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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
I am thankful for this forum and am seeking advice or opinions.
PROFILE: I am male, 30, 6′ 140lbs, somewhat sedentary. Married, very low STD risk. No health history, no surgery.
SYMPTOMS: Years of right sided groin pain that had a quick onset. Pain is mostly in the right side pubic mound area under the pubic hair, about an inch above and to the side of the start of the penis. Pain is sometimes in testicle and vas defrans and inner thigh area across from same testicle too. Pain is always one-sided, never on other side. Pain can change from a dull discomfort to sharp stab, sometimes it feels like a groin nerve is being pressed or agitated.
The attached picture shows where pain usually is focused, with the dark blue spot representing the primary spot of pain, and the blue outline showing the general pain area. To me it looks like I have a faint swelling under the pubic hair in the area of dark blue as well, but the faint swelling doesn’t move if I cough.
Pain is duller usually when I wake up in the morning and generally increases as the day goes on. Poking or pressing on that specific blue highlighted pubic area is like a hot-spot, it hurts like something deep under there is a problem. Bending over or sitting down sometimes hurts too, I assume because it maybe pressures that area. Bowel movements do not hurt directly but something about having a bowel movement can lead to increase in pain afterwards. Having a very full bladder, a lot of gas or constipation seems to often worsen the pain as well, I assume from internal pressure.
TREATMENT: 6 different antibiotics, abandoned idea of longterm course due to GI side effects. Prescription Advil lessens pain but it does not go away. Prescription Hydrocod reduces pain but I do not take it due to side effects.
RESULTS FROM TREATMENT: No change in symptoms, minor temporary relief from pain meds.
TESTS: CAT scan normal but mentioned of inconsequentially small fat stranding in right groin canal area. Urine and prostate test normal. Testicle ultrasound showed some possible inflammation. I have done the turn and cough test where they rest a finger in scrotum but the doctor did not feel anything. I did have another doctor with turn and cough put their finger up higher closer to the pain area and think they may be able to feel something but they couldn’t tell for sure.
CURRENT STATUS: I was told I probably do not have a hernia, but if I did have a hernia it would eventually break through and be obvious. Basically I was told to live with the pain and wait, or go to a pain clinic.
MY QUESTIONS: Due to the location of pain, I wonder if there is a hard to detect hernia? Is hernia surgery worth pursuing? Is it better to go into pain management than to try and see if there is a hernia to fix? Is freezing out the nerves a better option? Any thoughts or opinions?
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7 Replies
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
A hernia specialist can help decipher the intricate differences and confirm your diagnosis.
Our book is written for the physician audience. But I am sure many patients would enjoy reading it. It’s quite good.
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
Dr. Towfigh,
Thanks for your reply. Symptoms (pain and sensitivity located mostly over pudental nerve sometimes into genital area started 1 year after last surgery in 2013 which was lightweight mesh placed to reinforce a light overlay done in 2010.
I am trying to better understand how you determine if a hernia is present or not, or if there is some sort of nerve problem that is not a hernia. I am in Colorado Springs and looking for a hernia specialist who really knows how to diagnose these issues.
Is the ultrasound the best imaging for this?
Also would your book be helpful for patients without medical background?
Thank you for this forum.
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
Springsman,
Depends on the timing of your pain. Last surgery was 3-5 yrs ago. When did the symptoms start?
And yes, not all radiologists are cognizant of the subtleties in mesh findings on imaging and their clinical implications. -
Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
May I ask a followup question? I have very similar pain and sensitivity but no inflammation. Also prior mesh placement 3-5 years ago, first an overlay and later reinforced, both with lightweight mesh.
Is it possible that this could be nerve irritation from mesh? And how is decision made on true cause, if that is possible? I had recent CT, radiologist did not indicate problem. Wonder if different imaging (ultrasound?) or analysis by hernia specialist can show either nerve problem or small hernia as you mentioned.
Do you look for different indications from imaging than a radiologist would?
Thank you.
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
Yes to all your questions, except:
No, nerve injection is not diagnostic for hernia.
Start with an ultrasound.
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
Thank you for the follow up, I will look into the film review idea first and go from there. I was now offered nerve injections too but that made me hesitant if it does not assist in diagnosis or treatment, and if I had an anatomical problem like a hernia I don’t see how that would help anyway.
Would sacroiliitis show up on the CAT scan? My thought is that vasitis would have been tackled by the battery of antibiotics but they keep wanting to prescribe more, I got the feeling it was a placebo and they just wanted me out of there quick.
I have been paying more attention to the mild swelling in the area, it seems to be gone when I wake up in the morning and after on my back for a bit, but it appears again after a few minutes of standing or sitting. It doesn’t always hurt to press on the swelling area but sometimes it is tender to touch and pressure, I don’t know if that suggests anything.
Could a small hernia be causing general groin pain but only sometimes be tender to direct touch?
Could a small hernia sometimes irritate a groin nerve and make the pain worse and sometimes not be irritating a groin nerve?
Is a nerve injection diagnostic for hernia?
Is there a specific test for determining a hernia is a problem or not?
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Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?
Your workup is incomplete and not acceptable. The pain is obviously real and there is a treatable cause for it.
The CT and Ultrasound are both positive but not diagnostic. I would recommend having the films re-reviewed. Alternatively, if these do not provide an answer, I recommend MRI.
Most likely, you have a hernia. Alternative causes are vasitis and sacroiliitis.
Do not burn or destroy any nerves. It will not cure any hernia. Also, it’s rare to unlikely to have a primary nerve problem without any trauma or surgery.
If you’d like to send me your films I can help review them. Just contact my office or fill out an online consultation on my website. Or, let us know where you live and we can recommend a specialist nearby.
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