IMMEDIATELY POST-OP WHEN CATHETER IS STILL IN (FIRST 7-10 DAYS USUALLY):
- Do NOT perform Kegel exercises when the catheter is still inside.
- Walk every day. Whether it is for 5 mins or 30 mins. This will prevent blood clots as well as facilitate healing by bringing blood flow to the pelvis. Do not push yourself to the point of fatigue or pain. It may be best to walk 3 different times during the day, starting at 5-10 mins intervals and building up to one 30 min walk.
- Sleep is also important–make sure you are getting plenty of rest so your body can heal.
- Continue drinking 4-6 oz of water every hour, stopping 3 hours before bed. You are still drinking water only, so no caffeine, alcohol, soda, tea, flavored water, tonic/sparkling, etc., NOTHING BUT PLAIN WATER. This is to reduce inflammation and bladder irritation and set your bladder up for successful retraining and healing.
AFTER OPERATION ONCE CATHETER HAS BEEN REMOVED:
- Remember initially you will likely be ‘leaking like a faucet’ when the catheter is first removed. This is not a sign that you will remain incontinent. It is because your bladder and pelvic floor muscles have been ‘lazy’ while the catheter was in—they did not have to work. It takes time to retrain them.
- Once the catheter is removed, resume bladder retraining schedule (See Pre-op Prostatectomy for detailed information on this), however, now you will start at a 1 hour interval. Go to the toilet every 1 hour whether you feel urge to urinate or not. Once you have gained more bladder control, increase the voiding interval by 30 minute increments. So from one hour, to 90 mins, to 2 hours, etc. until you are voiding every 3 hours again.
- DO NOT go to the toilet any sooner than 1 hour to ‘prevent leaking’; all this does is train your bladder to empty before it’s full and will not reduce your incontinence. Stick to your schedule even if you are still leaking a lot. That is what the under garments are for. The more consistent you are with your bladder schedule, the quicker you will retrain your bladder. Remember you’ve created muscle memory by starting this prior to surgery so give your body time to adjust. Do not create bad habits. Another bad habit is to elect to not use the toilet at all since you are not feeling an urge and/or have already leaked all the urine out of your bladder into your under garments. Do not do this either. You have to remind your bladder that it is supposed to hold your urine until it is time to empty at the toilet. Go every 1 hour and increase from there as you gain more control.
- Continue drinking plain water as instructed above until you are back to voiding every 3 hours and no longer leaking. This will likely take several weeks.
- Resume Kegels as you were prior to surgery – if they are painful, reduce the intensity and frequency of this exercise, if still painful then stop performing them for a couple days then try again. If you continue to have pain with Kegels after a couple weeks then consult your Doctor. See Kegels for more information on how to perform the pelvic floor muscle contractions correctly.
- AVOID CONSTIPATION: it is important to not strain/force/push when you defecate. Prevent this by using a stool under your feet during defecation. There is not a set height the stool needs to be as long as it brings your knees higher than your hips (90 degrees or less). If you have a high toilet then you will need a higher stool. Having your knees higher than your hips allows for the puborectalis muscle to relax, increasing the puborectal angle so the stool can evacuate easier with less effort. You can also ask your doctor for a stool softener recommendation if needed, especially if you are taking medicine that may constipate you. Look at the Bristol Stool Chart. Your stool should be a Type 4. If it is Type 1,2, or 3 then you may benefit from a stool softener or fiber. Check with your doctor before starting any supplement or medication. See What is Normal and Constipation for further information and treatment of constipation.
WHAT TO EXPECT AFTER SURGERY:
- You should expect to see improvement on a weekly basis, meaning less leaking on average week to week. If you are still ‘leaking like a faucet’ as you were when the catheter was first removed, consult with your Doctor. However, keep in mind that each individual heals at their own pace and it can take up to a full year to gain continence. If at 4-6 weeks your leaking has not improved or you feel your progress has ‘plateaued’ then come back to physical therapy at your doctor’s recommendation. But make sure you have been following the above program accurately and consistently. If you are all but dry except for ‘stress incontinence’ (leaking with sneeze/cough/laugh, exercise, movement, effort) then come back to physical therapy within 8 weeks post-op (See Stress Incontinence). If at 6 weeks post-op you are still having pain with Kegels and/or sitting then you will need to come back to physical therapy. Your Doctor may need to write a referral for you to do this.