It is not uncommon for a gentleman to come in to see me complaining that everything south of his belly button hurts. This includes abdomen, groin and testicles. The challenge then becomes to try and sort out where the origin of pain is and what we classically call “referred pain”. History taking and physical examination become key tools in making a correct diagnosis. I cannot stress enough how important accurate answers are to the history taking process.
There are several possible causes for this particular pain. They may include such disorders as constipation, appendicitis, diverticulitis, kidney/urinary stones, prostatitis, an STD or Epididymitis, a hydrocoele, a primary or secondary cancer, testicular cancer,orchitis to name some.
If the pain seemed to originate in the abdomen, what could it be? Constipation, which is characterised by infrequent, very hard stools causes a distension of the large bowel with associated gas build up. This causes pain and discomfort in the lower region of the abdomen. Possible causes for constipation could include an inadequate consumption of liquids, a lazy bowel or antihypertensive medication that has a diuretic component as these drugs tend to force more liquid through the kidneys than out through the stool.
It is possible for appendicitis to cause pain just below the umbilicus and/or across the right abdomen. In some cases of perforation of the appendix, infection can spread from the abdominal cavity and into the testicle; thereby, also causing pain in the testicle.
Diverticulitis is another possible cause of lower abdominal pain which could spread in to the testicles. This disease is caused by the inflammation of small blister like pockets that form in the inner lining of the large intestine. Pain in the lower left abdomen, severe constipation, fever and a swollen abdomen are characteristic of diverticulitis.
Kidney or urinary stones also have to be considered in the whole picture. Kidney stones are formed from the abnormal crystallization of urinary salts and when they lodge themselves in the ureters, urine is prevented from flowing into the urinary bladder. This first causes the ureters to spasm and as urine starts to back up into the kidney often excruciating pain results. Some men have told me the pain could be likened to women’s labor pains. I’m not sure how they can make that comparison but the severity of the pain is well documented. Because we are dealing with the “urogenital system” it is not untoward to expect transferred pain into the testicles.
Prostatitis, an inflamation of the prostate, can be bacterial or non bacterial in nature. It is characterized by pelvic and low back pain, fever, chills, a very tender prostate and distended bladder. Other symptoms could include problems voiding, painful ejaculations and low libido.
Another possibility for abdominal, groin & testicular pain is the presence of an inguinal(groin) hernia. These occur where there is a weakening in the muscular wall of the abdomen such that a portion of intestine is allowed to pass through the inguinal canal and into the scrotum. There is a feeling of heaviness and the scrotum may be swollen. Hernias can be caused by lifting something too heavy, or increased abdominal pressure due to laughing, coughing or sneezing. Relief from hernial discomfort or pain is usually only accomplished by lying down.
I would be remiss in omitting the part that a primary or secondary cancer could play in the cause of abdominal, groin, back and testicle pain. Here primary sites could be kidney, late phase testicular, prostate, colon, pancreatic etc. However, a whole book could be written on this area, which is not the purpose of this post.
For information on abdominal, groin and testicle pain caused by epididymitis, orchitis, testicular torsion, and testicular cancer there are other posts that deal with each separately or you can go to the link below to purchase my book which gives you in depth information.
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