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Post RRP - Discomfort in Perineum / Prostate site

User
Posted 19 May 2020 at 09:36

Will be interested to hear how well the Gabapentin works for you and any side effects? I keep getting offered codeine and that doesn't touch it. Although I should add that now I am doing way more exercise that has certainly helped!


 


 


Originally Posted by: Online Community Member


A quick update since my last post:  Perineum and groin pain was certainly not improving, so went to GP to get his take on it.  He did a full examination and came up with a few possibilities, including Burstitis, lymphocele, pelvic abcess ... he ruled out arthritis as hip joints are fine.  So he contacted the urologist that did my op for his thoughts.  The urologist suggested doing an ultrasound scan of the whole area, and in the meantime going on a course of nerve-blocking meds (Gabapentin) to make life bearable while we organise the scan and decide where to from there.


So ... watch this space - the saga continues.  I really need to be fit by the middle of July when our calving season starts!  Fingers crossed!


User
Posted 22 May 2020 at 03:47

Hi Mark.  The Gabapentin has definitely helped.  I'm on day 10 with it now and up to 2 doses a day at 300 mg each.  It has effectively stopped the perineum pain from radiating down the thigh and into hips, so I'm lots more mobile.  It's not a painkiller as such, in the way that NSAIDs work, so there is still localised perineum pain which can be controlled with Paracetamol if needed, but it's generally tolerable now.


 


The somewhat bad news is that our radiology dept is backlogged for 8 to 10 weeks because of the Covid-19 situation.  So I won't be getting my ultrasound scan until probably late July / early August.  But until that happens I'm thinking the possibility of ischial bursitis, as the pain does seem to be centralised around the right side ischcial tuberosity - there is a bursa located there which could have become inflamed and not responding to OTC anti inflammatories.


 


So, yes, it might be worth you checking with your GP if you think Gabapentin might work for you, especially if your pain is radiating down other nerve bundles.  As for side effects, I personally haven't experienced any yet, but 600 mg a day is nowhere near the maximum allowed dosage.


 


Originally Posted by: Online Community Member


Will be interested to hear how well the Gabapentin works for you and any side effects? I keep getting offered codeine and that doesn't touch it. Although I should add that now I am doing way more exercise that has certainly helped!



 

Edited by member 22 May 2020 at 03:52  | Reason: Typo

User
Posted 26 May 2020 at 15:46

That is a major pain (literally) on the delay to the ultrasound. I would expect they will not find much to write home about (which I guess is good news) and suggest more painkillers. I suspect more men have this nagging problem than perhaps let on? Mine a lot better now but the pain has moved to my tailbone!! No idea why and GP just throws painkillers at the problem. Perhaps I may just stay off everything for a time now and let it settle down on its own!


Good luck once the scan is booked!

User
Posted 16 Jun 2020 at 09:58

Hi all.  Well, there have been some interesting developments since my last post regarding this persistent problem.  Had the ultrasound done at a private clinic for a couple of hundred dollars - wasn't prepared to wait til August for the hospital appointment.  Pelvic ultrasound was completely normal - no lymphocele, no abscess, no blood clots, no fluid build-ups, nothing!  Everything in there looked perfect.  So back to GP for further examination.


On consideration of the fact that the pain is present only when weight-bearing on right leg, and certain activities involving hamstring and adductor muscles, and the pain is absent when standing still, we've come to the conclusion that the pain is musculoskeletal - not neuropathic, as we thought.  The thinking is that the surgery may not have caused any nerve injury at all - rather the pain caused by the fact that, following surgery, I had a month of very limited physical activity during recovery, and then started work and exercise again, stretching tendons and muscles too soon and too abruptly.  Of course, the hamstring and adductor muscles are anchored at the ischium - right where the pain is centered.  There might even be some irritation and inflammation of the ischial bursa into the bargain.


So - starting a programme of physio exercises for two or three months.  Will continue painkillers as needed, but might replace the Gabapentin with Tramadol, as Gabapentin is only mildly effective with neuropathic pain and it now appears that my pain is nociceptive anyway, so Tramadol should prove far more effective.


Let's see how this goes!

User
Posted 16 Jun 2020 at 10:24

Interesting stuff and not altogether surprised the ultrasound didn't show anything! My problems appear to be musculoskeletal too. I am now trying to avoid the painkillers as I can usually get by and things are slowly improving. Tried Tramadol and that didn't do anything except make me feel a bit odd! A hot water bottle applied for 20 mins to a problem area seems to be my salvation right now...


Good luck with the continued treatment :-)


Mark

User
Posted 31 Jul 2020 at 04:32
Thank you all so much for sharing your experiences. I’m two weeks out of the op and already worried by the “ near anus” pain and testicle pain....reading this was very calming...realizing it’s normal. Thank you so much.
User
Posted 29 Sep 2020 at 04:08

Well, guys - I can't believe another 3 months has flown by since I last posted here!


The good news is that the extreme perineum pain I was experiencing has now completely gone.  It was certainly due to excessively strained adductor and hamstring tendons which the Physio believes happened as a result of the few weeks down time, recovering from the Rad P operation and then pushing the boundaries getting back to work.  It took 16 weeks to come right - so if the same thing happens to you, don't despair - it takes ages to heal!


Apart from that, everything else is great: no incontinence, steadily returning erectile function, no detectable PSA, and fitness returning to normal.  A great outcome, especially given the challenge of previous bi-lateral inguinal hernia mesh repairs.  I was very worried at the time that would compromise the surgery, but the surgeon made a lateral incision rather than the normal vertical one, to miss the mesh repairs.  And, in fact, the scar is much less noticeable done that way.  So for those of you who have had previous hernia repairs, don't despair - it's a bigger challenge for the surgeon but still can produce a great outcome.

User
Posted 05 May 2022 at 01:58

Glad I found this forum,   recovering I think well from robotic prostate removal but two weeks out still constipated and that results in pain and spasms in rectum.  It is somewhat comforting to know this is very normal.  Not that it makes the discomfort any less, it takes the worry away that something is very wrong.


Biggest issue is bathroom every 20-30 minutes which makes for a very difficult night of sleep


 

User
Posted 05 May 2022 at 09:51

Hi Steve. Are you taking lactolose and senna? They help. Also prune juice is great and more natural. 1 glass in the morning does the trick. You may want to start your own thread so your posts don’t lost. My hubby is 6 week post op. 

User
Posted 28 Sep 2022 at 16:51

Another useful thread, thanks everyone. I’m two weeks out from RALP with my TWOC tomorrow. Perineal discomfort started about a week ago so I’ve invested in a memory foam ring designed for people with piles, new mums etc. Once you get the right position, it can make a real difference. About £20 off Amazon. 

User
Posted 28 Sep 2022 at 18:21

Nick , due to having some problems with a stricture I have done numerous TWOCs and never failed. I make sure I am well hydrated before I get to the hospital, listen to the nurses and you should be fine.


My stricture was possibly caused by the catheter getting tugged out after getting stuck, it should just slide out, without any resistance or pain. If it gets stuck I would ask for a urologist to attend.


After three samples of around 200mls I was scanned to make sure I was voiding the bladder. Make sure you have some pads , the hospital will usually give you a few. I always took a waterproof cover for the car seat and a towel just in case of leaks, I never needed them.


Hope all goes well.


Thanks Chris 


 

User
Posted 28 Sep 2022 at 18:44

Thanks Chris. All good advice, as usual. I’ll post an update tomorrow 


cheers


Nick

User
Posted 29 Sep 2022 at 17:01

TWOC this morning, took about 2 hours from arriving to leaving. All good. Been in pads all today, pretty much leaking most of the time. Just made the mistake of sitting down too long without changing pad and urine soaked through my trousers.


Does everyone else do their pelvic floor exercises and just do a little wee every time they contract the muscles? To me it makes sense that I do these whilst standing at the loo, rather than just peeing into the pads. 


What does everyone else do?


Thanks 


Nick

User
Posted 29 Sep 2022 at 18:11

Hi Nick 


So I am doing the pelvic floor in different positions. Standing, sitting and laying on the floor. I am using the squeezy app to guide me. I found when doing the quick exercise I do sometimes leek a little when I relax. So this is day 3 for me since catheter removal. I think I may have seen a little improvement today. But I can be see it's going to take time. Fortunately I am dry at night and using 2 medium pads per day. I have found that if I am starting to leek a lot it's because I need to pee, I don't have that feeling that I had pre op that my bladder is full and I need to go. I also notice my flow is not as good as it was pre-op but I think there has been a bit of improvement today.


It is frustrating but I am sure things will get better for you.

User
Posted 29 Sep 2022 at 18:11

The removal of the catheter this morning significantly reduced the perineal discomfort. Not gone entirely, but a lot better than it was. 

User
Posted 29 Sep 2022 at 19:22

Thsnks to everyone for sharing their experiences regarding perineum pain and discomfort after radical prostatectomy surgery.


I am 4 weeks out from my robotic surgery and was concerned that the pain in the perineum area was not improving. I find the only relief I can get is to lay flat on my back for a few minutes to let the pain pass. But it returns when I stand, sit, or walk. My doctor said this was normal, but didn't say how long it would last. 


I am not taking any pain medication, but based on your postings I may consider this!!


 


Thank you all, and I'll update my progress. I am scheduled for a follow up visit with the surgeon in three months.

User
Posted 29 Sep 2022 at 20:33

Hi Jim,


So good to have someone just ahead of me, blazing a trail! 


2 pads a day sounds good, I’ve used about 6 already but I might be changing them too soon. I was hoping I’d be one of the few who bucked the trend and was dry from day one. As if! 


I think maybe more trips to the loo to empty the bladder before I fill the pad. 


Cheers


Nick

User
Posted 29 Sep 2022 at 20:37

Jack, I think most people would say take painkillers if they help you to live a more normal life.


also I am learning that patience is important. 


cheers


Nick

User
Posted 05 Oct 2022 at 14:02

I just had my removal operation on Saturday 1st Oct, very informative thread giving me an indication of what I face over the next few weeks/months. 


   My issue at the moment is leakage, i still have a catheter fitted but feel like i have a lot of urine leaking from my penis. I have tried repositioning the tube and bag. I it normal to have a lot of leakage?

User
Posted 05 Oct 2022 at 16:31

David, passing lots of urine down the outside of the catheter, known as bypassing, can be a sign of a blocked catheter. Are you still passing plenty of urine into the bag and does the bypassing reduce when laying down or at night.


You could get the catheter flushed out, but you were probably told do not let district nurses etc change your catheter. 


It can just be the catheter is a position where it is easier for the urine to come out of the penis instead of through the catheter. Best not to mess around with the catheter, you could call the ward that discharged you for advice 


Thanks Chris 

User
Posted 05 Oct 2022 at 17:01

Originally Posted by: Online Community Member


David, passing lots of urine down the outside of the catheter, known as bypassing, can be a sign of a blocked catheter. Are you still passing plenty of urine into the bag and does the bypassing reduce when laying down or at night.


You could get the catheter flushed out, but you were probably told do not let district nurses etc change your catheter. 


It can just be the catheter is a position where it is easier for the urine to come out of the penis instead of through the catheter. Best not to mess around with the catheter, you could call the ward that discharged you for advice 


Thanks Chris 



 


The bypassing/bag filling seems better when lying down or sitting back with feet raised. I just expected the catheter to take all or most of the urine from my bladder.  I will phone the hospital in the morning to check if no improvement. 


Thanks 

User
Posted 05 Oct 2022 at 18:44

David, there are variations in catheters but generally the catheter after surgery has the drain hole above the balloon in a urethral situation. So if the balloon is sitting slightly high in the bladder more urine will accumulate at the outlet of the bladder. Laying down or laying back means the urine can get to the drain holes easier and not so much urine will accumulate.


The hospital may give you some advice. I have a permanent suprapubic catheter and an infection can cause me to leak more out of the penis than into the bag. I had several procedures after RARP and sometimes had to wear a pad  in addition to having a urethral catheter.


Thanks Chris 


 

User
Posted 05 Oct 2022 at 18:53

I have been wearing a pad since discharge, initially the pad was just a little wet, but today it has been soaked, that's why I thought that there might be a problem. 

User
Posted 05 Oct 2022 at 19:57

David, I think it would be fair to say it is not what usually happens, I don't like using "normal" . Is there a problem, not necessarily but good that you are going to ring the hospital for advice. I am assuming the catheter is not trapped, kinked or bent and that you have the bag below the level of your bladder. Sometimes a bag change can help the flow,I don't know why, but many people on a Facebook catheter site say it solves the issue. 


Thanks Chris 

User
Posted 05 Oct 2022 at 21:03

I have a spare bag so will try changing it. Had a couple of times where the tube bent,but have been extra careful to route it to make sure that it doesn't get blocked and have it strapped to my thigh. 

User
Posted 25 Oct 2022 at 09:14

Hi Guys,


Interesting thread re pain in the Perineum area.


I had my RARP nearly 4 years ago and recently finished a course of RT. I've found since RT started I have real discomfort when out cycling and find I have to get out the saddle to relieve the aching. I've changed the racing saddle to a gel type which didn't help so I've now fitted the gel saddle off my hybrid to my road bike and bought new padded cycling shorts which all help to some degree.


Anyone else experienced this and any other tips to ease the discomfort


Cheers


Rob

Edited by member 25 Oct 2022 at 09:22  | Reason: Not specified

User
Posted 25 Oct 2022 at 19:10
Rob
You can get a prostate friendly sandle. They have a cut out in the middle so that you are supported on your sit bones.
Amazon among others have a selection

Cheers
Bill
User
Posted 26 Oct 2022 at 15:00

Thanks Bill for your tip - my current saddle does have a cut out in it which is supposed to aid ventilation to the nether regions. My  gel racing saddle didn't have this feature though which is probably why it was uncomfortable.


Rob

User
Posted 12 Nov 2022 at 16:22

I am 2 1/2 years post RARP and am still getting pain from my perenium area when sitting for some time, eg. watching TV. It is more an annoyance than a severe pain, but I would like to know if anyone else had had a similar problem and what they have done to relieve it. I stopped doing pelvic floor exercises about a year ago as my continence was under control. 

User
Posted 12 Nov 2022 at 19:59

Dennis, have you had any noticeable change to your urine flow, smelly urine or visible bits in the urine. I had issues with kidney stones and surgical clip migration. Have you had your urine tested. 


Thanks Chris 

User
Posted 12 Nov 2022 at 20:03

Chris, I haven’t had any change to my urine? but I do self self dilation weekly as I had a stricture about 18 months ago. 

User
Posted 12 Nov 2022 at 21:36

Dennis ,I developed a stricture not long after surgery and had lots of dilatations and had a long period of doing daily self dilatation. The self catheterization could be the cause of the perineum pain either through rubbing, introducing an infection or dragging some debris into the urethra.


Thanks Chris 

User
Posted 12 Nov 2022 at 21:41

Thanks for that Chris. How long did you did you continue with self dilation?

User
Posted 12 Nov 2022 at 23:10

Dennis, you probably don't really want to know. I did it for around three years, in that time I went back into theatre around 12 or 13 times. We were taking a very conservative approach to the treatment preferring dilatation to incisions into the scar tissue. Prior to needing salvage RT I had a suprapubic catheter fitted in case the RT caused the stricture to close up. Quite rare but the SRT damaged the bladder and I have the suprapubic catheter for life. I can still pass urine through the penis so the stricture is open.


I did find doing weekly like your self was better than daily or every other day.


I was going to have urethral reconstruction and possibly an artificial sphincter but the rare bladder damage meant it was not a practical solution.


Thanks Chris 

User
Posted 13 Nov 2022 at 20:52

Wow Chris, you have certainly been on a challenging journey!


I am also in my 70s and try to keep myself active and fit. I consider myself very lucky that my PC was detected in a routine medical before I retired. I had no symptoms! I always feel so fortunate when I hear the experiences of men with advanced prostate cancer


I have a call with my consultant, (Name removed by moderator), on Friday when he will advise me of my latest PSA test. I will take the opportunity to advise of the ache from my perineum, although minor,  as it is not something we have discussed previously.

Best wishes for the future and managing your ailments. 


Dennis


 


 

Edited by moderator 13 Nov 2022 at 22:38  | Reason: Not specified

User
Posted 16 Nov 2022 at 15:29

Originally Posted by: Online Community Member


"I am 2 1/2 years post RARP and am still getting pain from my perenium area when sitting for some time, eg. watching TV. It is more an annoyance than a severe pain, but I would like to know if anyone else had had a similar problem and what they have done to relieve it. I stopped doing pelvic floor exercises about a year ago as my continence was under control."


 


 


Dennis,


You say you've stopped your pelvic floor excercises - I was told by my incontinence nurse I would need to do them for life as with any muscle if you don't use it/them, the muscles become weak and the risk of becoming incontinent again increases.


I would be interested to know if anyone else has stopped doing pelvic excercises and how did it affect their continence


Rob

Edited by member 16 Nov 2022 at 15:30  | Reason: Not specified

User
Posted 16 Nov 2022 at 15:51

Hi Rob, I have now been advised by one of the specialist nurses at PCUk to restart my pelvic floor exercises for the reason you state. Regards, Dennis

User
Posted 17 Nov 2022 at 16:16
Hi Dennis,

A small inconveniance doing the excercises if it means no problems with leakage

Best wishes
User
Posted 17 Nov 2022 at 16:32

Agreed Rob

User
Posted 18 Feb 2023 at 10:48

I am 2 weeks today post op, and the advice and comfort given on here is terrific.


All the issues are clearly more common than I thought, and my biggest concern is going to be that my job, requires me to drive for upto around 3 hours max, sit on my backside and drive the same home.


I will be working from home after next week for a while, but again its sat on my bum at a PC.


Any tips at all, and I am looking forward to bag removal on Monday? 


 

User
Posted 18 Feb 2023 at 12:13

I went back to work 4 weeks post RP. I sit on my backside 8 hours a day. Yes certain sitting positions would give me a level of discomfort. For 1 I would get up and walk around a bit. Since I was doing my pelvic floor 6 times a day my alarm forced me to do this. I also checked my sitting position regularly. Obviously driving is not going to make either of these easy to do.


4 months post op back into bad habits but no discomfort...

User
Posted 18 Feb 2023 at 12:38

Thanks Jim, any tips on sitting at all? 

User
Posted 18 Feb 2023 at 12:39
It seems very quick to be going back to work. General guidance in the past has been to have at least 6 weeks off after keyhole RP and 10-12 weeks following open surgery. If you must return to work so soon, perhaps just a couple of hours a day to begin with - physical recovery from RP uses about 5000kC per day so you may feel very tired very quickly and at this point, you don't know how continent you will be.

Some men do recover exceptionally quickly but many need those 6-12 weeks and there is no shame in that. The very macho "I was playing golf the day I had my catheter out" or "I competed in the World's Stongest Man the next day" creates a misleading picture of what is normal and can make other men feel they are somehow being soft or weak.

I don’t know of any official data but based on the membership of this forum, the men who have gone on to develop hernias almost all did far too much too soon.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 18 Feb 2023 at 13:14

Hiya, I will be working from home to start with for some time. 


My work is almost all behind a laptop screen, so it's not exacting, but yes I will not be putting myself in any physical danger.


I think that because you cannot see it, you just don't appreciate just how much has gone on underneath. My wife keeps telling me as much. I'm certainly not macho enough to say "hey look at me". So I will be listening to everyone and certainly taking your advice, thank you.

User
Posted 18 Feb 2023 at 15:48
Ha! I wasn't suggesting that you would be entering any strongman competitions... I was thinking of a member here some years ago :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 18 Feb 2023 at 17:44

I think I'm underestimating what has happened (as my wife keeps reminding me) lol...

User
Posted 18 Feb 2023 at 18:54
As I said, your body needs 5000 calories per day to heal after RP - that's either a lot of food to consume or a lot of resting up!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 18 Feb 2023 at 20:27

Makes you think doesn't it. 


I shall take and use all the advice I can get.


It's been so quick, that i've still not had time process it all.

User
Posted 20 May 2023 at 18:14

9 days out of RARP surgery and today started with the pain - almost like severe constipation but my bowel movements have been quite loose so jumped on to Google and found this conversation. So thanks for all of the comments and I now feel more comfortable that this is a typical issue and nothing to be concerned about.
Bladder control seems to be reasonable - very slight leakage and I know I have 30 secs to get to the loo after standing up - but I do seem able to start the flow on command and the bladder is emptying in one go - been a few years since I had that LOL

Watched a video on YouTube of the entire procedure today - I can post a link if anyone wants it - now I know why it takes a couple of months to heal LOL.

Edited by member 20 May 2023 at 18:16  | Reason: Not specified

User
Posted 28 Jun 2023 at 00:01

Hi Rich,


read your post. You could not have described my situation any better! I am 7 weeks post RP and still have perineal pain when sitting that radiates into my penis. This occurs after sitting on a firm chair or riding in a car. It makes my bladder spasm and feel like I have to pee, which I don’t need to most of the time. Rest and sometimes ice makes it feel better. 
Unfortunately, I am grounded to be at home right now! 
Did your situation finally resolve? Like to hear the details. Give me some hope!


 


Jihn

 
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