Post RRP - Discomfort in Perineum / Prostate site

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.

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

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!

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

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. 

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

cheers

Nick

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.

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

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 

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

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

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 

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 

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

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

Best wishes

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? 

Thanks Jim, any tips on sitting at all? 

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.

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

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.