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Excruciating lower abdominal pain. Can it be HERNIA?

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I've been suffering from lower abdominal pain (mostly lower left). I uploaded a diagram with the site of pain (large dot represents the most painful spot even when very light pressure is applied, the large circle is area affected) The pain is aggravated by touching and walking. I've seen a general practitioner who referred me to a gastroenterologist and urologist (to rule out slight testicular pain I've been experiencing). The gastroenterologist diagnosis was a possible inguinal hernia and referred me to a hernia specialist (Dr. Surick at Beth Israel Hernia Center). The urologist did not find anything abnormal and said to follow up with the general surgeon to rule out any small hernias. Upon examination by the hernia specialist (Dr. Surick) and CT-Scan, any hernia was ruled out and only possible diagnosis was a strained abdominal muscle.

The problem is, this pain has been ongoing for over 5+ months. Is only getting worse (having problem walking), and is on both sides (not just left, but also right abdominal side).

Age: 28
Height: 5'10"
Weight: 145

Past Medical History:
Partial SLAP Tear - 1-1/2 years old patientago, improved with rest and therapy. However, forced me to stop rock climbing till now.

L4/L5 and L5/S1 Herniation and Bulge - 7 months ago. Woke up with pain, sciatica, and glute pain. Keep in mind this happened during the period of inactivity so it was not due to rock climbing. Cause is still unknown.

Colonoscopy - No Findings/unremarkable
CT Scan - Impression were unremarkable
MRI - L4/L5 and L5/S1 Herniation and Bulge: Undergoing physical therapy at the moment
Sonogram of Testicles - No testicular torsion or any other abnormalities.

I am at a dead end as no one seems to know the cause of the problem or who to refer me to however, the pain is excruciating and debilitating.

Any help is appreciate it, thank you.

Category: General Surgeon

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Category: Pediatric Surgeon
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Thank you for your query at

I have gone through the image.
The sites of your pain are on either side of the midline. This is over the rectus muscle.
The organs in the body are fixed and the sites of pain that you have mentioned do not fit into any organ involvement.
As all the Investigations are normal, the pain is of muscular origin only. It can be quite severe and debilitating.
I prescribe a skeletal muscle relaxant to my patients with similar complaints.
If your current treatment regimen does not include one, please discuss with your doctor to add one. This along with the combination of analgesics should take care of your pain.
Also, you need to give rest to the abdominal muscles. Avoid working out and other strenuous activity.
Nothing to worry as the pain will subside over time.

If you have any queries, do let me know.

Wish you good health.

Patient replied :

Thank you for your response.
I want to further include a possible issue that's connected and started about the same time. Along with the abdominal muscle pain as mentioned before I've been having some testicular pain. However, I forgot to mention that randomly at times I get a dull pain at the tip of my penis. This pain occurs and last for a couple of hours to 1-2 days then dissapears for 2+ weeks at a time. I've looked online and everything points to prostitis. However, if is bacterial in nature wouldn't it have been severe by now since it hasn't been treated? Further, I've read that prostatitis could cause abdominal/pelvic floor pain and that abdominal muscle issues could also cause prostitis symptoms. What's your opinion as to the proper diagnosis, cause, and treatment?
Who should I be following up with? A Urologist, General Practicioner, or another doctor? It doesn't seem like any of the doctors I've visited have been able to connect the two issues and the problem has only gotten worse.
Lastly, you mentioned muscle relaxants. Are there any specific ones you've seen good results with in your patients? I'm allergic to valium, narcotirs, shellfish, and penicillin among a number of common allergens.
Thank you, I simply want to know how these things are correlated and how to treat it as no one seems to either care or know what's going on yet the pain is very real and very debilitating.


The testis is suspended by cord like structure called spermatic cord which has coverings extended from the abdominal wall muscles. So, abdominal muscle pain can cause pain near the testis.

Usually, a stone in the ureter can cause pain in the lower abdomen and radiates to the tip of penis. The urine comes from urinary bladder through the urethra upto the tip of penis. So, infection of the urethra can cause pain in the penis tip. In one area, urethra is surrounded by prostate. Your pain can't be due to prostatitis as it you would have had more specific and severe symptoms.

If it is a ureteric stone or urethral infection causing the pain, you can get it relieved and you can prevent it by drinking plenty of water.
Another condition which has to be mentioned here is Intermittent testicular torsion.Here, there will be pain in the testis, radiates to the abdomen due to twisting of the cord . Spontaneously, it gets derotated and pain will be relieved. It is quite rare and I have only seen a single case in my 17years old patientof surgical practice. So, you have to get color doppler of the scrotum at the time of pain to evaluate this possibility.

So in summary, there can be two possibilities in your case, a ureteric stone or intermittent testicular torsion. So please get an Ultrasound KUB (Kidney, Ureters, Bladder) as well as a color Doppler of the scrotum at the time of pain. You can consult a general surgeon in this regard as he deals with abdomen, scrotum etc.

I prescribe skeletal muscle relaxant and analgesic tablet which contains Chlorzoxazone as the relaxant.

Hope I have answered your query. Please let me know if I can assist you any further.
Thank you.

Patient replied :

I followed up with my doctor and after mentioning your suggestion of a relaxant, I was prescribed Cyclobenzaprine 5MG.
Around June 9th was the first time I felt the testicular pain upon which I visited the ER. At the time they did do a sonogram and doppler (looked like red and blue lines/dots in the screen). They said it could have been testicular torsion but since the pain had subsided from 9/10 to 0/10 they expected not to find anything.
Since then I haven't really had any painful testicular episodes however, every now and then I am experiencing pain in the tip of my penis after urinating. This is them accompanied by a feeling of having to use the restroom (like I need to defecate) yet I know I don't. The day after the possible testicular torsion episode, I visited my general doctor which ran a series of blood test and a urine sample culture however, everything came back negative as to why I wasn't prescribed any antibiotics. Do you believe it could be an infection? Is this a bladder or kidney stone? I'm unsure if the sonogram performed at the time of the emergency room visited was only on my testicles or if they covered the kidneys/bladder.
Assuming it was an infection or a bladder/kidney stone, wouldn't the infection be extremely bad by now or in the case of a bladder/kidney stone, have passed the stone by now?
I did noticed the pain in the tip of the penis and urethra today after peeing but I also did not drink much water (urine was very yellow/concentrated) would this indicate more of a possible infection?
I'm making an appointment with my general doctor and possibly a urologist (should I?) to see i they can run some blood tests again.
Lastly, what tests do you think I should ask for/get done? I want to know other than a CBC, what else do you recommend to figure out any connections between the main symptoms which once again are:
- Tip at the tip of penis
- Slight burning/feeling or having to urinate/defecate after peeing some times
- Abdominal muscle pain
- Some testicular sensitivity
Once again thank you so much, truly appreciate all the help and professional insight.


Passing concentrated urine along with pain at the tip of the penis can be due to irritation from the concentrated urine / urethritis (inflammation of the urinary opening=urethra) or a urinary tract infection. You can go for a urine culture and sensitivity test to narrow down the cause.
After urine culture and sensitivity testing, if an infection is detected, the most appropriate antibiotic which works against it will also be known.
Unless the presence of stone is confirmed before, you cannot know whether it has passed or not.
To visualise stones in the kidney, ureter or bladder, an ultrasound scan of the abdomen has to be taken.

Please consult your general physician or a urologist and get an ultrasound abdomen and a urine culture and sensitivity test done.
Once you get back the reports, I can clarify further.
Nothing to worry as whatever the specific cause, it will resolve soon.


Dr. Hari Charan Perigela
Category: Pediatric Surgeon
Fellowship: DNB, General Surgery, National Board of Examinations, New Delhi, 2001
Residency: MS, General Surgery, Sri Venkateswara Medical College,Tirupathi, 2000
Medical School: MBBS, Kurnool Medical college, 1995
Dr. Hari Charan Perigela and 4 other Medical Specialists are ready to help you

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