Introduction
One of the major benefits of keyhole surgery compared to open surgery is a much faster return to normal activities and general exercise. However, radical prostatectomy is still a major operation for a patient to undergo that requires many weeks for the body to fully recover, so it’s important to understand what you should and shouldn’t do in the first 12 weeks after surgery in order to optimise your recovery. Not only that, but in the weeks leading up to surgery there are exercises that you should do to make recovery much smoother.
Before surgery, start your pelvic floor exercises
- These should be started before surgery and only stopped once you are completely continent after the operation.
- You’ll be shown how to do the exercises during your pre-operative assessment visit, but essentially these pelvic floor muscles are the ones that you use to interrupt your urine stream. A strong pelvic floor therefore allows you greater control over your continence after the operation.
- More precisely, the muscles aid urinary control whilst your valve of continence recovers from the operation. This valve essentially switches your urine stream on and off, and is affected during surgery. Stitches in the valve take 6 weeks to dissolve and the scar tissue surrounding it takes up to a year to soften, so we need to help it after the operation. By creating a strong pelvic floor with your exercises, the muscles are able to squeeze around this valve and help it to close during the recovery period.
I’ll be covering how to perform the exercises in a later article as it’s slightly out of the scope of this article, but for now there is an excellent guide from Prostate Cancer UK here, as well as a video to watch here.
Exercise after surgery
Firstly and as a general note, you should know that walking as soon as possible after surgery is important for patients as it significantly reduces the likelihood of two important potential complications. Firstly, deep vein thrombosis or DVT (a clot in the leg) can result from being stationary for too long. Secondly and related to DVT, there is a risk of a pulmonary embolus or PE, which is where a DVT clot travels to the lung.
Day 1 after surgery
Once your drains have been removed and your drip has been disconnected (which is usually after breakfast) your large catheter bag will be swapped for a smaller version that can be strapped to your thigh inside your trousers. You should potter around the ward and spend some time sitting in your chair as the recovery begins.
Day 2 after surgery
You should aim to walk around the ward and the corridors on your floor, increasing what you did the previous day in preparation for your discharge home on the second or third post-operative day.
The first two weeks after discharge home (days 2 and 3 onwards)
- For the first 2 weeks after discharge you should gradually increase your activity level.
- Don’t lie down or sit in a chair for prolonged periods (this avoids the risk of DVT, as mentioned above).
- Do get out of the house. Get some fresh air and stretch your legs.
- If it hurts, don’t do it! This is a sign from your body, so respect it.
Lifting
- Avoid lifting heavy objects such as suitcases or big boxes for 6 weeks, as this can strain the abdomen and cause injury.
- Lighter objects such as shopping bags can be lifted after 2 weeks.
Driving
As soon as you can stamp hard on the brake pedal of your car you are safe to drive. This is usually 7-10 days after surgery.
Golf, tennis, running and going to the gym
- Patients can gently start this after 4 weeks.
- Don’t lift heavy weights (or do exercises like squats or deadlifts) for 6 weeks as this can strain the abdominal/pelvic muscles (see ‘Lifting’ above).
- Remember – if it hurts, don’t do it!
Cycling
Cycling is a unique exercise to be careful with as the seat of the bike puts direct pressure on the area where your prostate was. As a result, cycling should be avoided for the first 12 weeks after surgery to allow the new join between your bladder and urethra to heal before being subject to the sustained pressure and trauma from a narrow bike saddle. If your saddle is wide to distribute the pressure (as in a gym exercise bike) or has a perineal area cut out then you can cycle after 6 weeks but for no more than 30 minutes at a time.
Ongoing support
If you do need any more help and advice on what you can and can’t do, our Nurses are on hand to support you during your recovery. You’ll be given their contact details in your information pack before the operation.