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Why does my rectum hurt after prostate surgery?

Pressure in your rectum, as if you need to have a bowel movement. The prostate gland lies just above the rectum, so this feeling is common. It will usually go away with time.

mskcc.org - About Your Prostate Surgery
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This guide will help you get ready for your prostate surgery at MSK. It will also help you understand what to expect during your recovery. Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring it with you every time you come to MSK, including the day of your surgery. You and your care team will refer to it throughout your care.

About Your Prostate

Your prostate is a walnut-shaped gland located below your bladder and above your rectum (see Figure 1). It surrounds your urethra, which is the tube that carries urine out of your body. Your prostate works with other glands in your body to make semen. Seminal vesicles are the small glands near your prostate that make the fluid in semen (see Figure 1). Lymph nodes are small bean-shaped structures found throughout the body. They make and store cells that fight infection.

Figure 1. Male reproductive system

About Your Prostate Surgery

A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body. A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision (surgical cut), which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.

Open Prostatectomy

In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button (see Figure 2). They’ll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.

Figure 2. Open prostatectomy incisions

Laparoscopic or Robotic-Assisted Prostatectomy

During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen (belly) (see Figure 3). They’ll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to help with this procedure.

Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready. As you read through this section, write down questions to ask your healthcare provider. You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure. I take a blood thinner, such as: Aspirin Heparin Warfarin (Jantoven ® or Coumadin ® ) Clopidogrel (Plavix ® ) Enoxaparin (Lovenox ® ) Dabigatran (Pradaxa ® ) Apixaban (Eliquis ® ) Rivaroxaban (Xarelto ® ) There are others, so be sure your healthcare provider knows all the medications you’re taking. There are others, so be sure your healthcare provider knows all the medications you’re taking. I take prescription medications (medications my healthcare provider prescribes), including patches and creams. I take over-the-counter medications (medications I buy without a prescription), including patches and creams. I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.

I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.

I have sleep apnea.

I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.

I’m allergic to certain medication(s) or materials, including latex.

I’m not willing to receive a blood transfusion.

I drink alcohol.

I smoke or use an electronic smoking device, such as a vape pen, e-cigarette, or Juul ® .

. I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care. If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help keep them from happening. If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay. Here are things you can do before your surgery to keep from having problems:

Be honest with your healthcare providers about how much alcohol you drink.

Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you: Get a headache. Feel nauseous (like you’re going to throw up). Feel more anxious (nervous or worried) than usual. Cannot sleep. These are early signs of alcohol withdrawal and can be treated. These are early signs of alcohol withdrawal and can be treated. Tell your healthcare provider if you cannot stop drinking. Ask your healthcare provider questions about drinking and surgery. As always, all your medical information will be kept private.

About Smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help. MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

About Sleep Apnea

Sleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep. OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure.

Ask About Medications

We recommend taking medication to help you achieve an erection. This is to promote blood flow to your penis in order to keep these tissues healthy. Most insurance companies, including Medicare, don’t cover sildenafil citrate (Viagra®) or tadalafil (Cialis®) prescriptions. Check with your insurance provider before surgery to see what your policy covers. If these medications aren’t covered, affordable options may be available. Work with your healthcare providers to start this process before your surgery.

Within 30 Days of Your Prostate Surgery

Presurgical Testing (PST)

You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment.

It’s helpful to bring these things to your appointment:

A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams. Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.

The names and telephone numbers of your healthcare providers.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:

An electrocardiogram (EKG) to check your heart rhythm.

A chest X-ray.

Blood tests.

Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.

Complete a Health Care Proxy Form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment. A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent. For information about being a health care agent, read How to Be a Health Care Agent. If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

Consider Banking Your Sperm

This surgery will make you infertile. You will still be able to have an orgasm. But you will not be able to make the sperm needed to have biological children. You should consider sperm banking before your surgery. Ask your nurse to tell you more about this process. For more information, ask your nurse for the resources Building Your Family After Cancer Treatment: Information for Men and Sperm Banking.

Male Sexual and Reproductive Medicine Program

Most men will find it hard to have an erection right after surgery. Consider making an appointment with an expert to talk about the effects of this surgery on your sexual health. Call the Male Sexual and Reproductive Medicine Program at 646-888-6024.

Do Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read How To Use Your Incentive Spirometer.

Exercise

Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier. Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a Healthy Diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Identify Your Caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For Caregivers

‌ Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Do Pelvic Floor Muscle (Kegel) Exercises

These exercises will strengthen the muscles that will be weakened from the surgery. Practice Kegel exercises before your surgery so you’ll know how it should feel. For more information, read the resource Pelvic Floor Muscle (Kegel) Exercises for Males. ‌ Do not do pelvic floor muscle (Kegel) exercises while you have a Foley catheter in place.

Buy Supplies

A 4% chlorhexidine gluconate (CHG) solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser (such as Hibiclens®) at your local pharmacy without a prescription. You also need to buy a saline enema (such as Fleet® saline enema) for your bowel preparation. You can buy this at your local pharmacy without a prescription.

7 Days Before Your Prostate Surgery

Follow Your Healthcare Provider’s Instructions for Taking Aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary Supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Herbal Remedies and Cancer Treatment.

2 Days Before Your Prostate Surgery

Stop Taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. NSAIDs can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 Day Before Your Prostate Surgery

Follow a Light Diet

Follow a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.

Note the Time of Your Surgery

A staff member from the Admitting Office will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014. The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

Do Your Bowel Preparation

The night before your surgery, use a saline enema as instructed on the box.

Shower With a 4% CHG Solution Antiseptic Skin Cleanser (Such As Hibiclens)

The night before your surgery, shower with a 4% CHG solution antiseptic skin cleanser. Wash your hair with your usual shampoo and conditioner. Rinse your head well. Wash your face and genital (groin) area with your usual soap. Rinse your body well with warm water. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water. Dry yourself off with a clean towel. Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for Eating Before Your Surgery

‌

Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.

The Morning of Your Prostate Surgery

Instructions for Drinking Before Your Surgery

‌  You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else. Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take Your Medications As Instructed

A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower With a 4% CHG Solution Antiseptic Skin Cleanser (Such As Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before. Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things To Remember

Wear something comfortable and loose-fitting.

If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes. Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.

Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.

What To Bring

A pair of loose-fitting pants. Sweat pants are a good choice.

Brief-style underwear that’s 1 to 2 sizes larger than you normally wear.

Sneakers that lace up. You may have some swelling in your feet, lace up sneakers can accommodate this swelling. Your breathing device for sleep apnea (such as your CPAP device), if you have one.

Your incentive spirometer, if you have one.

Your Health Care Proxy Form and other advance directives, if you have completed them.

Your cell phone and charger.

Only the money you may want for small purchases (such as a newspaper). A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one. This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.

Once You’re in the Hospital

You’ll be asked to state and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day. When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet With a Nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams. Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.

Meet With an Anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

Review your medical history with you.

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Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.

Talk with you about your comfort and safety during your surgery.

Talk with you about the kind of anesthesia you’ll get.

Answer your questions about your anesthesia.

When it’s time for your surgery, you’ll remove your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles. You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of your care team will help you onto a bed. They will put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV to make you fall asleep. You’ll also get fluids through your IV during and after your surgery.

During Your Surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. A urinary (Foley) catheter will also be placed to drain urine from your bladder. Once your surgery is finished, your incision will be closed with sutures. Your breathing tube is usually taken out while you’re still in the operating room. This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home. As you read through this section, write down questions to ask your healthcare provider.

What To Expect

When you wake up after your surgery, you’ll be in the Post Anesthesia Care Unit (PACU) or recovery room. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a thin tube that rests below your nose. Or, you may have a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs. You’ll have a urinary catheter in your bladder to monitor the amount of urine you’re making. You may also have a Jackson-Pratt® (JP) drain to draw out fluid that collects under your incisions. You may have a pain pump called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA). Your pain medication will be given through an IV line. Your nurse will tell you how to recover from your surgery. Here are examples of ways you can help yourself recover safely. You’ll be encouraged to walk with the help of your nurse or physical therapist. We’ll give you medication to relieve pain. Walking helps reduce the risk for blood clots and pneumonia. It also helps stimulate your bowels so they begin working again. Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read the resource How To Use Your Incentive Spirometer.

Common Questions

What is the Recovery Tracker?

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker. Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes. Your answers to these questions will help us understand how you’re feeling and what you need. Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read About Your Recovery Tracker.

Will I have pain after my surgery?

Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers.

Typical pain after prostate surgery includes:

Pain in your abdomen in the area of your incisions.

Gas pains.

Pain in another part of your body, such as your back and shoulders. Pressure in your rectum, as if you need to have a bowel movement. The prostate gland lies just above the rectum, so this feeling is common. It will usually go away with time.

What other symptoms may I have after my surgery?

Gas Pains After Your Laparoscopic or Robotic-Assisted Prostate Surgery

The gas used during your surgery may apply pressure and cause pain in different areas of your body, especially your shoulders. This will go away after a few days. Walking around will help your body absorb the gas faster and help your pain.

Bladder Spasms

You may have bladder spasms after surgery. These can feel like sudden and intense cramping pains in your lower abdomen and penis. You may also feel an urgent need to urinate. These spasms usually get better with time.

Bruising

You’ll have some bruising on your abdomen, penis, and scrotum. This will go away within 1 to 2 weeks after your surgery.

Bloating

You may have bloating in your abdomen for several days. Walking can help relieve gas and bloating. Avoid carbonated (fizzy) drinks until you start to pass gas.

How can I manage my pain at home?

You may still have some pain when you go home and will probably be taking pain medication.

Follow these guidelines to help manage your pain at home.

Take your medications as directed and as needed.

Call your healthcare provider if the medication prescribed for you does not help your pain. Do not drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy (very sleepy). Alcohol can make the drowsiness worse. As your incision(s) heal, you’ll have less pain and need less pain medication. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol ® ) and ibuprofen (Advil ® or Motrin ® ) are examples of over-the-counter pain relievers. Follow your healthcare provider’s instructions for stopping your prescription pain medication. Do not take too much of any medication. Follow the instructions on the label or from your healthcare provider. Read the labels on all the medications you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Do not take more than one medication that has acetaminophen without talking with a member of your care team. ) and ibuprofen (Advil or Motrin ) are examples of over-the-counter pain relievers. Pain medication should help you get back to your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active. Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

How can I reduce the swelling in my penis and scrotum?

You’ll have swelling and bruising of your penis and scrotum. Your scrotum may get as big as a grapefruit. This is normal and will slowly go away once your catheter is removed. You can help reduce the swelling by raising your scrotum on a rolled towel while you’re sitting or lying down. It also helps to wear brief style underwear instead of boxer shorts.

Do I need to change my diet?

The first few days after your surgery, you should have light foods until you have your first bowel movement. Light foods include a sandwich, yogurt, soup, and liquids. Avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower. Once you have your first bowel movement, you can go back to your regular diet, as tolerated. Drinking plenty of liquids is important while your catheter is in place after your surgery. Soups and broth are good choices until you get your appetite back.

How will my bowel function change after surgery?

You may not have a bowel movement for up to 5 days after your surgery. This is normal. If you’re passing gas but have not had a bowel movement by the second evening you’re home, take MiraLAX. Take it until your bowel movements are back to normal. If you have not had a bowel movement in 4 days, call your healthcare provider. If you have not passed gas in 2 days, call your healthcare provider. Don’t use an enema or a suppository for at least 6 weeks after your surgery.

How can I prevent constipation?

Take 1 capsule of docusate sodium (Colace ® ) 3 times a day. This is a stool softener with few side effects. ) 3 times a day. This is a stool softener with few side effects. Walking can help stimulate your bowels so they start working again. Drink 8 (8-ounce) cups (2 liters) of liquids daily. Drink water, juices, soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of the body. Slowly increase the fiber in your diet to 25 to 35 grams a day. Fruits, vegetables, whole grains, and cereals have fiber. If you have an ostomy or have had recent bowel surgery, check with your helathcare provider before changing your diet.

Can I shower?

Yes. You can shower 24 hours after your surgery. Taking a warm shower is relaxing and can help with muscle aches. Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering. Leave your incision uncovered, unless there is drainage. Call your healthcare provider if you see any redness or drainage from your incision. Don’t take tub baths until you discuss it with your healthcare provider at the first appointment after your surgery.

How do I care for my incisions?

The location of your incision will depend on the type of surgery you had. It’s normal for the skin below your incision to feel numb, because some of the nerves were cut. The numbness will go away over time. By the time you’re ready to leave the hospital, your surgical incision will have begun to heal. You and your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like. If any liquid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision. Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incision, they can be left uncovered. If you go home with Steri-Strips™ (thin pieces of tape) on your incision, they’ll loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them. If you go home with glue over your sutures (stitches), it will also loosen and peel off on its own, similarly to the Steri-Strips. Don’t pick at the glue or try to peel it off.

When is it safe for me to drive?

You may drive after your catheter is removed if you aren’t taking pain medication that can make you drowsy. Don’t ride on a bicycle or motorcycle for 3 months after your surgery.

What exercises can I do?

Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Slowly increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your healthcare provider before starting more strenuous exercises.

When can I lift heavy objects?

Check with your healthcare provider before you do any heavy lifting. Normally, you shouldn’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 6 weeks after your surgery. Ask your healthcare provider how long you should avoid heavy lifting.

Will I have any tubes or drains when I go home?

Urinary Catheter

When you go home, you’ll still have the urinary catheter (see Figure 5). Your nurse will teach you how to care for it and will give you supplies to take home. The catheter is usually removed 7 to 14 days after surgery. Taking care of your catheter is a big part of taking care of yourself after surgery. For more information, read the resource Caring for Your Urinary (Foley) Catheter.

Figure 5. Urinary (Foley) catheter

You may have blood, stringy pieces of tissue, and blood clots in your urine while you have your catheter in. This is normal. It happens because the incisions (surgical cuts) inside your body are healing and the scabs are coming off. Drink 1 (8-ounce) cup of water every hour while you’re awake to help pass the blood. You may also have blood or urine leaking from the tip of your penis around the catheter when you’re walking or having a bowel movement. As long as you’re seeing urine draining into your drainage bag, this is normal. If you don’t see urine in your drainage bag, call your healthcare provider. Keep the tip of your penis clean and dry. Apply the lubricating gel that your nurse gave you around the tip of your penis. This will prevent irritation.

Caring for Your Uncircumcised Penis

After your surgery, you might pull your foreskin (the loose skin that covers the head of your penis) back to clean or lubricate the tip of your penis. Always put your foreskin back over the head of your penis after cleaning or lubricating. If you leave it pulled back, it can get stuck behind the head of your penis and keep blood from flowing through your penis. Putting your foreskin back over the head of your penis will prevent serious problems.

What should I expect after my catheter is removed?

For 2 days after your catheter is removed, your bladder and urethra will be weak. Don’t push or put effort into urinating. Let your urine pass on its own. Don’t strain to have a bowel movement.

Are there special instructions to follow after my catheter is removed?

After your catheter is removed, you should decrease your daily liquid intake to what you normally drink. You should be drinking 4 to 6 (8-ounce) cups of liquid every day. Limit the amount of liquids you drink after Empty your bladder before you go to bed. This may prevent you from having to get up at night. Limit how much alcohol and caffeinated liquids you drink if you’re having a lot of urine leak.

Talk with your healthcare provider before you start your Kegel exercises.

After your catheter is removed, call your healthcare provider if you:

Can’t urinate.

Have severe pain in your lower abdomen when you’re urinating.

Will I have trouble controlling my urine?

The muscles that hold urine in your bladder will be weak after your prostate is removed. This is why you may have trouble controlling your urine.

Other reasons you may have urinary leakage include:

Your bladder is full.

You’re tired.

You drink alcohol or drinks that contain caffeine.

It may take several months to get full control of your bladder.

Once your catheter is removed, you can do exercises to strengthen your muscles. These are the pelvic floor muscle (Kegel) exercises you practiced before your surgery. You may also have urine leakage after your catheter is removed. It will slowly decrease over time. You may have some leakage when you strain, cough, or lift things. This is called stress incontinence. At first, you may notice that your bladder control is better at night. This is because there is less pressure on your bladder when you’re lying down. For the first few months after your surgery, you may feel that you have to urinate often. Your bladder will take time to expand after it has been kept empty by the catheter. For most people, urinary control will not be a problem. Your muscle strength will continue to improve for up to 12 months after surgery. If after 12 months you’re having problems with controlling your urine, talk with your surgeon. Surgical procedures such as a urethral sling or an artificial urinary sphincter may help. For additional information, visit the National Association for Continence website www.nafc.org. ‌ Call your healthcare provider right away if you have severe pain in your lower abdomen when you’re urinating or if you can’t urinate. The catheter may need to be put back in.

When can I go back to work?

Most people are able to return to work about 2 to 4 weeks after surgery. You may be comfortable with desk or office work once your catheter is taken out. If your work requires heavy physical activity, you may need a longer time to recover. Talk with your surgeon about when it will be safe to return to work.

When can I resume sexual activity?

You may resume sexual activity after your urinary catheter is removed.

Will I be able to get an erection?

Erectile dysfunction, usually called ED, means not being able to get an erection. After your prostate surgery, it will take time (weeks to months) for your erectile function to recover. In the first weeks after your catheter is removed, you may not be able to have erections hard enough for sex. That’s true even if you use medications such as sildenafil citrate (Viagra). Your care team will talk with you about options to try to improve your ability to have an erection.

What are my options for treating erectile dysfunction?

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We recommend taking medication for erectile dysfunction every day. This helps with blood flow to your penis to keep these tissues healthy. Many insurance companies don’t cover sildenafil citrate (Viagra) prescriptions. Check with your insurance provider before surgery to see what your policy covers. Your healthcare provider will give you information about your medication plan. Keep following this plan until your see your surgeon during your post-operative (post-op) visit.

Your plan may be one of the following:

Medication Normal dose Challenge dose sildenafil citrate (Viagra) Take 25 mg 6 nights a week. To make the 25 mg dose, split a 100 mg pill into 4 pieces. Use a pill cutter from your local drug store. Take 100 mg 1 night a week. sildenafil citrate (generic) Take 1 (20 mg) pill 6 nights a week. Take 5 (20 mg) pills 1 night a week. This is a total of 100 mg. tadalafil (Cialis) 20 mg pills Take 1 (20 mg) pill every other day. Don’t take a challenge dose. A 20 mg dose of tadalafil (Cialis) is the highest dose you should take. tadalafil (Cialis) 5 mg pills Take 1 (5mg) pill 6 nights a week. Take 4 (5 mg) pills 1 night a week. This is a total of 20 mg.

About the Challenge Dose

When you take the challenge dose, take the medication on an empty stomach. Take it about 2 hours before your evening meal. The medication takes 30 to 60 minutes to start working. It will last in your system for up to 8 hours. At any time during these 8 hours, try to become sexually aroused through contact with a partner or yourself. Write down what happened and tell your healthcare provider during your next visit. If you haven’t had any response after trying the challenge dose for 4 weeks, call your healthcare provider. They may refer you to our Sexual Medicine team.

What if the pills aren’t working?

You may not be able to have erections hard enough for sex right away, even with pills such as Viagra. This will take time. Taking the medication your healthcare provider prescribed to you can help improve your ability to have an erection. But it may not work for everyone. If the medication isn’t working for you, there are other things you can do to get an erection. If you’re interested in learning about other treatment options for erectile dysfunction, make an appointment with our Male Sexual and Reproductive Medicine Program by calling 646-888-6024.

When will I get my pathology results?

Your surgeon will get your results 10 to 14 days after your surgery. If you don’t get a phone call after 14 days, call your surgeon’s office.

What should I talk with my healthcare provider about?

Your final pathology report.

Your PSA results.

Any problems with your recovery.

Any other treatment that you may need.

What kind of follow-up care will I need?

You’ll need to have prostate-specific antigen (PSA) blood tests done after your surgery. PSA is a normal protein made by your prostate gland. PSA levels typically rise when there is cancer. If the cancer was completely removed, the PSA level should not be detectable. Have a PSA blood test done: 6 to 8 weeks after surgery. 3 to 6 months after surgery. 12 months after surgery. Starting 12 months after your surgery, have a PSA blood test done every 6 months. Do this until 5 years after your surgery. Starting 5 years after your surgery, have a PSA blood test done every 12 months. Do this for life. Your healthcare provider may ask you to have PSA blood tests done more often. If they do, your nurse will give you more information. If possible, have your PSA blood test done at an MSK location. If you can’t have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK healthcare provider’s office.

Can I continue at MSK for my follow-up care?

Yes. We offer thorough follow-up care in our Adult Survivorship Program for people treated at MSK for prostate cancer. Your doctor will help you decide when you’re ready for this step. The program will help support you as you recover from the physical and emotional effects of prostate cancer. We also will watch for any signs of the cancer coming back. An NP will work closely with your doctor and will be responsible for your care. The NP is a member of the prostate cancer treatment team at MSK and an expert in the care of cancer survivors. Your NP will:

Look for signs of the cancer returning.

Manage any effects of treatment, such as pain and fatigue.

Recommend screening tests for other cancers.

Provide counseling about living a healthy lifestyle, such as diet, exercise, and quitting smoking.

During visits with your NP, you will:

Talk with you about your medical history.

Perform a physical exam.

Order tests, such as X-rays, scans, and blood tests.

Make referrals to other healthcare providers, if needed.

Prescribe medication, if needed.

If you would like more information about our Adult Survivorship Program, talk with your healthcare provider. You can also visit our Adult Survivorship Program online at www.mskcc.org/experience/living-beyond-cancer/survivorship/adult-survivorship

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. MSK nurses, doctors, and social workers can help you, your family, and friends handle the emotional aspects of your illness. We can help whether you’re in the hospital or at home.

What if I have other questions?

If you have any questions or concerns, please talk with your healthcare provider. You can reach them Monday through Friday from to After , during the weekend, and on holidays, call 212-639-2000. Ask for the person on call for your healthcare provider.

When to Call Your Healthcare Provider

Call your healthcare provider if:

You have a fever of 101 °F (38.3 °C) or higher.

Have severe pain in your lower abdomen (belly) when you’re urinating.

Aren’t able to urinate.

You have swelling or tenderness in your calves or thighs, especially if 1 leg is more swollen than the other.

You become short of breath or are coughing up blood.

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery. As you read through this section, write down questions to ask your healthcare provider.

MSK Support Services

Visit the Cancer Types section of MSK’s website at www.mskcc.org/types for more information.

212-639-7606

Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia

212-639-6840

Call if you have questions about anesthesia.

Blood Donor Room

212-639-7643

Call for information if you’re interested in donating blood or platelets.

Bobst International Center

888-675-7722

We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Caregivers Clinic

646-888-0200

www.mskcc.org/caregivers

At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.

Counseling Center

646-888-0200

Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Female Sexual Medicine & Women’s Health Program

646-888-5076

Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Female Sexual Medicine & Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. We can help before, during, or after your treatment. Call for more information or to make an appointment.

Food Pantry Program

646-888-8055

We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service

www.mskcc.org/integrativemedicine

Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010. You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.

Male Sexual and Reproductive Medicine Program

646-888-6024

Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). We can help before, during, or after your treatment. Call for more information or to make an appointment.

MSK Library

library.mskcc.org

212-639-7439

You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org

Nutrition Services

www.mskcc.org/nutrition

212-639-7312

Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Patient and Caregiver Education

www.mskcc.org/pe

Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program

212-639-5007

It can be comforting to talk with someone who has been through a treatment like yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. Your conversations are private. They can be in person or over the phone.

Patient Billing

646-227-3378

Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office

212-639-7202

Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison

212-639-5935

Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions

917-862-6373

You can request private nurses or companions to care for you in the hospital and at home. Call for more information.

646-888-8106

At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Social Work

www.mskcc.org/socialwork

212-639-7020

Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.

Spiritual Care

212-639-5982

Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion). MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program

www.mskcc.org/tobacco

212-610-0507

MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

Virtual Programs

www.mskcc.org/vp

Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care. Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.

External support services

Access-A-Ride

web.mta.info/nyct/paratran/guide.htm

877-337-2017

In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network

www.aircharitynetwork.org

877-621-7177

Provides travel to treatment centers.

American Cancer Society (ACS)

www.cancer.org

800-ACS-2345 (800-227-2345)

Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers

www.cancerandcareers.org

A resource for education, tools, and events for employees with cancer.

CancerCare

www.cancercare.org

800-813-4673

275 Seventh Avenue (Between West 25th & 26th Streets)

New York, NY 10001

Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community

www.cancersupportcommunity.org

Provides support and education to people affected by cancer.

Caregiver Action Network

www.caregiveraction.org

800-896-3650

Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network

www.corpangelnetwork.org

866-328-1313

Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club

www.gildasclubnyc.org

212-647-9700

A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days

www.mygooddays.org

877-968-7233

Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation

www.healthwellfoundation.org

800-675-8416

Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House

www.joeshouse.org

877-563-7468

Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project

http://lgbtcancer.com/

Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility

www.livestrong.org/we-can-help/fertility-services

855-744-7777

Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program

www.lookgoodfeelbetter.org

800-395-LOOK (800-395-5665)

This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute

www.cancer.gov

800-4-CANCER (800-422-6237)

National Cancer Legal Services Network

www.nclsn.org

Free cancer legal advocacy program.

National LGBT Cancer Network

www.cancer-network.org

Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds

www.needymeds.org

Lists Patient Assistance Programs for brand and generic name medications.

NYRx

www.nyrxplan.com

Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance

www.pparx.org

888-477-2669

Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation

www.panfoundation.org

866-316-7263

Provides assistance with copayments for patients with insurance.

www.patientadvocate.org

800-532-5274

Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope

www.rxhope.com

877-267-0517

Provides assistance to help people get medications that they have trouble affording.

Prostate Cancer Support Services

The American Urologic Association Foundation

www.auafoundation.org

866-746-4282

Offers free information about prostate diseases.

MSK Incontinence Specialist

646-497-9068

If you think you’d benefit from a consultation with a urologic surgeon specializing in incontinence, talk with your surgeon for a referral.

MSK Prostate Cancer Support Group

646-888-8106

This is a monthly meeting for men who have been treated for prostate cancer. Call for more information or to register.

National Association for Continence

www.nafc.org

Provides information and support for people dealing with incontinence.

National Comprehensive Cancer Network (NCCN)

www.nccn.org

215-690-0300

Has information and resources for people living with cancer and their caregivers, including support groups and education. The publication Prostate Cancer Guidelines for Patients may be helpful.

Prostate Cancer Foundation

www.pcf.org

800-757-CURE (800-757-2873)

Provides prostate cancer education and support programs.

US TOO

www.ustoo.org

800-808-7866

Provides prostate cancer education and support programs. Meetings are open to people living with cancer and their caregivers. US TOO has a monthly newsletter called Hotsheet. This section has the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery. As you read through these resources, write down questions to ask your healthcare provider.

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