ZocdocAnswersI had a prostatectomy over 12 weeks ago and still have serious pain. What should I do?

Question

I had a prostatectomy over 12 weeks ago and still have serious pain. What should I do?

It's been nearly 12 weeks since surgery and I have a great deal of pain between the anus and scrotum, pain in the scrotum (especially after sitting for a while) and bladder spasms that have been extremely painful. My urologist has me on amitriptyline for pain and sanctura for bladder spasms. My doctor says that my pain is not normal but does not have any explanation for the pain. Can you help?

Answer

I think there is one of two different possible causes for this pain. First, this pain may be due to an immediate complication of surgery such as a blown suture or an infection. This is the kind of thing that you would need to have taken care of by your urologist right away. I assume that you have had the routine follow-up after your prostatectomy and if you have, I imagine your surgeon has ruled these things out. These kinds of problems tend to cause significant pain, sometimes blood loss, and signs of infection if an abscess or another type of infection is present. It seems from your question that this is not what your doctor thinks is going on. Because your urologist has you on amitriptyline, I think that he or she assumes that your pain is due to some type of nerve damage or nerve irritation most likely secondary to the surgery. This kind of pain can be very annoying and difficult to treat. It persists even after the tissue damage from the surgery heals. The medications used for this pain are different than the typical medications were use for postoperative pain. The only way to know if the amitriptyline is going to work is if you stay on it for long enough to see if the pain improves. This usually requires that you get to a higher dose than the initial dose. There are other medications for nerve pain that might be tried, but if this pain persists and your urologist continues to treat you with the same medication, I would consider getting an appointment with a pain management specialist.

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