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Hernia-repair pain or urological?
Hello, I’m 43 and I’ve been having multiple sources of pain, but I’m unsure of where to go from here. I’m going to explain my current pains first, and then my history with these pains.
My pains:
1) I have a left dull ache (slight pressure feeling) on the left side of my scrotum. I’m not sure if it’s coming from within my scrotum, my testicle or my abdomen. I think it’s probably coming from within my scrotum, possibly an ejaculatory tube. This started two months ago in conjunction with left testicle pain I was having. I saw my primary doctor for the testicle pain, he thought it was Epididymitis. He gave me a two week course of Cipro and it went away. However, the dull ache on the left side has continued off and on. Ejaculation, and even arousal, triggers the pain, and the pain lasts for days and dissipates each day until I ejaculate again. I ejaculate about two days a week. This has been going on for two months.
2) I have pelvic pain across my pelvis which I would describe as a dull cramping feeling. The pain comes and goes, and is usually accompanied by more frequent urgency to urinate. This pelvic pain started about four months ago, two months before the testicle pain episode and scrotum episode. When I first saw my primary doctor about it, it was also accompanied with loose stools. I feel that when I’m less stressed, the pain is much less. It seems to have gone away several times, only to return. My primary doctor did a urinalysis, bloodwork, digital rectal exam, hernia check and testicular ultrasound. The urinalysis showed no signs of an infection, the dre showed no signs of an enlarged prostate, and no signs of hernia. The ultrasound showed a few hydrocells, an epididymal cyst and no masses. Basically, he said everything looked good. When I told him I was still having the left side scrotal ache, he referred me to a urologist, which I haven’t seen yet.
My history:
1) Twelve years ago I had an inguinal hernia repair with mesh on the left side. (seven years before that I had one as well on the same side, but without mesh). The first 14 months after my surgery, I had the exact same pain on the left side of my scrotum, which was also triggered by ejaculation. Since that first year, I usually get at least one or two flareups of pain per year whenever I do something different, like lift something heavier than normal, and the pain can last anywhere from a week to 4 months. However, since the end of that first year post-op, the pain has been triggered by straining/lifting, not ejaculation. It’s the same pain I’m feeling now, just with a different trigger.
2) Ten years ago I was diagnosed with chronic prostatitis by a urologist. Initially, the pain was a pressure/ache in my perineum, as well as a stinging feeling in the tip of my urethra. Ejaculation was also a trigger when this was at it’s worst. Several courses of antibiotics solved the issue, but I occasionally get flare ups if I eat too many peppers or other spicy food. But for the most part, I’ve had it under control. And it’s important to note, the pain associated with my prostatitis flare ups feel NOTHING at all like my current pains.
So this is where I stand. I feel like my left side scrotal pain may be related to the old hernia repair, however I’ve never had testicle pain associate with it like I did a couple of months ago. And ejaculation hasn’t been a trigger for the hernia-repair pain for many years, just the first year of post-op. The pelvic pain I feel could be stress related, as my work as been a little more stressful, but the urinalysis did not show anything as far as infection.
My questions are these:
1) What different conditions could I be facing here? I will see a doctor eventually, but I’m trying to educate myself first as to the possibilities.
2) What types of tests might I encounter going forward? I’ve read about cystoscopy and to be quite honest it makes me very nervous and reluctant to race to the doctor.
3) Could this be related to the old hernia repair, possible nerve entrapment getting worse?
4) What type of doctor should I see?
Thank you
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12 Replies
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Right. No point in delaying the diagnosis.
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Dr. Towfigh,
I went to a urologist a couple of months ago. He thinks it’s prostatitis related and gave me another 10-day round of Cipro. My symptoms once again went away on the Cipro, but then came back a few days after finishing the cipro, just like before. My only trigger has remained ejaculation, but the pain has really gotten better the past couple of weeks. The duration and intensity of pain has slowly decreased after each ejaculation. However, I sneezed yesterday while sitting down (something I normally try to avoid), and since then the pain has come back. If this is small hernia recurrence, I suppose there is no point in waiting for it to get better before seeing a hernia surgeon? I think I already know the answer but figured I’d ask you anyway.
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not infection. just pain. due to mesh inflammationon or irritation of vas and its nerves.
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quote drtowfigh:1. Yes. Imaging may show a recurrence even if there is no examination finding.
2. Testicular pain may be related to inguinal hernia. Also, antibiotic has anti-inflammatory effect. So if pain is improved on antibiotic, it may have been a bacterial infection or a mesh-related inflammatory problem. If pain is cured with the antibiotic, then most likely that’s infectious.
So, you’re saying it could have been a testicular bacterial infection ’caused’ by a recurrent hernia? And would the ejaculation trigger be hernia related? Somehow the hernia causing inflamation the vas deferens? Similar to vas deferens pain post hernia repair?
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1. Yes. Imaging may show a recurrence even if there is no examination finding.
2. Testicular pain may be related to inguinal hernia. Also, antibiotic has anti-inflammatory effect. So if pain is improved on antibiotic, it may have been a bacterial infection or a mesh-related inflammatory problem. If pain is cured with the antibiotic, then most likely that’s infectious.
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quote drtowfigh:Hernia-repair pain or urological?
new hernia
Dr. Towfigh,
Would a recurrent hernia account for pain after ejaculation, or for the fact that the left testicle pain went away after a few days on the Cipro? This has me very confused.
A lot of this reminds me of the hernia pain I felt my first year post-op. But I’ve never had the strong left testicle pain (which went away), or the the general pain/cramping across my pelvis which comes and goes, and is sometimes accompanied by an urge to urinate more. -
quote Chaunce1234:chrpainman, I am not a doctor just a fellow patient, but:
Personally I would try requesting a dynamic ultrasound with valsava on the side you are experiencing groin pain on.
As Dr Towfigh suggested, an MRI with valsava can be even better but sometimes it is harder to get insurance or a doctor to sign off on, and some clinics do not know how to perform the proper test, you may want to present some research to help your case with that. Here is Dr Towfighs research on that particular matter https://www.ncbi.nlm.nih.gov/pubmed/25141884
Start noting if any particular activities worsen the pain, improve the pain, or change the nature of the pain. That can be helpful for a doctor to troubleshoot as well.
Perhaps seek out a hernia expert or groin pain expert in your region, they could help rule in/out a hernia recurrence or other possible issues. There are experts scattered around the country and the world, but you may have to travel to get to one depending on your location.
Thanks, I’ll bring that up to whomever I see.
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chrpainman, I am not a doctor just a fellow patient, but:
Personally I would try requesting a dynamic ultrasound with valsava on the side you are experiencing groin pain on.
As Dr Towfigh suggested, an MRI with valsava can be even better but sometimes it is harder to get insurance or a doctor to sign off on, and some clinics do not know how to perform the proper test, you may want to present some research to help your case with that. Here is Dr Towfighs research on that particular matter https://www.ncbi.nlm.nih.gov/pubmed/25141884
Start noting if any particular activities worsen the pain, improve the pain, or change the nature of the pain. That can be helpful for a doctor to troubleshoot as well.
Perhaps seek out a hernia expert or groin pain expert in your region, they could help rule in/out a hernia recurrence or other possible issues. There are experts scattered around the country and the world, but you may have to travel to get to one depending on your location.
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Hernia-repair pain or urological?
My primary doctor did a hernia evaluation on me when all this started and didn’t feel anything. Does further testing often find a recurrence that a typical evaluation would not?
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Hernia-repair pain or urological?
new hernia
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Hernia-repair pain or urological?
My last urologist visit was nearly ten years ago. I recently consulted with an online urologist and he thinks it’s more likely to be related to either my ongoing prostatitis or a hydocele. I have an appointment set up with a urologist locally in a few weeks, I’ll probably start there.
When you say a small recurrence of my hernia repair, you mean a flare up of pain from scar tissue / past nerve entrapment or a new hernia?
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Hernia-repair pain or urological?
Sounds like you may have a small recurrence of your hernia repair. I would focus on ruling that out, since it seems that you are already being adequately evaluated urologically.
A hernia specialist general surgeon is the best. Peruse this site for recommendations near you (Search button below).
Nerve entrapment does not occur years after a hernia repair. It is a problem early after a hernia repair.
I usually get an MRI pelvis with valsalva to help in the evaluation.
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