Ongoing anal pain one year after prostate surgery

[DaveH]

Hi guys. Just joined the forum.

I have a pudendal nerve block scheduled for June 2016 and wanted to basically find out if anyone else knows of or has experienced what brought me to this point.

In June of 2015 I had laser surgery to reduce my prostate. At the time I was experiencing my second episode of extreme urinary frequency/urgency, constipation and rectal "fullness", as well as pain in the perineum. After the surgery all of the urinary symptoms were much alleviated and the perineal pain went away entirely. In it's place was a constant pain in my anal sphincter (much worse when sitting) along with severe constipation. I also completely lost the sensation of orgasm (which has come back somewhat). There also is some pain urinating which makes my anal pain worse for a while. My urologist who did the surgery later told me he probably shouldn't have done it while I was having other symptoms.

After 3 months of straining and laxatives in order to have a bowel movement I saw a gastroenterologist. I was diagnosed with Pelvic Floor Dysfunction and went to bio-feedback which allowed me to stop straining but did nothing at all for the pain.

So then I went to a Recto/Anal surgeon. I have seen him three times. First he gave me a compounded ointment which did nothing. Then he prescribed 2.5mg valium 3 times a day which did nothing. Before the last visit I took 10mg valium just to see what it would do and it took the top edge off the pain so he upped the prescription.

My next visit is in June where he told me that if the pain is still present the next step is a pudendal nerve block.
He previously talked about Botox but I guess he changed his mind.


Has anybody else developed pudendal pain after surgery? Can anybody explain to me how laser surgery (which my doctor said was conservative) could lead to this? Did the surgery just change the symptoms of a pre-existing problem (first urologist said I had Chronic Pelvic Pain Syndrome) make them more severe? What are the chances of a surgical mishap involving the pudendal nerve?

I would appreciate ANY kind of reply. Thanks.

[janetm2]

Welcome Dave,
Sorry to hear that you are now dealing with more and different issues. Not sure what happened but I can say from experience that the constipation can definitely irritate the nerve and I have had spasms come on from that and work hard to keep it at bay. The nerve block can help with diagnosis. Good luck.
Janet

[DaveH]

Dear JanetM - thanks for the reply. I am sort of getting my constipation under control and I no longer have to use stimulant laxatives like senna. Oddly, this all happened after I quit taking Flowmax, which was prescribed for me when I only had urinary symptoms back in 2011. Due to the hypersensitivity of the nerves down there my bowel movements all come with an an extreme urge to go, but at least I am having them daily (only using stool softeners, magnesium and vitamin c megadose supplements). I just hope I am going through a very extended healing process and nothing permanent happened during the surgery. After one year the pain is about 15-20% less and it is pretty much constant except sometimes for an hour or so after a bowel movement. Unfortunately, my improved regularity has not translated into any noticeable pain reduction. On the positive side, the pain never seems to affect my ability to fall or stay asleep, which was not the case when my urinary symptoms were predominate.

[Violet M]

Hi Dave,

Yes, pelvic surgery, including laser surgery could affect the pudendal nerve. Laser beams can cut through tissue. http://www.fda.gov/Radiation-EmittingPr ... 115910.htm
Pelvic structures and nerves are close together in the pelvis and even with laser surgery, adjacent structures or nerves can be damaged but I don't know if that is what happened to you. Whatever happened, hopefully over time you will experience healing.

But, it could also be that your pelvic floor muscles are tense or overly contracted. Valium is a muscle relaxant which could explain why it helps take the edge off your pain. It might be smart to be evaluated by a pelvic floor physical therapist who is knowledgeable in treating patients with pudendal neuralgia if you haven't already been evaluated. Biofeedback is good for some things but for tight overly contracted muscles, often myofascial release is also used.

It must be really frustrating to have just traded one set of symptoms for another. There are 3 branches of the pudendal nerve coming off of one main trunk so there are many different symptoms that can be associated with pudendal neuralgia depending on what part of the nerve is affected. I wish you all the best in figuring out a diagnosis and finding the right treatments.

Violet