What an ache in the groin could mean for men

Non-specific symptoms in the groin or pelvic region for men may be caused by CPPS, which is treatable. — 123rf.com

John, a slightly overweight man in his fifties, came to see me with a gloomy grimace.

For several months, he had been suffering with a nagging ache in his groin.

And I am the sixth doctor he has seen.

His pain worsened whenever he ejaculated or sat for too long. Sometimes, the pain radiated to his lower back.

Having gone through several doctors and specialists, multiple tests (including an overseas test) and different courses of antibiotics, John was exhausted, frustrated and depressed.

“Dr Taufiq, I don’t know what else to do. The other doctors told me that there’s nothing else I can do and that I might just be imagining my symptoms.

“They said there is nothing wrong with me as all tests came back negative,” he said.

As I studied his test results and his different medications, I knew that he did not have an infection.

I examined him and found a few sore areas in his groin region and around his prostate.

My diagnosis was that he was most likely suffering from chronic pelvic pain syndrome (CPPS).

I recommended that we try at least one session of extracorporeal shockwave therapy (ESWT).

When CPPS is present, this treatment will usually cause the patient to experience an intense sensation in the areas affected with inflammation, followed by relief of symptoms within the next few days.

In men without CPPS, there is no discomfort at all.

During the ESWT session, John did feel the intense sensation that subsided as the therapy progressed.

When he came back for a review a week later, he was beaming.

He told me that he was so happy he had finally found a solution to his problem.

He went on to complete four sessions of ESWT. After the sessions, there were no more symptoms, and he went on with his life and activities pain-free and grateful.

I advised him to lead a healthy lifestyle, exercise regularly and lose weight, as this can help to prevent the recurrence of CPPS.

Symptoms and causes

CPPS is a condition characterised by non-specific symptoms in the groin or pelvic region, such as:

• Painful urination
• Burning sensation in the urethra
• Pain on ejaculation
• Difficulty in ejaculation
• Erectile dysfunction
• Non-specific groin ache
• Anal pain
• Lower back pain
• Lower abdominal pain or discomfort
• Urinary symptoms like weak urinary stream, problems voiding, incontinence, frequent urination and nighttime awakening

It is due to inflammation of any of the structures and/or tissues in the groin or pelvic region.

Usually, it is difficult to localise or find the exact location of the pain.

CPPS can be due to several causes:

• Previous infection in or around the prostate
• Stress, anxiety or depression
• Problems with pelvic floor muscles
• Previous damage to pelvic floor muscles
• Smoking
• Excessive alcohol intake
• Different types of food, e.g. spicy food
• Changes in weather

As you can see, CPPS is not easy to diagnose. This is why some doctors may miss it or just dismiss it totally.

It is also important to rule out infections as a cause before we can conclude that it is CPPS and start treatment.

Treatment

Treatment may include antibiotics and anti-inflammatory medication.

However, oral medication requires long-term therapy and it may not be effective.

ESWT has been shown to be very effective in treating CPPS.

It is non-invasive, has no side effects, no downtime and patients experience relief in symptoms after only one session.

For complete clearance of symptoms, three to four sessions are normally required.

Most patients do not experience any more symptoms after these sessions.

Dr Muhd Taufiq is a general practitioner (GP) in Singapore. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in these columns. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.