Post RRP - Discomfort in Perineum / Prostate site

Greetings All.  This has been a most informative and encouraging thread for me so far.  I am just 6 weeks post-op (Open nerve sparing RRP) and so early days yet.  I haven't even had a follow-up with the surgeon yet, due to Covid-19 lockdown restrictions and so don't even know my present PSA level (it was 9.8 pre-op).  I doubt it would be down to undetectable levels this early.

Anyway, I found this forum while looking for advice about perineal pain.  I had very little pain at all in the perineum area until last week when I woke up one morning with sore hips and groin and perineum.  Thought initially it was the onset of osteo arthritis in hips (I have had it in finger joints in the past) but affecting both sides at once so quickly seemed highly unlikely.  Then I wondered about lymphoceles (I had a few nodes removed) and may still get that checked out.  However, on reading this thread I'm obviously expecting too much too soon as far as overall healing is concerned.  It seems everyone's pain symptoms are quite diverse in nature, so I'll just continue on Nurofen and Paracetamol until I can get to see the surgeon after all this pandemic fiasco is over.

Thanks, all, for sharing your experiences here.  Much appreciated.

Rok

Hi guys

I have had numerous dilations for scar tissue but do recall having perineum pain as a regular recurring problem. I did have pain in the perineum for a few months post op, as posted earlier in this conversation. I have frequently been catheterised and that does cause pain to the perineum. Following my last dilation I did get extreme pain in the perineum and was prescribed antibiotics which did absolutely nothing. At the follow up urology appointment a couple of weeks later, I brought it up with the doctor who said it was an infection, after some discussion he prescribed a different antibiotic and it soon went.

Are your flow rates good and is your urine a straw colour.

Thanks Chris

Edited by member 18 Apr 2020 at 09:10  | Reason: Not specified

Mark

Great to see you are doing well. Have my 2nd set of PSA bloods next week since my RARP op on 27th Nov 2019. Last bloods <0.01 so fingers crossed. I still get perineum discomfort mainly from sitting in front of the computer. Great to read these posts as puts my mind at rest. When I mentioned it to the Prof in February he said it will last for a while as I’ve had major bowel/urological/abdominal surgery. He said it’s often easy to forget this given external appearance.

hope you are enduring the lockdown and wish you the very best.

TG

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!

Edited by member 18 May 2020 at 00:00  | Reason: Typo

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.