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Right side, lower abdominal pain, groin pain
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Right side, lower abdominal pain, groin pain

I’m a 35 y/o male, 178cm and 155 lbs. I’ve been experiencing right sided abdominal pain for about 6 months now. The pain is under my right ribs. The pain radiates to my right side back as well. I’ve practiced weight lifting, swimming and karate for years. I'm completely unsure what caused it. It started as very minor pain, more like pressure. I’m fairly athletic and exercise 3-4 days per week, or used to… I haven’t been able to since I’ve had this side pain. The odd thing about the pain is that over few weeks it has gotten a lot worse, rather than getting better and since then stayed almost at the same pain level. This pain has stayed with me every single day for the last 7 months. It gets worse when I sit down. It’s not a sharp stabbing pain, it’s more of a severe ache. It feels like a warm/burning/almost tingly sensation on my right side. The pain goes over to the right side of my back, above my hip bone just below my ribs. It’s like my whole right torso is affected! Sometimes I feel the pain in my right testicle, which feels swollen and painful at the bottom of the right sac. I have a hard time sitting at my desk for work. Also, driving long distances is very uncomfortable and painful now. It feels like someone is poking me right below my right ribcage and I feel a lot of pressure and a pulling sensation on the right side of my back at times. My right oblique muscles are felt very tight on examination. When sneezing I feel a strong tingling in my right side. Sleeping on my right side doesn’t bother it at all, and when I wake up in the morning, the pain is pretty much gone! But of course within the first 10-15 minutes I start walking around a little bit and sitting down to eat my breakfast, it starts. It progresses throughout the day. (I have a desk job, and of course sitting makes it worse….) I can no longer exercise, all I can do is walk, and even that aggravates it sometimes. Food doesn’t seem to make any difference. What I eat doesn’t bother it. Nobody can figure out what I have. I’ve had many different types of blood tests, I’ve had a CT scan of my right side abdomen, a colonoscopy, an ultrasound of my right side, MRIs on my abdomen and thoracic spine and everything has shown up normal. I’ve been checked for kidney stones, gall stones, kidney problems, liver problems, gallbladder problems, hernia but so far, everything is normal! I did go to physical therapy for a couple of weeks, but it did not help, it only caused me more pain. Same thing with a chiropractor. I have also tried acupuncture and injury massage therapy with no luck. I think it is an abdominal muscle tear - sports hernia (athletic pubalgia), inguinal hernia or something urological (epididymitis, varicocele, prostatis, etc). It looks like some of the nerves are affected, because of the tingling sensation, but the spinal MRI did not reveal anything. Do you have any idea what this can be and how can be treated? What other diagnostic tests should I have?

Please, help if you can.

Vlad
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13 Comments Post a Comment
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Avatar_dr_f_tn
Hi,

Based on what you have posted ,you have undergone a series of tests already and they have all showed normal results.

At this point, what I can think of is a musculoskeletal or nerve related problem.There is no specific diagnostic test that will help us identify these.Usually a battery of tests are done and in your case you had most of these. A spine disorder or nerve impingement has been ruled out.

At this point, I suggest you have a urologic consult done.Gastrointestinal and spine related problems have been excluded. You have noted a sensation of swelling in the groin area.It is best to have this evaluated in case this may give us a clue on what causes your symptoms.

Continue with your pain medications .If you are undergoing any form of therapy do continue it.Physical therapy sessions may help .A referral to a rehabilitation or sports medicine specialist may help guide you through this.
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Avatar_m_tn
Here are some new developments today. I have received the results from the scrotum ultrasound and they found "prominence and echogenicity involving the right epididymal head which measures about 7 mm. These findings are consistent with regional or focal epididymitis". My STD urine samples came back negative as expected.
My family doctor has prescribed Cipro 500 mg bid for 10 days. He does not think the pain is related to the right side lower abdominal pain and tingling, but I think he is wrong. I had this sensation of swelling in the groin area and pain, approx. since my abdominal pain has started. But I do not think at this point there is a bacterial reason. If this is epididymitis, it is probably chronic. Interesting enough, on the CT scan I had 4 months ago, they mentioned enhanced 9 mm Meckel diverticulum and suggested possible Meckel diverticulitis, but the surgeon neglected it. Was there some infection going on related to the whole picture?!? I will ask for urological referral, but meanwhile how do you think I should proceed?

Thanks,

Vlad
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Avatar_dr_f_tn
Hi,

At this point, the tests showed an apparent focus. Taking your medications and completing the course of your antibiotics will be a wise move for now. This may be an underlying infection. A prostatic secretion culture may be able to help here instead of the usual urine culture.A follow up consult with your physician after the course of medications will be necessary to assess your response to the antibiotics.
You have mentioned of a diverticulitis. This may also help explain your symptoms.

Do you have any recent change in bowel movement?

Any change in the character and caliber of your stools?

Have you had a stool examination done?

Diverticulitis may present with more symptoms like vomiting, abdominal pain, and bloatedness.Do you have any of these?


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Avatar_m_tn
Hi Vanessa,

To answer your questions, I have not experienced change in bowel movements, vomiting or bloatedness. I am taking the antibiotic, which does not seem to help at all and I will request a referral to Urologist. I am 80% convinced my condition is sports hernia.

Thanks,

Vladimir
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Avatar_m_tn
Update: My costochondritis diagnosis was made by the doctors at the Sunnybrook Pain Management Clinic, after reviewing all diagnostic tests I have collected for the last 10 months - MRI (thoracic, abdomen), contrast CT scan (pelvis, abdomen), abdominal ultrasound, blood and urine, colonoscopy report. Every test came back negative and I was getting really frustrated. The doctors at the clinic performed the hooking maneuver, which caused a lot of pain on the right side, but almost none
on the left side. My pain is just below the ribs, on the right side and it refers to the back. The pain is position based, more aggregated when sitting, almost pain free when in bed. There is a condition similar to costochondritis called slipping rib syndrome, which may be what I have. Currently, I am going for myofacial release massage and I would like to include the prolotherapy in my treatments. Some people have reported very good results in decreasing the pain. After 10 months of drug trials (meloxicam, neurontin, cipro), which did not help at all, 2 months of acupuncture and physio I am not very optimistic, that this will be fixed at all. And I used to be a competitive swimmer, also have a black belt in karate and used to run in marathons. Very sad!

Vlad
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Avatar_m_tn
Hello,

My current diagnosis is costochondritis with reffered pain in the upper right abdomen and low back. I have some slight pain in the lower ribs 11/12. It does not make much sense to me, since costochondritis is self-limiting and should disappear in 2-3 months.
There are other conditions though, which could make it chronic like seronegative spondylopathies. My pain is traveling thru the T10/T11 nerves, like a band.
The pain is burning with tingling and muscle twitching when worse after prolonged sitting. My family doctor is doing the following blood tests to check for any of the seronegative spondylopathies:

Erythrocyte sedimentation rate (ESR)
Immunoglobulins (Ig)
C-reactive protein (CRP)
rheumatoid factor (RF)
antinuclear antibodies (ANA)
human leukocyte antigen HLA-B27
Sacroiliac Joint X-Ray: Looking for abnormalities of the SI

Something else to consider is a MRI of the brain for MS, but with the Canadian health care system this is not going to happen soon. Good thing is, next month I will be in vacation in Europe, where I can pay and have the test on the day and bring the CD back.

I will keep you posted,

Vlad
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Avatar_m_tn
Hello,

I have just returned to Canada from a vacation in the country I was born (in Eastern Europe). I have spend two days in one of the best hospitals there, meeting 6-7 specialists and undergoing many additional test, trying to confirm the diagnosis of costochondritis or finding something else. I will not go into details, but very few people have been tested so extensively. The only test I have opted out was the diagnostic laparoscopy. I have spend a small fortune, but in Canada this would cost me a downpayment for a condo and take about a year.

The end result was: chronic insertionitis, or inflamation (inflammation) at the insertion of the internal
oblique muscles into the lower ribs. Prescribed therapy: anti-inflamatory  physiotherapy - ultrasound, magneto therapy; cortico-steroid shots, anti-inflammatory medications, etc.

Again, my symptoms are burning pain and feeling for pressure, just below the right ribs, which starts building when sitting for a long time (at least 1 hour). I have started
special exercises complex and Tai Chi each morning with 1 min cold water shower afterwards. This builds my energy level and gives me some temporary releif. There is no pain when sleeping.

I am about to start the physiotherapy, but first wanted to check if somebody else out there has this condition or knows how to treat this chronic insertionitis of the abdominal muscles.

Thanks,

Vlad
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Avatar_n_tn
Vlad,

I have been suffering from a very similar pain on the same side, the right. I too have had all types of CT scans, ultrasounds, Urologist visits, you name it. Funny, I'm 38 now and I haven't been able to continue in the gym or my karate classes since December because of all this pain. In March or April of this year, I went into the emergency room because of this severe pain on the same side, the right. I've had kidney stones, and have IBS (irritable bowel syndrome) though it's been under control. The pain would be in my right side under the last rib in my back (kidney area I think), continue under the right ribcage line, and stop right at the abdominal area -- then a stabbing pain in the right side abdominal area and travel downward the right inguinal with intermittent pain in the right testicle. The hospital did all CT scans, checked for hernias, etc. I had 2 weeks prior had a complete CT scan and ultrasound of my kidneys and abdominal areas. Everything came out negative, but the pain was still there. The hospital as well as the other facility did state I had an extreme amount of gasses everywhere.

I know lodged gasses can cause the nausea and extreme pain, but this has been too frustrating. I've seen so many specialists, have had all these tests and blood work, and all comes out negative. My primary doctor stated fibromyalgia. Things started to calm down and the pain pretty much went away. Then about 3 weeks ago, the lower right inguinal and side abdominal pain has flared up again. Again, all tests have come back negative, but I still have pain. The only difference between my symptoms and yours is the addition of pain in that area where above the hip bone and below the last rib are, all that soft area then traveling into the soft tissue beside the pubic bone (in the inguinal area).

Many, many similarities and no known cause here, just pain. I'd like to know your current state, and if there is anyone else out there suffering like this.

In God's Harmony,
Roddy
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Avatar_f_tn
Have they cheeked for h-pylori.
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Avatar_n_tn
H-pylori is not present. I had a thorough blood analysis done some time ago and it wasn't present. Besides, my current symptoms are not really in the abdominal areas where h-pylori normally causes discomfort. Most of the pain right now is still in the lower right inguinal area, and underneath my right last rib towards the back.
I have scheduled an appointment next week with a surgeon to rule out any possibility of a hernia, and any ligament/tendon/muscle tear. I'll post an update as soon as I have the results.

In God's Harmony
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Avatar_f_tn
i have similer problam since 5 months but nobody tell me what the reson behind ,some doctor says this is nerve pain and walking is the best  medicine
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Avatar_m_tn
hola,todo empezo tras maniobra de elevacjon al subir a tabla de surf,oi un click,pronto empezo dolor,tras eco rotura fibrilar en abductor superior drcho,dolor en pubis derecho referido a abdomen derecho y cadera y lumbar derecho,tras eco,rm,y tac,todo negativo,hernia ingunal,pubalgia negativa tras rehabilitacion,ahora artrosis lumbar,y por fin una osteopata cree q sea spoas iliaco,ahora tras estiramientos parece q remite,levo ya once meses y ahora comienzo a nadar,tengo 35 años
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Avatar_n_tn
Vlad, I have very similar pain symptoms. I also have had tests, gone to different doctors, physio, chiro, and have not had any success in treating the pain. It has got progressively worse over a period of 6 months now. I am totally frustrated with this. Have you had any recent success in treating your condition.?

Desparately looking for help.

Len
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