Suggest Treatment For Severe Pain Above The Pubis

Posted on Tue, 23 Aug 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 23 Aug 2016 Answered on

Tue, 13 Sep 2016 Last reviewed on

Question : male, 66, with pain bilaterally above the pubis, determined by general surgeon not to be hernias, feels like muscle strain or hernia, I am curious as to possible causes. anatomical charts thus far unhelpful to identify musculature or organs that might be affected

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
Please give details and post actual reports.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Male/66 - pain - bilaterally above pubis - for a year - sometimes more acute than others - no hernia as determined by a General Surgeon - curious to know the possible causes - anatomical charts thus far unhelpful to identify musculature or organs that might be affected - Cialis daily for BPH - begun recently, after years of taking Avodart; taking acyclovir for apparent but unproved Herpes ...

Please give additional details for me to assist you better:
- Type of pain? like throbbing/ burning/ dull ache/ discomfort/ cutting ...
- What are the enhancing factors?
- Which things lessen the pain? - relieving factors.
- Recent reports of any investigations done like ultrasound, blood tests like PSA, urine, CT scan for the painful area?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (6 hours later)

Pain is sharp, more so when attempt to sit up or raise legs from supine position. Pain is more acute after sexual ejaculation, regardless of position of partner. Nothing lessens the pain. No tests, other than hernia exam.

Answered by Dr. T Chandrakant (2 hours later)

Brief Answer:
May be prostate and lower abdominal muscle problem.

Detailed Answer:
Thanks for your feedback.
This looks to be due to prostatitis may be with inflammation of the muscles and its insertion at the pubic XXXXXXX
With the additional history you have provided, I would advise you the following:
Consult a General Surgeon again, may be another- second opinion.
- Per-rectal digital examination particularly to palpate prostate, its tenderness, surface, any mass, irregularity, movement of the rectal mucosa over it.
- Ultrasound of the whole abdomen, particularly for genito-urinary system - prostate and to see with high resolution mode on the affected area, to compare the muscles on either side.
- MRI of the lower abdomen may help really well, as it can find out the inflamed area so well, Radiologist has to know what to look for.
- Blood test of CBC, Sugar and others and particularly PSA that is prostate specific antigen.

I hope this will help to get the correct diagnosis and a proper plan of treatment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar