Right side, lower abdominal pain, groin pain

[vnenov]

’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

[vnenov]

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

[vnenov]

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

[vnenov]

Hello,

My current diagnosis is costochondritis with reffered pain in the 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

[vnenov]

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 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

[Croat]

I have same pain... it started 2 month ago when i went to doctor and he gave me voltaren :S
Voltaren helped a lot and after 10 of treatment the pain was gone but came back after almost a month. Tomorrow I will go to see another doctor....
I am form Europe and all test are free here so I hope that they will find the problem...
I will update after that ;)

[SGT712]

my lower right back/lower right abdomen has actually been bothering me for quite some time.  i would feel discomfort (pressure) only when i was sitting and it was completely random.  sometimes it wouldn't even hurt at all but other times it would hurt not too long after i sat down.  thought it might have been a pinched nerve since it only occurred when i was sitting.  it got progressively worse the past few months until i went to get it checked out.  i had all sorts of tests done including ultrasounds and MRIs but they all came back negative.  the only test i wasn't able to get done was the MRN (basically like an MRI but for nerves) since i didn't have health insurance (and still don't since i'm currently temping).  i even went to acupuncturists and had them do acupuncture and cupping but it didn't really seem to help.  just recently i went to a massage therapist and he seemed to work wonders.  most of my lower back pain is gone after a few sessions but i'll occasionally feel pins and needles accompanied sometimes by burning sensations and tightness on my lower right abdomen.  i have a feeling it's connected with whatever's going on in my lower back.  i've been going to the hot tub at my local gym a few times a week because i heard the heat helps injuries. i'm still not sure what it is i have but i'm going to stick with this regimen and will try attending some hot yoga classes as well.

vnenov and croat, any updates on your current situations?

[Dr Vinod]

The best thing about you is there is nothing in your scans and MRI, so you have not damaged anything.
Ergonimics at work is very important, please select the best chair for you and also keep moving and walking after you sit for some hours.
Massage and other things are a good idea but always go to a professional and take care of your back, do regular exercise and strengthen your back muscles which support your spine.
Take care

[bkecskemeti]

Ergonomics at work is indeed important, but unlikely to make a difference in such a case. Moving and walking around is good general advice, but again, not sure if it helps in such a chronic case. For me, nothing really helps except lying down and having a rest. And of course, after getting up it starts again.

[dallascowboy319]

I just read your complaint about right-sided abdominal pain under the ribs with accompanying testicular pain on the same side. You described my symptoms perfectly. It only bothers me while sitting for some length of time or perhaps while bending over to pick up an object from the floor (which results in a compression of my abdominal area).  This condition started in January of 2009 and continues to this day.

I am a very active 59 year old male in otherwise good health, however I was diagnosed with a common liver cyst after an abdominal ultrasound two years ago. Most liver cysts are asymptomatic and are usually discovered incidentally while looking for causes to other conditions.

I have been to my internist (abdominal ultrasound), to a gastroenterologist (CATscan, and colonoscopy) and to a urologist. All test results are normal and they have no idea what is causing my pain.

A close friend who had hip replacement surgery claims that her symptoms were similar to mine prior to her diagnosis of her hip joint  deterioration and that she has not experienced the problems since she had hip surgery. I am going to an orthopedist next to see what they can find, but I am frustrated by the continuing pain and lack of a clear diagnosis.

Please let me know if you find an answer to your symptoms and I will do the same.

dallascowboy319

[daveofderby]

I’m male, 38 and have very similar same symptoms and it's been going on for 7 months.  The doctors don't seem to know and I found it hard to find a reason as test were normal and I couldn't link it to what I was eating or doing.

I have now finally worked out that the pain gets bad when sitting too long in the same position (e.g. at a computer or driving) but it didn't always happen until I finish my journey (ie. move from sitting position) which is why I couldn't link it.

It reduced greatly over the summer and came back in Sept. I didn't drive much over the summer and wasn't at work.

I have found that if I stretch my torso by leaning back my abdomen muscles are pulled and it is painful, but after a few stretches much less overall pain for the rest of the day.
I am trying now to research the reason for this. It’s as if compressing my muscles for too long a period is perhaps building up something in the muscle to cause pain? A chemical imbalance of some sort?

[chris410]

im 22 y/o male who has the same exact syptoms. (right abdomen and right testiclular pressure. Its not pain, they just feel sensitive. I haven't had this problem until I started working a desk job in June, so I think theres a general consesus that staying in one place for too long causes this. I will start exercising and keep you posted.

[brian13]

39 y.o.male with similar symptoms. CT scans negative, although there is a stable 1.5cm liver hemangioma. No testicular pain, but some other tear-like symptoms in the right abdomen (I'm an active overage soccer player).

In addition to the right pain below rib cage, pain also bounces about hitting on kidneys, below sternum, and also higher on the rib cage. 90% of the discomfort is centered below right rib cage, though.

Recently I've developed belching/burping that might be related and point towards a GI cause. Any thoughts anyone?

[DeanWest]

I just came across your posts and am so happy I have.
I'm 39 year old male, that has had the EXACT symptoms for almost 7 months now. I have had test after test after test and still nothing has come up. I will be going for a colonoscopy in the New Year and am very nervous about it. It is one of the only tests left, and get very stressed at the prospect of colon cancer.
I will take all of your information with me to see my Doctor and hopefully the colonoscopy results will be as negative as the rest of the tests.
Once again, I thank you for your posts. It truly has helped.

Dean

[gf700]

6 months with same condition described in the original post.  Feels fine getting out of bed, but always there a few hours later.  Lots of sitting at work.  Some days a little better than others.  Next step abdominal ultrasound.  NSAID's have had no impact.  Original pain onset following excessive abdominal crunches and cable crunches in May.  Pain just on right side just beneath lowest rib, but often radiates to the side and back along the rib.  I was very athletic until this happened, now totally inactive.  Very frustrating.

Greg

[omara74]

Hi,

I wish this was an email telling you what I've found out about my condition. You have accomplished one thing, and that is I'm starting to believe it is not depression. It's not only you and your condition, but the help has come from those that respond to your column as well. December 8th I received the results of my CT Scan. I have a 1mm stone in my bladder, but it should not be the cause of my pain. It's too small to cause this kind of discomfort. Remedy to my problem; drink a lot of water, and call me later. I have yet to find out if a 1mm stone has ever caused severe pain. After all, I received this information through a desk clerk, who received it from the Doctor's Nurse. I want it to be this stone so bad. Let it be the stone, please. Anyone out there ever have a 1mm painful stone. I'm not sure what my next step is gonna be. I guess I can check out the "Depression" theory, and maybe my mind will be free of the pain causing depression. Later.

                                          Mike O

  

[rockwilda]

I am 24 year old male and started having groin/testicle pain on a daily basis last February. First I went to my Doctor for the STD check and UTI test...both clean. The doctor also performed a physical exam in which he felt a tenderness in my Epididymis. He prescribed 30 days of antibiotics which pretty much did nothing. The pain did seem to slow down but I am still not sure if it was just me ignoring it since my tests came back clean. Over the summer the pain got worse and it began to slowly rise toward my abdomen. Now as i said before I'm 24 and until recently I lived on my own and did not cook. So the past few years I have lived on alcohol, fast food, spicy food, cigarettes and coffee (large amounts) on a daily basis.  This is why I did not go to the Doc and complain about stomach pain. The fact that I have no health insurance is another reason I did not go back. Since the fall the pain has gotten extremely worse. The pain starts when I wake up with a throbbing in my testicles, upper/inner things, and groin. It also feels like theres something trying to rip its way out of my lower abdomen. As the day goes on the pain seems to travel higher, up into my rib cage, all around my torso and my lower back into my tailbone. By the evening it feels like Andre the Giant has had me in a bear hug for most of the day. I also move my bowels 3-4 times a day, sometimes 3 of the 4 are before noon. (thats without all the junk food beer and coffee too)  Sometimes randomly during the day I get a stinging pain in my urethra (feels like the cotton swab during the STD check) that is without urination or ejaculation. I went back to the Doc...more Epididymis antibiotics....no results and more pain. I switched doctors in October and my new one performed another physical exam to check for hernias or any type of lumps, a urine test and a blood test of my intestinal area...clean again. I just had an abdominal/pelvic CT getting the results tomorrow. It seems that the past month the pain stays on one side of my body at a time. Some days its from my left testicle straight up the whole left side of my body almost to my nipple. Other days its the same on my right side from top to bottom. I drive a truck most of the day and that increases the pain in my groin and testicles...also coming home and sitting on the couch the rest of the night makes it worse. I do exercise a few days a week although that does not bother my groin, it increases the pain in my torso. I know self diagnosis is not good but I have been doing a lot of reading the past couple weeks because I do not have insurance or the money for all the testing needed right now and it seems many men have had a dozen tests and no results. Seems like CPPS matches all of my symptoms except the pain during ejaculation and urination. I have also a lot more gas, belching, farting, terrible acid reflux, and heartburn. Like i said I ignored it for so long because of my unhealthy lifestyle and diet but after all the research theres no way its just from that. I have not had a prostate exam but I am thinking if the CT results dont show anything Urologist is the next step...any advice would be helpful!

[prosncons72]

Mostly for the men:
Sports hernias can cause the lower ab, groin pulling or spasms. They are hard to diagnose as there is usually no buldge unless the membrane tear enlarges enough for the intestine to come through.
For everyone else, microtear in the ab muscle...it is frustrating.

[Pejj]

Any updates on the situation?? I am going to request a urine test and abdominal ultra sound for similar pains in right groin area, pubic area, lower and upper abs and sides.
Weird strange pains, nothing too harsh but still worrisome.  Also I notice a slight burning sensation after peeing and maybe after ejaculation sometimes so I thought maybe it's related.  There is one spot on my lower right abdomen area which is tender when I press it a little.
I feel your pain, both of you and it's important to me to know what the source of the problem is.
Anything new with you guys?

[Mr_PC]

Just curious if anyone with these symptoms has a shortened iliopsoas on the affect side.  It is very simple to identify.  I have provided a youtube link below for the test.  Or you can simply google "Thomas Test."  Let me know if the hip is excessively flexed.  Feel better.

Tim

http://www.youtube.com/watch?v=9PLXyShrNDc

[bkecskemeti]

Thanks for the link. In my case, no sign at all of shortened iliopsoas. Interestingly, one of the doctors I visited insisted on a diagnosis of shortened iliopsoas (despite I told I do not feel any stretch in the Thomas test) and prescribed manual theraphy and "iliopsoas release", which was extremely painful, and did not help at all :(

[memyselfni_06]

WOW! I am completely blown away right now. I am so very shocked at the amount of people that share the same problem as I. I am a 34 year old female. I first noticed this pain around age 27. I was working for a Press company that required me to use my arms all day. Pulling them from over my head to about waist level in order to steam press pants. When I went to the doctor they tested me for gall bladder failure. To which the tests came back as normal. The pain seemed to diminish on its own. Then 3 years ago I became interested in working out. I began working out on the core ball. All was well. Seeing great results I then tried the bender ball. For those of you that don't know it's a very flexible ball about the size of a soccer ball. The very moment I began using it I noticed the famous pain in my side again. I immediately stopped working out, thinking maybe I had pulled a muscle. But it never went away. For the last 3 years the pain has been continuous...it rarely lets up. When I wake in the morning I feel the most relief. But it usually starts up again within 15 minutes or so of being awake.I have been to the ER several times. They always suggest gall bladder. The test has been done again two more times and is normal. I went to the ER in another state to which they suggested ulcerative colitis. However I have no insurance and could not afford the test. Upon another ER visit they referred me to another surgeon who refused to believe it was my liver, gall bladder or pancreas. He wouldn't even discuss doing the exploratory surgery on me *quoting it was expensive and I had no insurance. He said I had torn rib cartilage....costochondritis. I got a second opinion from his colleague and he agreed with his friend! I was laid off my job because they said I could not lift anything heavy for 2-3 months. Well, it has been 7 months now and I'm still in pain!!! I found a doctor a month ago that donates his time *for free*. He spent an hour with me...and I didn't have to pay him a dime...funny. The other doctors charge hundreds of dollars and your lucky to see them 10 minutes...they rush you out. He suggested a pancreas problem. But because I have no insurance and am on unemployment so I can't afford the tests. There are many similarities between my case and all of yours. I have always been a binge drinker on the weekends. I quit drinking about a year ago. Still no relief. I love coffee and drink a lot of it daily, I love spicy food and I could have possibly injured myself...so which one could it be...or all of the above. I have twitching in my side along with the pain and sometimes feel like I'm being stabbed. I am belching way more than normal. This pain mainly resides on my right side at my ribs...the pain can radiate around to my back and toward my belly button. All I know is I am terrified and very depressed. I pray to God every night that he will let me wake with the morning sun....I'm so scared.

[bulko24]

i have the same pain right lower abdomen pain through my testicle..i am 23 but no test yet..i have diarrhea for 4 days then my stool got so hard after that i have pain in my hip..sometimes my right leg got numb.....if this is appendicitis i can't play basketball, run or walk...any idea??plz help me..i am afraid on surgery if neccessary..=(

[pjm312]

I came across this post a year ago, and have pretty identical symptoms. Shortly after a run I experienced pain around my left groin. Over time it spread to my right groin and up into my right abdomen. The pain subsided in my groin and stayed on in my right side lower abdomen. It was constant and worsened by activity and sitting down. It only seemed to be relieved by laying down--and sometimes not even then. Tests showed now internal organ damage or hernias. For over a year doctors (radiologists, physical  therapists, chiropractors, interal medicine, pain management specialists, etc) could find nothing and where treating me as if I was a liar (I was even sent to mental health for an evaluation) and the military was considering discharging me.
Eventually my groin pain returned and along with it a clicking in my left hip. I brought this to the attention of my doctor and was referred to orthopedics. There it was suspected that I might has a tear in the tissue surrounding my hip. An arthorgram (an MRI where dye is injected into the joint that reveals the presence of tissue tears) was done and a tear was confirmed. So, I have a tear in the labrum surrounding my left hip socket. As it was explained to me by a phsyical therapist, this tear causes my hip to "kick out" of its normal alignment a want to give out. The muscles surrounding it clamp down and brace themselves to hold me in alignment sometimes causing me stiffness and pain. But along my opposite side, in my core, my right side abdomen, this bracing down tight to hold me upright and this over exertion and always being tight causes the pain in my side.
Currently I am awaiting an appointment with a surgeon to discuss treatment. Apparently labral tears can go without symptoms for a considerable time. Also, as in my case, their syptoms often do not immediately give indication as to their source. The only way to confirm a labral tear is with an MRI.
I hope this information can be helpful to someone else experiencing similar pain. A

[lisalmor]

I am a 37 year old female. I was wt lifting and running 5-7 miles everyday until Oct when I injured something. I was doing hanging leg raises and just had that feeling I needed to stop. I didn't experience any pain or a snapping sensation at all. I continued with my workout. In the next few days I started to feel right sided abd pain, groin pain that followed my illiac crest into my lower back and kidney area. The following week the pain was so bad I was in the ER. They did an ultrasound and labs..found nothing, the following week I was in the doc's office and had a full ultrasound done of all of organs except my heart...came back clean. In the mean time I'm taking Darvon which did nothing for the discomfort. Nothing helped. I was then referred to sports medicine and they cleared me..had another hip/femur xray taken. Went back to the doc's office and got a CAT scan...again nothing. Had my newly put in copper IUD removed. Didn't help at all. So here we are in Jan and even though the discomfort and pain are somewhat better it still is occurs. Some days I can't feel it all. Other days it comes back in full swing but not as bad as that first and second week.  I've tried to work out and do light wt lifting but I am scared to death that I am really going to hurt something or make whatever it is worse.  The pain seems to wax and wanes, and I can never quite localize it.  Heat often makes it feel better. Since time has gone on I often have a muscle spasm type feeling in my right calf. I think I may have some nerve involvement now too. I feel like I'm going nuts. I'll mention the labrum tear to my DR. I have a feeling they are just going to through me into neurology and give me a spinal tap to check for MS or something though.  Please post what you find out.

[gopackerswin]

I guess it's good to know I'm not the only one.  I am a 55 year old female who is very active.  For over a year now I've had a pain in my right side right under my rib cage.  Sometimes it feels like it is extending into my front and my back.  It is definitely worse when I am standing for any length of time, to the point that I need to bend over or sit.  I am actually starting to lean to the right as I subconsciously try not to pull this area.  I don't know if it's muscle related but as someone else said, it feels deeper.  Right now I am sitting but it is aching big time.  Too much stretching or exercise today?  Not enough?  It's hard to know what to do.

[dagnabbitsumb1tch]

i had the same problem for a year started in november of 08 til november of 09 when i couldnt bear it no more, i was puking and could not stop due to the pain, 'dry heaves' for 24 hours sucked.  I was 43 at the time i went to the E.R.,. they said my gall bladder was the culprit so they did an emergency surgery to remove the gall bladder and rushed me to another hospital to remove a blockage from the bile duct going to my pancreas. My pancreas was nuecrotic, or dying, then they sent me home, . one week later i was back in the E.R. puking.  then they said it was my appendix so they did another emergency surgery to remove it. my appendix had holes leaking into my abdomin making me sick and very painful. that fixed it, ive not been sick since except for a kidney removal the following month because they said i had kidney cancer when they did all the test on me. so before it gets too bad have the gall bladder and pancreas looked at real good, and if one has to come out, make them do both in one surgery, you won't regret it. the gall bladder or appendix might not kill you, but if it is making your pancreas die, then you die. thats what they told me, i almost died twice.