Pain After Prostatectomy: What is the Cause?

Dear Dr. Motola,

I'm experiencing coccyx pain 4 to 9 weeks after radical prostatectomy and it is very debilitating. Is this a reported problem with some patients after such surgery?

Histopathology indicated that cancer is specimen confined and MRI, CT and total body bone scan do not reveal any extraprostatic disease nor metastatic involvement of skeleton. Lymph nodes and seminal vesicles are not involved.

Is it possible that pelvic floor exercises are causing the problem due to pull of muscles attached to coccyx or muscle(s) in spasm. Or is likely to be a problem from the operation which should settle down with time? 

The pain that you are experiencing is most likely related to the healing process from the prior surgery. The pathology report demonstrates localized disease and the pain is not related to the primary disease. 

The pubococcygeus muscle is the muscle that you are contracting with the pelvic floor exercises, and although not well described in our literature, it is possible that some of your discomfort may be related to an overzealous approach to the pelvic floor exercises (Kegels) that you are performing.  Try to not do them for a short period of time, and observe if the pain diminishes.