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Undetermined Lower Pelvic
I have pain mainly in the area between the scrotum and the anus. This pain does not occur while laying down but occurs while walking or sitting. After being rested there is no pain when starting to walk but it increases the longer I walk or sit. When pain is severe there is some sensation up the penis and the anus. When pain is severe there is a burning sensation when urinating. Even when laying down with no pain the pain will appear prior to a bowel movement. However, there is no pain during the bowel movement. Ten years ago I had prostate cancer which was treated with brachytherapy and IMRT beam radiation. There seems to be no prostate pain during ejaculation. Urologist says there is no infection and no bladder blockage. The problem first appeared when I took a sharp step up a cliff on my left leg. Then the problem subsided. Subsequently I was flyfishing and felt a pain in the groin when climbing out on a bank. A few hours later the pain appeared in a much more aggressive manner. Two months of rest brought it down somewhat and I thought it got better. I went to Alaska where I was active and it’s now painful beyond belief and no rest gives any improvement. I can only lay around. Two days ago I had a cat scan which showed 2 inguinal hernias. My doctor is suggesting that the pain from these hernias is unlikely to cause pain that far down. His experience is that inguinal hernia pain occurs further up. There is very little pain up where there an Inguinal hernia is usually found. This hernia was not palpable and everyone said it didn’t exist until the CT scan revealed it. At this point I am starting to have doubts that this scheduled surgery will target the problem.
What is your opinion Dr Towfigh? Is this the correct diagnosis or should I not go through with this surgery?
I live in the Central Oregon area but grew up in the LA area and am familiar with your location. Should I drive down for an examination? The pain is so severe that I don’t know if I could endure that drive.
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14 Replies
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Undetermined Lower Pelvic
idoncov, thanks for updating on your case and your progress. Please continue to update on these forums as you recover.
Do you mind sharing what type of surgery you had, where, and with what doctor? It could be helpful information to other patients.
Re bicycles: I know a few men who have groin and pelvic pain difficulties with riding bikes, and I know many men who have no issues with riding a bike, it may be an anatomical variance thing, and sometimes it comes down to the bike seat too.
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Undetermined Lower Pelvic
Regarding bicycle accident:
I’ve thought about this a lot. I’m not a bike rider. However, like most kids I rode my bike to school every day. I had a bike that was too big for me. At the age of about 14-15 I fell forward from the bike onto the the cross bar that male bikes have. The pain was unbelievable. I thought it would never go away, but eventually it did. About 5 years later my friend and I decided to ride our bikes from Hollywood to Ventura and back. Mine was a 10 speed with a narrow seat. I was in pain the whole time. And what frustrated me was that my friend rode his with no ill pain at all. I figured something was wrong with me ‘down there’ but if I just kept off the bikes I was fine. My family had no medical insurance anyway.
So could an injury have remained for so many years? I don’t know.
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Undetermined Lower Pelvic
I’ve had the left inguinal hernia and the umbilical cord hernia repaired, which still leaves the right inguinal hernia to do. It’s only been 7 days but the signs are very encouraging. Neither inguinal hernias were palpable so I’m assuming that the protrusion went into the inguinal canal?
1) I used to have to pee any time I sat down after a walk or when I woke up at night or in the morning. That need is gone.
2) I could not rest my arms across my abdomen for any length of time without feeling nerve pain that radiated from central abdomen to the lower groin area. Thats gone.
3) I used to feel a pain in the left perineum area that started when walking and wouldn’t go away until sleep. That’s gone.
4) After a short walk I could palpate a lump through the anus on the left side that could be pushed in but would pop out. This always occurred in unison with the ‘sitting on a golf ball’ sense described by prostatitis victims. That’s gone.
5) I had abdominal nerve pain that would always appear before pooping and was relieved by pooping. That’s largely gone.
6) The burning sensation at the end of urination seems to have diminished due to greater infrequency of urination. Doctor had theorized that this was due to irradiating the prostate area.
Due to the swelling from the surgery I still can’t sit for very long and really haven’t taken long walks. There still appears to be some aggravation when walking but much less than before.
It’s too early to come to major conclusions. Dealing with constipation during recovery was a major problem.
I’ve made reservations with Dr Jerome Weiss a month from now to do lower pelvic evaluation which would be likely followed by massage therapy of myofacial trigger points in the lower pelvis. I’ve never been too excited about this route because it seems that you’re treating the symptoms, not the causes. These trigger points seem to inflame by causes near them and you massage them until the ‘injury’ heals by itself. But, what the heck, if they reduce the pain then that’s what you’re after anyway. I plan the keep the appointments unless the issue resolves itself with the hernia healing.
The 2nd inguinal hernia is smaller I think but I’m going to have it repaired anyway. I think it’s a contributor to the ‘sitting on a walnut’ sense that still appears occasionally after a walk.
The recovery from the umbilical hernia has proceeded much faster than the inguinal hernia. Although more painful after surgery it healed fast and there is little discomfort now. The inguinal surgery is still painful down deep. That one might take a long time., although it’s not painful enough to require meds.
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Undetermined Lower Pelvic
Springsman,
Pudendal neuralgia is a nerve issue. The nerve runs from the lower back (sacrum) toward the very front, and follows the contour of the pelvis. It may be directly injured or entrapped by spasmodic muscles of the pelvic floor and hip girdle.
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Undetermined Lower Pelvic
Kristin Christensen, DPT is a Physical Therapist at Palo Alto Medical Foundation who is a specialist in pelvic floor issues. Surely there are others as well. Have you read the book “Headache in the Pelvis”? It is very detailed and may help you with specific pain issues in that area.
Turns out my issue is not a pelvic floor problem, maybe tight hip muscles. For the MD’s here, isn’t pudendal neuralgia a problem at the front of the hip area and not related to pelvic floor pain?
Also would a better alternative to surgery be interventional pain management with one or more of the newer techniques available?
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Undetermined Lower Pelvic
Do you do a lot of cycling(bicycle)?
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Undetermined Lower Pelvic
This is why examination is so important.
You may have a rectocele or obturator hernia.
A general surgeon or colorectal surgeon may be able to provide you with some guidance.
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Undetermined Lower Pelvic
Dr Towfigh
My issue still seems to me very much like hernia. I’ve been flat on my back for some time now and the pain still appears without activity. It always appears just before a bowel movement and diminishes after one. This is very consistent. It’s a pain in the groin area. This was a non palpable hernia. Could the fat/intestine have dropped down far enough to cause pain in the lower groin, near the anal region. Also when I stand up there is a firmness that appears inside the anus on the front side, the side facing the scrotum. When i place a finger in that area it feels like a soft protrusion near the entrance that can be pushed in. This is only felt when standing. It disappears when laying down. Could this be the hernia? It’s close to the area of pain.
Thank you for the responses so far.
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Undetermined Lower Pelvic
Thank you for your advice doctor. I am hoping that this can be treated with PT. I intend to see a Dr Jerome Weiss in the Bar Area for an examination and treatment. Virtually all Yelp reviews are positive about him although most say they got better and not permanently cured
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Undetermined Lower Pelvic
A primary pudendal neuralgia is difficult to treat and should be handled I. The hands of true experts. Dr Michael Hibner in Arizona is one.
It’s possible you have secondary pudendal neuralgia. That is, you have pelvic floor or hip girdle muscle strain or spasm and that is referring pain to you nerve. A good hip specialist may be able to help you figure this out.
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Undetermined Lower Pelvic
Thank you Dr Towfigh.
I didn’t want to hear that I had Pudendal neuralgia because there rarely appears to be a cure for it. Unlike hernia surgery it looks as though my best bet is a lifetime of physical therapy on myofascial trigger points which can flare up at any time. The nerve blocks and surgeries seem to be hit and miss in terms of actual resolution.
I can understand how some of the activities may have led to this condition but I’m not sure why coughing, passing gas, inhaling deeply, or defecating would cause pain so far down the pelvic area. I’ve actually had this condition in a milder form for about 20 years. About 4 years ago I had another illness that kept me bedridden for several months. After I started to get about the pain was completely gone. That lasted about 3 years. Then as the activities started to get more rigorous the pain came back and intensified. The other strange thing is that if I continued to tough it out with the activities I would reach a state where the pain was gone. But when it came back it was worse than the previous pain. It’s all a mystery. If any of this makes sense to you or give you any clues as to what is going on please comment because nobody else seems to have a clue.
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Undetermined Lower Pelvic
I cannot say definitively, but perineal pain, which is what you seem to be describing, is usually not a result of inguinal hernias.
Sometimes, obturator hernias can cause this symptoms. Sometimes, pudendal neuralgia can cause it. The pudendal nerve may be entrapped by scar tissue, if you had surgery there, it could be directly injured, such as with pressure from a bicycle seat, or may be entrapped by spasms of pelvic floor muscles, hamstring, etc.
So, perhaps you have hamstring or hip injury or strain that is causing secondary pain.
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Undetermined Lower Pelvic
Nobody has so far suggested that. I thought that since this issue first started with body raises with the left leg and has reoccurred and increased with activity it would not be a nerve issue. I have read some about pudendal neuralgia and some feel that it is a byproduct of something else that’s entrapping the nerve. Is that correct?
Are you suggesting my pain is likely not caused by the inguinal hernias found?
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Undetermined Lower Pelvic
Has anyone looked into pudendal neuralgia ?
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