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Testicular Pain due to Pelvic Floor Issues
(Specific) Problem / Symptoms: Since March 2011 I have had left testicular pain (sharp or burining) centered around what I can best describe as the spermatic cord or epidimitis and pain radiates along the left side of the pernium. Pain is greatest when testicle is being constricted, particularly painful in the process of being constricted. Putting on clothing, squatting and during cremasteric reflex is very painful. Sitting is slightly aggravating however walking is very painful, particularly if not in a straight line (athletic activities requiring fast movement are basically too painful to do). Standing with legs apart or lying almost completely relieves the symptoms. After activating cremasteric reflex and left testicle is raised pain is reduced significantly. Wearing less clothing relieves some of the pain. Pain generally increased after ejaculation.
Summary: My testicular pain (described above) started in March 2011 and has been consistent ever since. After several visits to different doctors a bacterial cause was ruled out and I was referred to Urology. Based on the pain description (sharp or burning) the Urologist believed that I may have a neuropathy of some sort and she referred me to a physical therapist specializing in pelvic floor therapy. After an internal examination she determined that I had a very high level of pelvic tone and we committed to a multi-modality therapy including internal trigger point massage, stretching and water walking. After 4 months of that proved ineffective the Urologist indicated that I may be a candidate for a Spermatic Cord Denervation to relieve the pain. To check for effectiveness the Urologist performed a Spermatic Cord Block with an injection of Lidocane (and some other anesthetic that I can’t remember). This procedure completely eliminated symptoms for a period of about 3 hours. I continued the physical therapy in the hopes that I would not need the surgery but eventually had the procedure in March 2012. The procedure did not eliminate the pain and in general made the pain worse. Of note the surgeon indicated that I had some anatomical anomalies possibly related to my Orchiopexy. The Vas Deferens was not connected to the testicle and the Epidimitis was raised up well above the normal location, so much so the surgeon had to consult a nurse to make sure he was actually seeing what he was seeing. Approximately 2 months after the surgery I developed a hernia on the lower right side of my abdomen without any overt cause (heavy lifting, straining, etc). After the surgery and the subsequent physical examination indicating the pain was still present, the Urologist referred me to the pain management clinic. The doctor at the pain clinic believed the problem was a neuropathy and suggested high dose anticonvulsant and high dose antidepressant to curb pain. I did not proceed with that treatment and instead went back to physical therapy. Since that time I have been trying a multi-modal approach including internal trigger point therapy, acupuncture, posture training, boxing and stretching. This approach proved ineffective so I stopped all treatment in an effort to calm the nervous system. It has become more stable but I do not have a path forward.
Of Note: I had a similar, if not the same, pain during the time I was having a series of kidney stones from age 19-22 (see below). At that time the pain was higher during times of kidney stones. After seeing 6 different urologists I was told to simply ‘live healthier.’ I started up a vigorous workout routine, diet and drank a gallon or more of water a day. From that time up until the emergence of this pain in March of 2011 I was pain free and kidney stone free.
Additionally I have symptoms which are typical of someone with a tight pelvic floor: bladder symptoms such as incomplete emptying, dribbling, getting up several times in the night, shooting pain symptoms that seem to originate in the lower abdomen and occasional golf ball feeling in the anus. These symptoms are exacerbated during times that are typical of pelvic floor aggravation: sitting, tight clothing and ejaculation. These symptoms have been mildly present in some form since I was a pre-teen however they occur with greater frequency now.
It may be unrelated but I was diagnosed with generalized anxiety disorder 1 year prior. I had been consuming an excess amount of caffeine and other stimulants during this time and through the onset of symptoms. I still consume caffeine but not regularly.
(Relevant) Medical History: Orchiopexy to remedy undescended left testicle at age 2. Appendectomy at age 7 after appendix rupture. Testicluar appendix torsion (I believe on my left testicle but unsure) at approximately age 11. Kidney stones (approximately 15, all passed without surgery) from age 19 – 22. Intermittent testicular pain (same symptoms as described above) around the same time.
Perscription Medications Tried: (Unless otherwise indicated, each of these medications has been ineffective) Gabapentin 1800mg per day, Lyrica 300mg per day [currently taking and offers a very mild level of relief], Vicodin 325 mg per day for 2 weeks, Alfuzosin 10mg per day, Ibuprofen 600mg per day, Ciprofloxacin 500mg per day for 2 weeks, sulfamethoxazole-trimethoprim 160mg per day for 4 weeks
Tests Run: (Unless otherwise indicated all tests were normal) Urinalysis with Microscopy and Culture x5, Ultrasound of testicle, Urine Culture with Gram Stain, CT Scan [indicated a 2mm kidney stone was ‘fixed’ in the upper portion of the left kidney], Lipid Panel, Testosterone total, Metabolic Panel, Fertility test
Therapies Tried: Internal trigger point massage, water walking, stretching, boxing, acupuncture (with and without electrical stimulation), abdominal ultrasound, external trigger point massage of upper back, top of spine and chest, meditation and behavioral therapy related to anxiety.
Summary: My testicular pain (described above) started in March 2011 and has been consistent ever since. After several visits to different doctors a bacterial cause was ruled out and I was referred to Urology. Based on the pain description (sharp or burning) the Urologist believed that I may have a neuropathy of some sort and she referred me to a physical therapist specializing in pelvic floor therapy. After an internal examination she determined that I had a very high level of pelvic tone and we committed to a multi-modality therapy including internal trigger point massage, stretching and water walking. After 4 months of that proved ineffective the Urologist indicated that I may be a candidate for a Spermatic Cord Denervation to relieve the pain. To check for effectiveness the Urologist performed a Spermatic Cord Block with an injection of Lidocane (and some other anesthetic that I can’t remember). This procedure completely eliminated symptoms for a period of about 3 hours. I continued the physical therapy in the hopes that I would not need the surgery but eventually had the procedure in March 2012. The procedure did not eliminate the pain and in general made the pain worse. Of note the surgeon indicated that I had some anatomical anomalies possibly related to my Orchiopexy. The Vas Deferens was not connected to the testicle and the Epidimitis was raised up well above the normal location, so much so the surgeon had to consult a nurse to make sure he was actually seeing what he was seeing. Approximately 2 months after the surgery I developed a hernia on the lower right side of my abdomen without any overt cause (heavy lifting, straining, etc). After the surgery and the subsequent physical examination indicating the pain was still present, the Urologist referred me to the pain management clinic. The doctor at the pain clinic believed the problem was a neuropathy and suggested high dose anticonvulsant and high dose antidepressant to curb pain. I did not proceed with that treatment and instead went back to physical therapy. Since that time I have been trying a multi-modal approach including internal trigger point therapy, acupuncture, posture training, boxing and stretching. This approach proved ineffective so I stopped all treatment in an effort to calm the nervous system. It has become more stable but I do not have a path forward.
Of Note: I had a similar, if not the same, pain during the time I was having a series of kidney stones from age 19-22 (see below). At that time the pain was higher during times of kidney stones. After seeing 6 different urologists I was told to simply ‘live healthier.’ I started up a vigorous workout routine, diet and drank a gallon or more of water a day. From that time up until the emergence of this pain in March of 2011 I was pain free and kidney stone free.
Additionally I have symptoms which are typical of someone with a tight pelvic floor: bladder symptoms such as incomplete emptying, dribbling, getting up several times in the night, shooting pain symptoms that seem to originate in the lower abdomen and occasional golf ball feeling in the anus. These symptoms are exacerbated during times that are typical of pelvic floor aggravation: sitting, tight clothing and ejaculation. These symptoms have been mildly present in some form since I was a pre-teen however they occur with greater frequency now.
It may be unrelated but I was diagnosed with generalized anxiety disorder 1 year prior. I had been consuming an excess amount of caffeine and other stimulants during this time and through the onset of symptoms. I still consume caffeine but not regularly.
(Relevant) Medical History: Orchiopexy to remedy undescended left testicle at age 2. Appendectomy at age 7 after appendix rupture. Testicluar appendix torsion (I believe on my left testicle but unsure) at approximately age 11. Kidney stones (approximately 15, all passed without surgery) from age 19 – 22. Intermittent testicular pain (same symptoms as described above) around the same time.
Perscription Medications Tried: (Unless otherwise indicated, each of these medications has been ineffective) Gabapentin 1800mg per day, Lyrica 300mg per day [currently taking and offers a very mild level of relief], Vicodin 325 mg per day for 2 weeks, Alfuzosin 10mg per day, Ibuprofen 600mg per day, Ciprofloxacin 500mg per day for 2 weeks, sulfamethoxazole-trimethoprim 160mg per day for 4 weeks
Tests Run: (Unless otherwise indicated all tests were normal) Urinalysis with Microscopy and Culture x5, Ultrasound of testicle, Urine Culture with Gram Stain, CT Scan [indicated a 2mm kidney stone was ‘fixed’ in the upper portion of the left kidney], Lipid Panel, Testosterone total, Metabolic Panel, Fertility test
Therapies Tried: Internal trigger point massage, water walking, stretching, boxing, acupuncture (with and without electrical stimulation), abdominal ultrasound, external trigger point massage of upper back, top of spine and chest, meditation and behavioral therapy related to anxiety.
WOW, this is 99% identical to me condition and search for treatment. I was referred for the Pelvic floor therapy route, but I am super skeptical about the outlook for that. Plan is to remove the testicle, but docs can't guarantee I won't still have phantom pain. One BIG difference is that you had a good response to the block, which in theory makes you a good candidate for the denervation, and failing that, removal of the offender. I did not get great results from the block, so my Uro thinks Pelvic floor attempt first and if no results, removal, but no guarantees. BTW- are you in Chicago?
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