All procedures involving the prostate have the same side effects – some degree of incontinence and erectile dysfunction. The symptoms and recovery vary greatly as the procedures vary – whether you have some kind of surgery as I did or you have surgery with chemotherapy and/or radiotherapy, radioactive beads, confocal radiography, ultrasound or hormonal therapy. But how long will it take you to recover?
The health professionals are right – everybody is different! So in fact it’s impossible to give anyone an accurate timetable for recovery. Your medical team will be very positive, supportive and encouraging which is their job. But the reality of recovery is often something else entirely.
Oh yes and of course you may be advised that “if you don’t use it you lose it”. So it’s important to keep going with the pelvic floor exercises and enjoying what sex life you can. Even “going solo” if necessary.
What to expect
Before my operation an acquaintance told me that it took her two years to recover from a gallbladder operation. I “knew” that was impossible. But actually she was right.
My medical team’s reticence in giving me a timetable for recovery of any kind was simply a convenient means of shunning the reality of the recovery period. When I started to get disappointed with my recovery I researched the subject. I found that a two year recovery period is generally accepted as the reality.
So indeed everyone is different and the recovery periods are also different, but on average here is what you can expect after prostate surgery.
Catheters and socks
The first week or two are pretty miserable. Having a catheter fitted isn’t much fun. Putting on anti-thrombosis socks every night, having to sleep on your back and having bandages and wounds all over your stomach aren’t much fun either. Pain isn’t usually a major feature although I did take painkillers for about three or four days afterwards.
The main sensation you’ll feel will be an overwhelming sense of absolute exhaustion. You won’t be able to concentrate. Or even stay awake for more than an hour at a time.
The best response to this is not to fight it. Simply sleep it off whenever your body tells you to.
Be very careful when you’re walking around, going up and down stairs and getting out of bed. You may find that episodes of dizziness and unsteadiness come on suddenly without warning. You might even find yourself falling over because of them.
This is when you really notice the benefit if you’ve been doing the exercises I recommend to improve your stability, agility and balance. If you don’t know or haven’t already seen what I’m talking about, have a look here.
Go out for a gentle walk if you’re up to it – even if it’s only to the end of the block and back. But make sure you take someone with you. Get them to bring a small fold up chair or stool in case you suddenly need to sit down and take a rest.
Out with the catheter, off with the socks
In about the 2nd week your catheter is removed. Then soon afterwards the bandages and stitches. Hooray!
But – nothing in your pelvic floor area will be working properly. The nerves in this area have been traumatised and are confused about what they should be doing.
This is demonstrated by major incontinence, constipation and even intermittent swelling of your penis. It may seem as though it’s trying to have an erection. But it can’t quite manage it.
Apart from confusion in your pelvic floor area, you’ll be feeling better every day. Keep going with the pelvic floor exercises and encouraging erections as much as possible.
Keep up the light exercise – maybe going up and down stairs slowly and carefully – and increase the length of your walks. Remember always to have someone with you just in case you have to sit down and rest suddenly or you feel unsteady.
Getting back to work
I was told that I’d be fit for work three to four weeks after my surgery. Just to be sure I decided to take six weeks off. But frankly I wasn’t fit for work even after six weeks.
Of course it depends on what sort of job you have and what demands it places on you.
If your job involves standing and walking around a lot, what little strength you have in your pelvic floor area will be severely challenged. If you have a desk job this isn’t so much of a problem.
But having to leave long meetings or protracted proceedings such as court cases regularly to change incontinence pads as I did, may not always be possible.
So depending on the kind of work you do, you may well not be fit to go back for eight to ten weeks.
In other words, by all means go back to work, but try to arrange to do only light duties initially and preferably only part-time.
If you have a demanding job, make sure that you can take rest periods of at least half an hour during the day and that there’s somewhere you can put your head down and have a little snooze.
Periods of exhaustion seem to occur in the afternoon. So ideally try to work in your workplace only in the mornings and if possible take work home in the afternoons. Then you can be flexible and do it when you’re fully awake and concentration levels are high.
When you are in your workplace it can be really helpful if you’ve got an understanding colleague or secretary who can field calls, customers and clients and bring you the occasional drink or snack.
Getting back to the gym!
Depending on your medical team’s advice, you can start going back to the gym after about six weeks. But initially only for light exercise! Start to get yourself going, start to get your balance, stability and agility back. Begin slowly with the lowest settings on the machines and slowly increase them with time as you feel comfortable and able to do so. The same applies to exercise you do outside the gym. The important thing is to be very patient with yourself and not to overdo it too soon.
Keep drinking lots of water
While you’re recovering from surgery you might feel tempted to drink less water because the more water you drink the more incontinent you appear to be. Whatever you do please don’t be tempted to drink less water. You really must keep drinking lots of water. If you don’t drink much water you’re laying yourself open to developing a urinary tract infection. And that’s the last thing you want. It’s sure to knock your recovery back by weeks.
Getting back to normal (a bit)
By three months, life is starting to return to normal. Incontinence, erectile dysfunction, and periods of tiredness (much less than before) still affect your life. You can usually manage a full day’s work, but your life is ruled by the availability of the nearest bathroom. Your muscular control has improved everywhere. Your stamina and strength have increased. And usually your ability to control what’s happening in the pelvic floor area will also be much better. With all these improvements you’ll also gradually start to feel better psychologically. But there’s still a long journey ahead.
The healing process
There’s a misconception about the healing process. If you’re starting to feel better by three months you’ll naturally expect that by four months you’ll be feeling even better. And by five months even better still etc etc. Actually it doesn’t work that way.
As the graph here shows, healing isn’t a straightline process as people expect – the blue line. You’ll have good and bad patches – see the red line.
(Blue line = expected recovery, Red line = actual recovery)
Whatever you do, be patient with yourself and accept that the downs are part of the normal healing process.
And keep going.
During the recovery period catching a cold/flu (which often makes you feel weak and tired anyway) and of course if you get a cough with it………. disastrous! Not only do you feel a bit depressed by being unwell, but the disappointment of your recovery spiralling downhill is demoralising to say the very least. But this is all natural and part of the healing process. The name of the game is accepting the ups and downs and appreciating most ‘ups’ are higher ‘ups’ than the previous ones, and most ‘downs’ are not down quite as bad as the previous ‘downs’.
And so the months wear wearily on! I found during this period that I could work at virtually full steam ahead with the odd tired patch along the way for about three weeks. Then I benefited from taking a few days off just to rest and relax. Each month really does get better even though sometimes you may feel that it isn’t so.
But there’s a different kind of progress. In the first few weeks life is dominated by waterproof underwear and pads. Then large waterproof pads only. Then thin pads.
And finally (in my case it was months 15 to 17) you start to feel that you don’t actually need any pads at all! Well, you occasionally have an accident so maybe you do, but then maybe you’re okay, but then, but maybe……….. it’s so difficult to decide to take that final step.
It’s all a matter of confidence and what you’re doing! If I was having a quiet day at home, doing very little physical activity, I would try going without a pad. But then if I was running around and having a busy day with lots of physical activity, I’d put in a pad. At this stage it’s a matter of confidence and control. As I had more dry days I became more confident. But also as I had more confidence I had more dry days!
By about 17 months I was actually dry. Well, depending on physical activity and how tired I was. I did have the odd “dribbly day”.
Unfortunately there are no really thin pads for men so I took to going to the women’s section in the pharmacy or supermarket. I bought the largest thin pads available, and cut them in half. More as a safety net for the odd dribble that might occur.
And finally I was decided I was dry! No pads! Nothing! (Although I still kept one or two pads in my jacket pocket just in case, but in fact I never used them.)
But something else started to happen. As I was no longer peeing all over the place, sexual activity started to improve. As I started to develop more confidence about controlling my bodily functions, so I became more confident. My reactions to stimulae became more focused, my erectile dysfunction started to fade (but more of this in the erectile dysfunction section).
And what about now?
Well it did take about two years to get back to normal so that acquaintance was right. And all the resources available from various prostate support groups and the Macmillan Cancer Nurses Organisation in the UK agree with her. But I do have a residual weakness. Occasionally, if I get up from my desk suddenly or I quickly stretch across the desk to answer the phone, or I have a sudden unexpected sneeze or cough, then guess what? Just a drop or two. Only enough to make my underwear slightly damp. A bit annoying it has to be said, but that’s it.
But even now there are times when I do consider using a pad. A night of heavy drinking is a time to consider wearing a pad. Alcohol is a muscle relaxant and it makes those critical muscles relax. It can lead to leaking.
So at the end of the week, when you’re physically tired and starting to relax, adding alcohol can be a recipe for a bit of incontinence. So is a bad bout of flu – especially if it involves coughing and sneezing.
So do I still use a pad?
Even though I’ve got one handy for emergencies? No! It’s usually only a little dribble and my male bravado wouldn’t allow me to even consider putting in a pad. That would be admitting defeat, even if only to myself. But shhhh….. don’t tell anyone…….. I have been known occasionally to excuse myself and go off to the toilet to fold up a few sheets of toilet paper to stuff into my underwear if I feel that I need to.