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Urology/pelvic floor muscles


QUESTION: I am 62. I had radical prosatectomy 3.5 years ago. I had severe pain after catheter removed which immediately disappeared after I self treated for constipation. The pain was a burning sensation in my groin area and penis. 8 months later the pain came back but was much less severe. The pelvic floor muscles seem to be extremely tense and prevent me from having an erection. I went back to surgeon and several doctors who had no idea what the problem was. I feel the pain when I am sitting and it almost always disappears as soon as I stand up. It also never occurs in the AM. This condition was probably caused by too many kegels, possibly done incorrectly, by bike riding at the same time the pain returned, and by intense exercise including basketball and hiking, especially climbing. I have only recently ruled out everything but pelvic floor muscle strain. I can easily stop the pain by simply resting. I was OK for the last 5 days until I decided to go for a hike which included climbing today with no indication of a problem while I was hiking. Several hours after I returned the discomfort was back. I have a difficult time with bowel movements, like I am pushing against a brick wall, but am not constipated. The pain usually starts about a half hour after a bowel movement, never during. Also had colonoscopy recently, no major issues found. No inflammation or obstruction. So my question is, how long should it take for rest to do the job so I can return to activities I enjoy?


Unfoftinately , the answer to your question is unknown. Your type of pain is an uncommon complication of your surgery.  You can try baclofen and valium (strong muscle relaxants)  and hot sitz baths. A physical therapy consult might also be of some help.

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QUESTION: I don't believe it is a complication of the surgery. I think it came from doing an excessive amount of Kegel exercises, possibly incorrectly, and riding a bicycle with the wrong kind of seat. If it had been from the surgery I would not have gone 8 months with no pain. However, I wasn't looking for treatment suggestions. I already know I can relieve the pain by avoiding certain exercises, doing reverse Kegels and employing relaxing techniques. My question was how long should it take for this to heal? I have no way of knowing because the discomfort from exercise doesn't manifest itself until hours afterward.


Once a radical prostate surgery is done, the anatomy is permanently altered and even delayed problems are considered complications.  Bicycle riding and incorrect level exercises are not known to cause the types of symptoms you have described.  scar tissue can form after surgery and this might contribute.

There is no way to predict how long, if ever, this may take to heal.

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QUESTION: " Bicycle riding and incorrect level exercises are not known to cause the types of symptoms you have described." This statement runs contrary to numerous testimonials on the internet, my personal experience, the opinion of my surgeon and common sense.
"Once a radical prostate surgery is done, the anatomy is permanently altered and even delayed problems are considered complications." So, what you're saying is that a complication occurred immediately after the surgery, disappeared for 8 months, and then returned for 2 and a half years? I don't think that makes any sense at all. The pain I have obviously has a cause and effect from repeated actions I have taken in the past. It happens at measurable, predictable periods after certain exercises. There is no doubt why it happens or what it is and I was not asking your opinion about that.


I should clarify.  Incorrect Kegels and bicycle riding can contribute to ED, perineal sensation alternations and some discomfort.  They do not typically, by themselves, cause pain during sitting severe enough to require treatment.  Your situation is altered as you've had radical prostate surgery which alters the anatomy.  Any such problem not present prior to the surgery that is in the same general area is generally considered a complication of the surgical procedure. The fact that it disappeared for months and then returned suggests something happened or didn't happen to cause this.  In other words, the surgery may have created the anatomy that allowed this other problem to develop.

Your actual question was how long it will take to heal.  The answer was it cannot be predicted.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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