel better than they are,” he says. “The body requires time for continued healing even after pain dissipates.”
Dubin says that most people should be able to return to all normal activities by the six-week mark. “However, it’s important to remember that everyone’s recovery period is different and everyone heals differently,” he says. Always talk with your urologist before increasing your activity level.
4. Adjust Your Lifestyle (and Consider Stool Softeners) to Prevent Constipation
“A diet that provides enough high-fiber foods like whole grains and fruits and vegetables with the peels on can help,” Petrancosta says. “And don’t forget to drink enough water. Staying hydrated is vital to help move stools along.”
But rather than focusing solely on diet, Petrancosta advises adopting a bowel-healthy lifestyle to prevent constipation. “There isn’t one specific food, but walking is essential as it reduces constipation, and people often overlook it,” she says. “We also suggest stool softeners such as Colace or laxatives such as Miralax or Senokot.”
5. Address Erectile Dysfunction Proactively
However, the rates vary widely, and Petrancosta says that being proactive can make a significant difference. “We start penile rehab right away,” she says. “Every patient follows a regimen using a low daily dose of medication like sildenafil or tadalafil, with a higher challenge dose before sexual activity.”
Petrancosta advises taking the medication on an empty stomach about 30 to 60 minutes before sexual activity. “This regimen usually lasts at least 12 months, because function doesn’t return overnight,” she says. Around 75 in 100 men who take these medications after a nerve-sparing prostatectomy report successfully getting an erection after using them.
Ask your healthcare provider about these other options to help you achieve an erection after a prostatectomy:
- Injectable Medications These are medications injected directly into the penis, most commonly a class of drugs called prostaglandins.
- Vacuum-Assisted Mechanical Devices These create an erection using a vacuum seal that draws blood into the penis and a rubber ring around the base of the penis to prevent blood from leaving.
- Penile implants A person may request surgery to implant a three-part device that supports erections. It involves a thin, flexible tube that runs along the length of the penis; a small, fluid-filled structure like a balloon that a surgeon fixes to the wall of the abdomen; and a button on the testicles. To achieve an erection, you push the button, which releases fluid from the abdominal structure into the tube, which becomes erect as it fills with fluid.
If you have a partner, you should try to have sex regularly. “Ideally, we say at least once a week, though some prefer two or three times,” Petrancosta says. “Trying at least once a week helps us gauge if your sexual function is improving over time.”
However, if changes in sexual function start affecting your quality of life, you may benefit from escalating it to a provider. “Specialists are available, including psychologists who focus specifically on sexual function in relation to cancer and surgery,” Petrancosta says, adding that at Memorial Sloan Kettering, there are “physicians focused solely on sexual rehabilitation and others dedicated to urinary function and incontinence.”
6. Manage Stress and Monitor Your Mental Health
If postsurgical stress or stress related to a cancer diagnosis starts to affect your daily life, it’s time to seek professional emotional help. Psychological treatment and relationship support are also important parts of managing erectile dysfunction, so don’t be afraid to ask for help.
Outside of your hospital network, other avenues for help are available. “The American Cancer Society, the Cancer Support Community, and Livestrong Fertility all offer valuable resources around mental health and prostate cancer recovery,” Petrancosta says.
7. Know When to Call the Doctor
Recovery takes some adjusting to, but there’s a stark difference between normal healing pain and a complication. “A lot of these issues are subjective, but when in doubt, reach out. We would much rather get your call and provide you with reassurance than not get a call when you need more immediate care,” Dubin says.
Prasad outlines several warning signs to watch for:
- Fever
- Worsening abdominal pain
- Nausea or vomiting
- Redness or drainage from a surgical cut
- Issues with a catheter not draining
- The presence of large blood clots
Experts advise calling your doctor or visiting an emergency room immediately if you experience any of the following symptoms:
- Signs of Infection “Any time you have a fever or chills, or see pus coming out of an incision, you should call your doctor or consider going to the emergency room,” Dubin says.
- Catheter Issues While seeing a small amount of blood after a catheter insertion can be normal, signs like urine leakage around the catheter can signal something’s off. “Other red flags include a sudden decline in urine output or no urine at all, noticing much more blood or bright red blood with clots, or experiencing new onset of pain in the pelvic area or abdomen,” Petrancosta says.
- Signs of a Blood Clot Shortness of breath or swelling, pain, or redness in one leg require immediate medical attention.
The Takeaway
- Following prostate cancer surgery, focus on gentle recovery by walking frequently and adopting a high-fiber diet with stool softeners to manage postoperative constipation.
- Be sure to clean the catheter and change the bag regularly. After the removal of a catheter, you can perform daily pelvic floor exercises (Kegels) to help speed up the recovery of bladder control and sexual function.
- While most people regain sexual function within one to two years, starting a proactive penile rehab regimen with guidance from your doctor can help you navigate these changes.
- Seek immediate medical attention if you experience red flags such as a fever over 101 degrees F, a sudden stop in urine output, or signs of a blood clot like shortness of breath or leg swelling.
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