7 March 2020: It’s only nine days since radical prostatectomy and my basic physical and mental functions are coming back. I am down to one strong painkiller per night. Yesterday my wife and I walked our normal 3 kilometre morning walk around our neighbourhood at almost normal speed. Urine control is better than 95% and bowels are back to normal (which is unusual after a long operation like mine). Sleep is still a bit difficult but improving. This is my progress report.
Recovery big picture
Physical healing is proceeding very well and yet I realise the finer aspects will take a long time. My energy is good for a few hours every day, but the afternoons are toast – thank goodness for lightweight TV to watch. My spiritual attention is foggy and it feels like time to open up. Returning to morning yoga the last two days has helped.
The cancer makes me much more aware of the deeper vulnerability in my body. It is time to reach out to experts and consider what changes to make, now the immediate urgent bit has been cut out. I start making lists of people to call.
Urine control – early experiences
In these early days, if simply feels as if the link between brain and bladder control is a bit disturbed. I tend to dribble a bit when there are double signals, for example while I am walking towards the loo and part of my brain is anticipating emptying my bladder, while the part that is supposed to “hold on” till I get there seems to just go offline for a moment. Another time while I was on the phone – as if I lost awareness and attention.
Simple bodily functions require a lot more attention at the moment.
Erectile function – signs of life
OK, so of all the aspects of recovery, this is actually pretty near the top of my list of concerns. I am feeling hopeful – noticed some nocturnal erections returning, if a bit feeble. And with a bit of attention I get some swelling down there during the day. My whole groin area is still sore enough that I don’t want to explore my sexual function any more than this brief check “are you still there?”
[Editor’s note: things got a bit more complicated in the months that followed]
You are lucky if you’re having some erectile response so soon. The standard timeframe for the nerves to bounce back (if they ever do) is up to two years or more from the surgery date. If you are taking nightly sildenafil to promote blood flow to the penis, you may notice some engorgement in the morning; however, you likely won’t have enough blood flow for a full erection. To address both penile shrinkage and potential scarring due to lowered blood flow, consider the purchase of a vacuum erection device. Regular usage of the VED is helpful in returning penile size and in preventing Peyronie’s Disease, which is caused by scarring of the penile tissue due to the lack of oxygenated blood.
The signal from the brain that tells you it’s time to urinate can become a bit muddled after being on a catheter for a week or more after prostate removal surgery. Since the primary sphincter muscle near the prostate is also removed during the surgery, your body now relies on a secondary sphincter muscle that’s a little more forward. It defintely feels different down there. This secondary sphincter must be beefed up to handle its new job, hence the need for doing Kegel exercises. Nightime urination may become a problem, as the signal to wake up and go to the bathroom may not be as strong as it was before the surgery. If you’re particularly overtired, you may DREAM that you are in the bathroom urinating, when you’ve not actually left the bed. A weak signal combined with reduced muscle control can lead to the occasional night-time accident. If you should suddenly wake up during the night, head for the bathroom immediately. In this way, you can train yourself to recognize the weaker signals to urinate.
Alcohol will irritate the surgical site and increase the urge to urinate. A glass or two of wine at dinner will have consequences later in the evening. It’s recommended to avoid alcohol for several months after surgery, while your body continues to heal. In some people, this sensitivity to alcohol can last a year or more. Besides its diuretic effect, caffeine will also increase the urge to urinate.