Severe Left Lower Abdominal Pain After Prostate Surgery: Seeking Medical Advice

Severe pain in the lower left abdomen one month after prostate surgery affecting daily life?

Hello Doctor,
My father underwent a prostatectomy one month ago and has been recovering at home.
A week ago, he started experiencing severe pain in the left lower abdomen near the groin, which radiates to the inner thigh and significantly affects his quality of life and mobility.
The symptoms observed are as follows:
1) Fixed timing of pain: The severe pain consistently begins between 7 PM and the following morning, with nighttime pain being unbearable, severely impacting his sleep.
The pain medication prescribed by the hospital has not provided significant relief.
2) Frequent urination: He consumes over 2000cc of fluids daily, with urination intervals during the day exceeding one hour.
He experiences approximately three episodes of urination at night.
3) No abnormal protrusions in the groin area, and it does not appear to be a hernia.
4) The urine color is slightly pale yellow and clear, with no abnormalities.
5) There is no sensation of residual urine after urination.
6) An ultrasound examination conducted a few days ago did not reveal any stones.
7) He has been taking the medication prescribed for overactive bladder, but there has been no noticeable improvement.
I would like to ask the doctor for guidance on the next steps for managing this severe pain and any recommendations.
Thank you.

Su Xiansheng, 30~39 year old female. Ask Date: 2021/08/01

Dr. Cai Zhuorong reply Urology

The condition you described is relatively uncommon and may require further examination.

Reply Date: 2021/08/01

More Info

After prostate surgery, experiencing severe left lower abdominal pain, especially radiating to the inner thigh, can be concerning and warrants further investigation. Given the symptoms you've described, including the timing of the pain, urinary frequency, and the lack of improvement with prescribed medications, there are several potential causes and subsequent steps to consider.

Potential Causes
1. Post-Surgical Complications: After prostate surgery, complications such as nerve damage, infection, or hematoma (a localized collection of blood outside of blood vessels) can occur. These complications may lead to significant pain and discomfort.

2. Nerve Entrapment or Damage: The surgical procedure may have affected nearby nerves, leading to neuropathic pain. This could explain the radiation of pain to the inner thigh.

3. Muscle Strain or Spasm: The surgery may have caused strain on the abdominal or pelvic muscles, leading to spasms that can be quite painful.

4. Urinary Tract Issues: Although your ultrasound did not reveal stones, other urinary tract issues, such as inflammation or infection, could still be present. The frequency of urination and the timing of your pain may suggest a connection to bladder irritation or overactivity.

5. Visceral Pain: Pain from internal organs can sometimes be referred to other areas of the body. The left lower abdomen pain could be related to issues in the bladder or surrounding structures.

Recommended Next Steps
1. Follow-Up with the Surgeon: It is crucial to return to the surgeon who performed the prostatectomy. They are familiar with the surgical details and can assess for any complications that may have arisen post-operatively.

2. Pain Management Consultation: If the pain is severe and unresponsive to standard pain medications, a referral to a pain management specialist may be beneficial. They can offer alternative treatments, including nerve blocks or other interventions.

3. Imaging Studies: If not already done, further imaging studies such as a CT scan or MRI may be warranted to evaluate for any complications that were not visible on ultrasound.

4. Urology Consultation: Given the urinary symptoms, a consultation with a urologist may help rule out any bladder-related issues that could be contributing to the pain and urinary frequency.

5. Physical Therapy: If muscle strain or spasms are suspected, physical therapy may help alleviate symptoms through targeted exercises and treatments.

6. Medication Review: Discuss with your healthcare provider the medications you are currently taking, including the bladder overactivity medications. There may be alternatives or adjunct therapies that could provide relief.

Conclusion
Severe abdominal pain following prostate surgery is not uncommon, but it should be thoroughly evaluated to rule out serious complications. The combination of your symptoms suggests that a multi-disciplinary approach involving your surgeon, a urologist, and possibly a pain management specialist would be the best course of action. Prompt follow-up is essential to address the pain and improve your quality of life. Always ensure that you communicate openly with your healthcare providers about the severity and impact of your symptoms on your daily activities.

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