DYSFUNCTION ISSUES and CHALLENGES
Once the catheter is removed, patients should expect their bladder, bowel and/or sexual function to be compromised. Most likely, bowel dysfunction will return to normal relatively quickly. Urinary tract and penile function, however, are typically among the most significant obstacles prostate cancer patients will face during their recovery. Most literature indicates it may take up to one year to gain full control of your bladder after surgery, while some patients may never fully recover.
The actual extraction of catheter is the easy part. Just breathe and relax.
Once the catheter is removed the real work starts. You will be instructed that you will need to ‘VOID’ your bladder within a 6-12 hour time frame. The voiding will indicate you are capable of passing urine after surgery. If you do not void, you are told they may need to re-insert the catheter.
QUESTION (multiple choice): What does it mean to VOID?
A. Standing at toilet and emitting a long or short stream of urine.
B. Laying sideways in bed and emitting a long or short stream of urine into a urine bottle.
C. Dribbling urine into 2-6 diapers within the first 6-12 hours.
ANSWER: All of the above.
Patient Insight: While it wasn't pretty, I opted for 'C’, as there was no way I was going to call my doc to report that I was having issues and needed to have the catheter re-inserted. Ask your medical provider for specifics on VOIDING!
According to the medical community: 'it is normal to have difficulty holding your urine after catheter removal. This is called urinary incontinence. Most patients use pads or adult diapers to control leaking urine, sometimes for up to one year'.
In reality, that definition simplifies the actual issues you will face in managing your pee after prostate cancer treatment and your lack of control will seem anything but normal. The prostate gland is in close proximity to multiple other organs (bladder, urinary gland, bowel tracks, localized nerves and muscles), so the trauma of both the treatment and catheter tube will absolutely result in some form of bladder dysfunction.
The level of dysfunction will vary greatly from one patient to another, ranging from:
1. No ability to urinate standing up or sitting
2. Dribbling of urine only into diapers
3. Able to urinate lying on back or sideways into a urine bottle
4. Short streams or squirts of urine on cue
5. Passing of gas (farting) while peeing.
No or limited bladder control will result in dribbling/squirting of urine when you move. Your ability to urinate will be improving when you are able to:
Dribble on cue
Squirt on cue
Produce a short stream on cue
The medical community offers these three phases, with the diaper remaining dry, as the sequence for INCONTINENCE REVERSAL:
After laying down
Expect bowel movements to be irregular in timing and consistency following treatment. It may take upwards of 4-6 days after surgery until your body is ready to have a bowel movement. Take stool softeners as directed to promote a rapid return to normalcy. The first and second bowel movements will most likely be hard as a rock, due to the anesthesia. The bowel movements from that point on will not be as hard. You may experience watery stool a few times, but this is nothing to worry about.
The inability to perform sexually is one of the most complex elements of the recovery process for most men. It not only impacts the patient in the most private arena of their personal life, it also deeply affects the relationship with another person. The physiology and psychology of the sex drive is already complicated enough without adding the dysfunction into the mix.
The literature covering the issue of sexual dysfunction presents a realistic picture of the multiple issues involved. The level of dysfunction and recovery will vary greatly from one patient to another: from full functionality to non-functionality. Dysfunction ranges from:
Inability to have children
No or minimal erection to full erection
Patient Insight: The what, when, and how for recovery is largely unpredictable; you will need to be patient. There are many resources in the medical community offering consultations and support to help you make decisions and process any sexual dysfunction.
WILL THE INABILITY TO HAVE AN ERECTION BE THE END OF A HEALTHY SEX LIFE?
NO!!! Sexual desire / feelings / emotions and capability of intimacy with a supportive partner will still be present. INCLUDING A CLIMAX??? The 'climax' does not go away (only difference- no semen comes out). Some men find the climax and sexual intimacy experience to be as intense, or possibly more intense than before the surgery. You nay find the Podcast: 'Mr. 80%', which covers sexual dysfunction helpful.
PAIN / NERVE REGENERATION
LOWER ABDOMEN / GENITALS
Most patients report minimal sensitivity in the surgical area for the first couple weeks, until the nerve endings start the regeneration process.
Patient Insight: It started as a feeling/sensation of something going on in my lower abdomen/genital area. Over the next few weeks the area became more sensitive and I experienced minor pain and discomfort. The regenerating nerve endings would throw in a few sharp jolts of pain every now and again to remind me it was doing its job.
STOMACH & STITCHES
For most patients there is no significant pain in the stomach or from the stitches. While the stomach muscles typically tighten up after surgery, they will gradually loosen over the next few weeks. Expect the stitches to be inflamed, and you may have a bloated stomach.
Patient Insight: To mitigate heat generated by the stitches you can use ice packs liberally throughout the process. Do not use lubricating ointment on the stitches, unless your medical provider recommends otherwise.
The Perineum area continued to be uncomfortable and painful, even after the catheter was removed. Any kind of sitting for the first three weeks was nearly impossible, but by the fourth week I could finally sit for an hour. I originally blamed the perineum discomfort on the catheter tube, however, once my nerve endings started to regenerate, I realized that the surgical removal of the prostate, plus some nerve damage, was the main source of the pain.
Patient Insight: I wanted to use my computer without sitting, so I used a large box to create a standing desk. Later on I purchased an actual computer stand.
Ongoing efforts to maintain good hygiene and the use of adult diapers/guards will be necessary to keep your living space clean and yourself healthy during recovery. Having rags/towels on hand at all times will be critical. Some additional hygiene tips:
Keep genitals clean and dry
Keep bedroom and bathroom floors clean by using mats and clothes/towels on floor
Keep bed clean with a mat and cover it with a towel, as the mat generates a lot of heat
Keep toilet and sink clean
Clean shower area as necessary
Use baby powder liberally
Use ointments when necessary
Change out rags and towels daily
DIAPERS OR ABSORBENT GUARDS
There are two options for protection from leakage. Diapers, are the best option for nighttime, while absorbent guards may be a better option during the day. The diapers generate a great deal of heat and humidity during the daytime.
Warning: the combination of leakage and a humid diaper can lead to yeast infection.
You will need to use brief underwear or a jockstrap to hold the guards in place.
Allow the genital area to dry, don’t wear either all the time in bed, allow the area to dry out!
Expect to use 6-9 diapers/guards per day during week one following the removal of the catheter.
DISCLAIMER: THE INFORMATION FOUND ON THIS WEBSITE IS NEITHER WRITTEN BY MEDICAL PRACTITIONERS, NOR DOES IT CLAIM TO BE QUALIFIED MEDICAL ADVICE. All content is written by fellow Cancer Patients that have gone through their own cancer recovery process. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.