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Posted 1/2/2011 1:27 AM (GMT 0)
What should one expect, in terms of having bowel movements, after a radical (robotic) prostatectomy? I am having this procedure in the next month and am worried about this. Will it be painful or more complicated than usual? I've read that constipation could be an issue and stool softeners are helpful for that. I'm hoping I won't have to go for days after the surgery just to avoid having to deal with this.
Posted 1/2/2011 2:04 AM (GMT 0)
Edward,

Welcome to HW

I had a DaVinci RP, and can just relate my experience.

The surgery, anesthesia, and pain meds all impact the intestines and rectum. I was told to expect some constipation, and pain in the rectum. Because of past colon issues, I was already taking a daily stool softener (docusate calcium), and the surgeon was agreeable to continuing that one, even while I was in the hospital (4 days - longer than most).

My first bm was before I left the hospital. I found the bigger issue to be dealing with bladder spasms and leakage around the catheter during the bm, but that was manageable.

Some members have suggested getting a raised/split home care style seat for the toilet, but I did not find that to be seriously needed (might have been nice).

Avoiding a hard stool is essential, as the prostate is against the rectum, and removing it leaves a part with little support, thus fragile. You do not want to develop a fissure/fistula. Better to go often than have problems.

Posted 1/2/2011 2:10 AM (GMT 0)
Constipation can always be an issue when you are using anesthetics or pain medications, especially narcotics like Vicodin.  I used as little Dilaudid as possible while in the hospital, but it still was four days before I had a natural or normal bowel movement.  Remember, you will have cleaned out your system with clear liquids and probably an enema or two prior to surgery, so it's natural to expect a lack of bowel movement until some real food is introduced back into your system.  The answer is to start walking as soon as you can get out of your hospital bed after surgery.  I was up and down the 300 yard corridor many times, dragging my I.V. pole along with me.  My wife was there to steady me for the first few trips, but it didn't take long to feel stronger and steadier. 

I had an added complication because the surgeon spent extra time freeing up some old bowel adhesions, and I think that complicated the return to normal function. 

Also, if you get bloated and full of gas, don't hesitate to ask the nursing staff to contact your doctor and ask him to order some simethicone or similar anti-gas medication.  The simethicone should be available to you at approx. six hour intervals, if you need it.

I would talk to your doc about stool softeners, and especially before using any laxative.

Good luck.

Posted 1/2/2011 2:19 AM (GMT 0)
After the pre-surgery bowel prep, your intestines will be cleaned out..Then, as a side effect of anesthesia, you may be nauseous for a day or two after surgery, jello and liquids at first..So it will be 3 or 4 days before you have a normal BM... It will take a week before your diet and bowels return to normal..Papaya is a GREAT stool softener..Difficult to find decent ones in the States this time of year..My surgeon encouraged me to walk as much as I was comfortable with right from the beginning..The walking helped a lot with getting everything back to normal..You can't just sit or lay around and expect to recover..
Posted 1/2/2011 2:46 AM (GMT 0)
Good ole prune juice gave me the kick start I needed.

Posted 1/2/2011 2:57 AM (GMT 0)
I've always relied on plain-water enemas (with very little water) just to have a bowel movement. It's not a problem at all for me as I actually prefer using them once a day as it puts me in-control of when I need to go and gives me a feeling of being more cleared out than not using them. But, I've read that after surgery, you should not use them----I assume that's because the hard, plastic tip could cause injury. I insert the tip only about 1/2" so maybe it's not a problem to use one after I would return to eating normal food.
Posted 1/2/2011 3:07 AM (GMT 0)
It shouldn't be a problem, but I took six days after surgery before going. I had open surgery and probably more narcotics than you'll have, so your mileage may vary. They gave me stool softeners, but the narcotics kept anything from happening for a while. No real pain or discomfort; it just took a while.

Once I got off the narcotics and onto some prune juice, everything was good. Metimucil is good too, and walking helps. As long as you don't strain, you should be cool.

Go easy at first, and don't panic if it doesn't happen right away. It'll happen.
Posted 1/2/2011 3:39 AM (GMT 0)
For most guys this seems not to be a big deal. Follow the diet and medication instructions that you are given and remember our mantra
walk, walk, walk, drink, drink, drink.

P.S. They didn't give me the prescriptions for the pain meds and stool softeners until I left the hospital. No big deal for me since the pharmacy is near by and my wife went out and filled them -- if your situation is different, talk to your doc about getting them in advance.
Posted 1/2/2011 3:52 AM (GMT 0)
I highly recommend the toilet riser--I wish I would have had one. My recovery from robotic surgery was relatively painless, but of all things, getting down and back up from the toilet was the most difficult thing I had to do. I swear, when I was at the hospital, somebody came into my house and lowered the toilet 10" closer to the ground.

Like the others, it took about 4 days for the 1st BM although I had lots of gas the 1st few days post surgery. I ate jello, rice soup and other bland foods the 1st few days (and just small qtys) so it took awhile to get things moving.

Good luck on the surgery.

Dan
Posted 1/2/2011 4:58 AM (GMT 0)
Edward -

You mentioned enemas after surgery - my colo-rectal dr. and the uro both said DON'T DO THAT. In a worst case you could actually puncture the rectum. Any damage at all is a problem.

Whenever I have colon relapses, the add-on for the daily stool softener is a tablespoon of mineral oil taken before going to bed. Keeps things moving easily.

 

Posted 1/2/2011 5:58 AM (GMT 0)
I'm with 142...be SURE to clear any enema plans with your surgeon..That's usually a BIG no-no along with suppositories..

When they do the original biopsy (or any biopsy) the sampling needles pass through your rectum and prostate. These puncture wounds tend to grow together with scar tissue as you heal from that procedure..The surgeon must separate the two when he removes your prostate..It's one of the more difficult parts of the operation..It can leave the wall of the rectum very thin and weak...They want that to heal for two months before anything gets stuck up your butt...So again, check with your surgeon...
Posted 1/2/2011 10:44 AM (GMT 0)
Edward

I had almost no problems, but I put that down mainly to the Dutch system not requiring me to stop eating and empty myself with laxatives before surgery - I was allowed a small breakfast at 7.00 when I was in surgery at 11.30!!

However...

No enema unless done with doc's approval.

I found that things went better by simply rubbing a little vaseline on my anus using toilet tissue.

Also the muscles tended to relax and do their business all by themselves if i sat on the WC with a book/magazine/newspaper.

A chair by the WC for support can help if there's space, and don't feel shy about asking a partner for help getting on and off the WC. Experience says they'd rather help than think you're in pain/trouble etc. You may also end up washing your backside in the shower rather than trying to get an arm behind you to wipe things.
Also a little urine is bound to leak out past the catheter during a BM, but you can be ready for it and perhaps place a bit of tissue there to soak it up or stop it going all over the seat etc.

And while walking is excellent that means lots of small regular walks not one big one.

I hope it all goes well.

Alf
Posted 1/2/2011 1:19 PM (GMT 0)
Edward, I can only tell you about the instructions my husband was given by the hospital after his surgery.  According to our surgeon, John would not be able to start solid food until his first BM...which was a great incentive since John was tired of broth, jello and apple juice (not unlike prep for a colonoscopy).  He started taking stool softeners almost immediately to prevent straining and pain...and they worked.  He had surgery on Tuesday, came home Thursday, and has his first BM first night (boy was he a happy camper).  After that, he was able to slowly introduce solid foods back into his diet - had a soft boiled egg the next morning, then had some pastina in broth, etc.  I remember that his first "real" meal was chicken cutlets with mashed taters...he thought I was the best cook in the world!  He continued with the stool softeners until the catheter was removed (9 or 10 days after surgery), then slowly stopped taking them as he body slowly resumed normal functions.

One thing I will tell you - and this doesn't apply to everyone:  when John had his first BM, the stink was unbelievable.  When we mentioned this to the surgeon, he said this is caused by the anesthetic and the volume of antibiotics that were pumped into his system.  The odor improved dramatically with each movement.

Good luck with your surgery.

Posted 1/2/2011 1:22 PM (GMT 0)
I was not allowed to have solid foods until I passed gas. It took about 2 days for that to happen. I was taken stool softeners and finally had a BM after about 4 days. I recall the second BM I sat on the toilet so long waiting that my feet fell asleep. A good idea above on the prune juice. I never tried that but I bet it would work.
Posted 1/3/2011 12:34 AM (GMT 0)
Edward,

I had the DaVinci robotic surgery 2 months ago. My experience in the hospital was painful gas cramps until I started passing gas late the second day after surgery. I did walk each day at least 3 times, and it seemed to help with getting the gas moving, started out with a few burps. I finally did pass gas the second day. I had asked about something for gas pain but was told there wasn't anything for it.

I was also concerned about my first BM. I was on vicodin and stool softeners in the hospital as well as about a week at home. My first BM was probably on the 4th day, and was not as bad as anticipated, there was some discomfort during but not after. Each day's discomfort was similar for a week or so but kept lessening.

For me it just happened, but did seem to take more days than it should have.

age 54
1 of 12 biopsies had cancer - gleason 3-4=7
still leaking some in the afternoon and worse on walks.
using the pump daily, on cialis, no luck with muse yet. No response from willy yet.
Posted 1/5/2011 4:18 PM (GMT 0)
I had my RRP on a tuesday, came home on wednesday, but didn't pass stools until the friday - after several failed attempts and lots of gas. I drank plenty of fruit smoothy and used an OTC stool softener/bulker (Fybogel). After my first movement, I went alternate days for a few days, and then daily. I'm still drinking the smoothy and the stool softener.

I tried to avoid straining; instead, I'd have some breakfast, smoothy and softener, then wait for nature to do its thing. The first couple of times, I also got a leakage of urine around the catheter, so be prepared for this.

Immediately I'd finished the paperwork, I went straight into the shower to clean up properly.
Posted 1/5/2011 10:30 PM (GMT 0)
if you are feeling stressed about noT having a BM, and feel constipated- the mixture I used after my RP (only needed it once) and previously (back in 1998) after my leg surgery ( no BM for 10 days) , was 5 oz prune juice and 5 oz milk - heat that up for 1 minute in the microwave - (and if not too hot for you) drink all of it down - and in about 20 minutes - you will feel the urge to go to the washroom .. and let nature take its course....
- and do avoid any forcing of the issue - that area has had enough trauma and is very sensitive ....
-you will also find your frequency of BM to be different as your body recovers...
all the best...
hugs
BRONSON
.......
Posted 1/5/2011 11:59 PM (GMT 0)
The one lesson we took away after the surgery was not to eat too much before the first bowel movement.
Paul's hospital had really good food and he was eating full meals with meat and vegetables soon after he started passing gas. He was in hospital for 4 days.

In retrospect he should have stuck to broth and jellies till his first bowel movement on day 5. He tried absolutely everything to go, prune juice, a variety of stool softeners but he found the first bowel movement very difficult and quite painful.

So our advice is, don't blindly accept what the hospital gives you, eat lightly till your first BM.

Regards,
An
Posted 1/6/2011 12:39 AM (GMT 0)
- and do avoid any forcing of the issue - that area has had enough trauma and is very sensitive ....

I paid the price for not heeding this advice. I developed a hemorroid about 8 days after surgery (my first one ever). It cleared itself up in about 5-7 days but I think I may have aggravated the problem by straining. I was taking stool softeners but still had some trouble jump starting digestive tract. Fortunately, this was the only problem I had during my recovery.

Dan
Posted 1/6/2011 2:01 AM (GMT 0)
So much good advice in one thread!

My experience was similar to most on here. Surgery on Monday - first BM on Saturday. A little discomfort, but not really pain. Definitely place some tissue around Jr to absorb any leakage around the catheter - it's normal, don't freak out. Don't strain and don't panic. Nature will takes it's course - sometimes with some help. Stool softners, walking and water made it work for me.

Best of luck to you Edward.
Posted 1/6/2011 2:53 AM (GMT 0)
 

Stool softeners ...

I had no diet restrictions from the beginning. However at that time I was taking oxycodone for pain unrelated to Psa.  Oxycodone causes constipation, so the stool softeners.  I have since stopped the oxycodone... self detox .. smhair another story all by itself.

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