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What Causes Persistent Groin Pain In An Elderly Person?

Posted on Tue, 22 Mar 2016

Question: I am a 64 year old male with debilitating lower left groin pain after exercise or when there is stool in the bowel. I was first diagnosed with diverticulitis, but a CT scan revealed no infection and only one diverticulum. I was next diagnosed with the need for a hernia repair, which I had, but it did not impact the pain. I was told I had nerve damage and was sent to anesthesiologist for pain control and had shots in the scar tissue, but with no positive results. I was also sent to a gastroenterologist for a colonoscopy and though they removed one polyp, there was nothing else of concern. I then went to a specialist in XXXXXXX who wrote a paper on nerve damage subsequent to hernia repair and he told me there was no nerve damage. I have a history of kidney stones, so was sent to a urologist and had a kidney X-ray and bladder scope, and although I have some stones in my kidney, the urologist told me this would not be the cause of my pain as it is too low in the groin. I next had an MRI and was told my prostate is enlarged and has nodules and I need a biopsy, but again was told this would not be the cause of my pain. The MRI did not find anything else wrong and all doctors have said they can't help me. What do you suggest I do next to diagnose the source of this intermittent, debilitating pain?

Answered by Dr. Panagiotis Zografakis (3 hours later)

Brief Answer:
IBS?

Detailed Answer:
Hello,

I've read your text and I understand that you've done all the tests needed to exclude the most common causes. None of the diagnoses you've mentioned fits in your case each for different reasons. When no "organic" disease can be detected, a "functional" one is suspected. Perhaps your intestine is more sensitive in normal stimuli compared to other individual's intestines. This is called the "irritable bowel syndrome" (IBS).

Although you haven't mentioned any diarrhea or constipation and the connection of the painful sensation to exercise does not seem relevant to IBS, there are cases with atypical presentation. I have some questions which may provide additional clues. Please answer them.
(1) do you have - sometimes - a sensation of incomplete evacuation of your intestine right after defecating?
(2) do you have diarrhea or constipation or alternating between normal and abnormal bowel movements?
(3) do you pass mucus with the stool?
(4) do you pass stool shaped like marbles?
(5) does this painful stimuli wake you at night?
(6) do you feel better after defecating? Does the pain go away?
(7) if the answer to question 6 is no, then what makes you feel better?
(8) have you tried any spasmolytics like mebeverine or otilonium?

I'll be glad to continue this discussion after you provide the answers.

Kind Regards!

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

Follow up: Dr. Panagiotis Zografakis (4 hours later)

(1) Yes, I defecate about 5 times each morning. I eat a lot of fiber to discharge as much as I can because it seems I am better with nothing in the canal. If I have a small degree of stool left it can be extremely painful.
(2) Yes, I seldom if ever have constipation, however diarrhea is common towards the end of multiple bowel movements.
(3) Yes, I pass mucus occasionally.
(4) No
(5) No
(6) Yes, but it can come back—and I'll go again.
(7) N/A
(8) None of these
Just came from a prostate biopsy yesterday and the doctor commented I had a very sensitive rectal wall. Could not finish the biopsy due to the pain.

Answered by Dr. Panagiotis Zografakis (8 hours later)

Brief Answer:
IBS is very likely

Detailed Answer:
Thanks for the additional info and accept my apologies for the delay which is caused by the huge time difference.

I've read your answers and I can now say that IBS is very likely. You fulfill enough criteria to diagnose it. I would have only asked for another test of parasites in the stool and stool culture just to be sure that no infectious cause applies.

Regarding management, coping with psychological stress is important because stress is a precipitating factor. Various substances like lactose, fructose or caffeine may also precipitate pain. Increasing fiber in the food may help but it may also cause bloating in some patients and even more bowel movements. Probiotics is rather ambiguous kind of treatment. Bifidobacterium infantis has been associated with better results compared to other probiotics. Any probiotic can be tried though.

When the aforementioned measures are not sufficient the patient may find some relief in antispasmodics like mebeverine. Certain patient may also benefit from antidepressants like the SSRI (selective serotonin-uptake inhibitors), for example citalopram 20mg per day. Depending on the patient's symptoms and predominant manifestations other drugs can help, for example loperamide for too many diarrheas.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!

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

Follow up: Dr. Panagiotis Zografakis (4 hours later)

Dear Dr. Zografakis— You have been incredibly helpful! I have been to numerous specialists over the last 4 years and all of them said they could not help me. Ironically, this began after returning from XXXXXXX where I sustained a devastating financial loss. Therefore, your comments of coping with psychological stress appear to be right on target. I have an appointment with my PCP on the 10th of this month and will discuss this with her further. Thank you so much for your extremely helpful input.

All my best,
Sandy Stokes

Answered by Dr. Panagiotis Zografakis (4 minutes later)

Brief Answer:
You're welcome!

Detailed Answer:
You're welcome!

Glad to help!

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

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