Groin pain persists after an antibiotic treatment for varicoceles
Dear Dr. Roach: Iama 76-year-old male who is in good health and doesn’t take any medications. I ride my bike 40 miles a week, play golf four days a week and go to the gym every other day.
About six months ago, I started experiencing pain in my right groin area. It generally only hurts when I’m in bed. After about three hours, it wakes me up. The pain can be intense; sometimes sitting hurts.
My doctor ordered an ultrasound, which indicated that I have mild bilateral varicoceles. I was put on an antibiotic, which did not help at all. I’m still experiencing pain. Are you familiar with this? Is there a solution? Can it lead to something more serious? — J.H.D.
Dear J.H.D.: A varicocele is a very common condition found in males during puberty. It is a dilated group of veins, very much like a varicose vein of the leg. They are more common on the left side and range in size from undetectable by physical exam to massive.
Not all varicoceles are symptomatic. Most commonly, the pain is dull and better when laying down than when standing up. I’m not convinced your symptoms are due to the varicoceles, which are mild and on both sides, because your pain is only on one side.
Furthermore, varicoceles are not treated with antibiotics, which makes me suspect that your doctor could have been concerned about inflammation of the epididymis (one of the tubes that carries sperm) or the prostate (which makes most of the fluid in semen). There are other possibilities, such as a hernia or compression of a nerve, which should be considered before considering surgical treatment of the varicoceles. A visit with a urologist is indicated, in my opinion.
Dear Dr. Roach: Iama 75-year-old man, and approximately six weeks ago, I contracted irritable bowel syndrome (IBS).
I have been coping with gas and diarrhea by adopting a diet recommended for this problem and by using Metamucil and probiotics. I would appreciate any help you can provide for coping with this. — G.B.
Dear G.B.: IBS is a common issue, more common in women than men and in younger (less than 50 years old) than older people. The hallmark symptoms are abdominal pain or discomfort; a change in bowel habits; and diarrhea, constipation, or both alternating. Relief of discomfort with a bowel movement is common, but not universal.
I am very concerned about the diagnosis of IBS in a 75-year-old man. It is possible, of course, but I want to be certain that your doctor has considered other possibilities, especially those that are more serious. Colon cancer heads that list, and you should be getting a colonoscopy regularly. If you haven’t had one very recently, you should get one.
Inflammatory bowel disease (IBD) is another concern that can usually be answered through a colonoscopy, but it is less common at age 75. Celiac disease, poor blood flow to the colon and intestinal overgrowth are all possibilities. A gastroenterologist is an essential consultant in this case.