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Terrible Chronic Pelvic Pain - Out of Ideas

I have been dealing with terrible pelvic/groin pain since September of 2019 . During this time I had CT, Ultrasound and MRI readings showing nothing more than that I was constipated and have varicose veins (mild case). I am writing this to get any idea of what I should do next as I am completely clueless now. I have thought I had a sports hernia, vascular diseases, and other nerve disorders.

I currently have no pain on exertion but am u nable to sleep on my back or side without extreme pain. Whichever side I sleep on is worse the following day and the other is better. Simply watching tv while lying on my back causes my leg to go numb and tingly.

This morning I woke up and my feet are tingly and my leg is numb in the middle front thigh. Pain is better now when I sit still than if I lay on my back or stand. Standing longer than 10 minutes is extremely painful.

I can however run or swim and feel better for several hours following and have no pain during it.

I have included a full background and timeline of everything in hopes that someone can give me a clue on what I should do next.

Thanks!

Background:

38 y/o male, married, intense exerciser 10+ hours a week marathon and weight lifting)

5’10 160 lbs

Resting Heart 30 bpm at sleep sometimes usually 37 at sleep. 46 at rest when awake.

No prior surgeries.

Low testosterone of 25 ng/dl (!!!) and 100 ngl/dl but averaged 400 ng/dl (275 - 1000(?)) over last 2 years.

All other bloodwork (Lymph, Blood sugar, Kidney, and other full panel bloodwork) is within normal range . Lymph absolute was 0.9 though and egfr was 68 one time, usually 97.

Problems (short story):

Varicocele, which was corrected during this time

Chronic pelvic pain and leg numbness

Possibly Illioinguinal/genitofemoral nerve compression or sports hernia?

Full story:

September 2019 - While using the Hack squat machine at the gym doing a set of rest pause squats to failure, I felt a sensation that felt like a tight pinch in my left lower lower quadrant of my abdominals. Immediately after this I went onto the Assault bike and then felt a burning t earing like sensation above my pubic bone of my groin . This left a burning sensation for a couple weeks. The area of my abs around my left superior epigastric vein felt a tingling/burning sensation on and off.

Early October 2019 - Ran a half marathon at a 7:15 pace with no pain (good for me), however I was unable to do hip bridges or squats with heavy weight or do abdominal exercises other than simple curl ups without pain.

October 26, 2019 - After eating at a restaurant with my family I had extreme right lower quadrant pai n. CT scan indicated nothing wrong except a full colon .

Thanksgiving November 2019 - Symptoms continue to improve, run a good 5k time and can now do light squats without much pain.

December 2019 - In the first week I hurt my foot and the left outside part hurt. I stopped running and only did biking and elliptical for the first few weeks. I now was able to squat and deadlift again with a heavy weight (around 315 lbs). Some burning sensation in groin after doing certain abdominal exercises and split squats.

Christmas 2019 - Decided to stop using the elliptical to help heal my foot. Pain was bad so reduced daily activity to less than 2000 steps.

January 7 2020 - Saw doctor about my foot x-ray showed nothing wrong. Instructed to stretch by pointing feet toward each other and extending pelvis forward to stretch my calves. Burning sensation felt in groin doing the stretches. Started to run again.

January 14 2020 - After stretching and doing abdominal exercises (same painful ones from December) I started a run and half a mile in I felt a “pop” in both sides of my groin . Right side was much worse.

January 21 2020 - Attempted to run again as slight improvement, however pain came back fast, reduced to a walk.

January 25 2020 - Saw urgent care doctor about groin pain, extreme pain when FADIR test is performed. Constant burning sensation in groin. Left leg had occasional shooting pain down the inner thigh, right groin overall worse.

January 28 2020 - No longer able to walk for exercise.

January 30 2020 - Saw PCP doctor about pain, diagnosed as groin strain, told to come back in 4 weeks if no improvement. Once at home I decided to start using heating pad on my groin and legs with hopes that it would speed up the healing. Attempted rehab exercises for adductors, just basic movements were very painful.

February 27 2020 - Pitting edema in my groin above pubic bone after heating pad used for about 30-60 minutes. Extreme pain in groin. Noticed pain near the vas deferns or the spermatic cord or veins on my right side.

March 4, 2020 - Went to doctor and instructed to go get an ultrasound of pelvis and scrotum to rule out hernia and testicular torsion. Found bilateral varicocele. Pain in groin but not really in the scrotum at this point.

March 2020 - Extreme pain in left groin upon waking one day. So bad it was hard to breath. I also would get extreme pressure build up when sitting for longer than 10 minutes at work or if I needed to stand still. I also noticed within minutes of eating eggs the pressure would build up (coincidence?)

April 14, 2020 - While still waiting to see the urologist I started to run again. I was able to do so only when using jock strap to reduce pain. At this point I had extreme pain. Noticed my lymph nodes in my groin which were tingly.

May 20 2020 - Urologist confirmed varicocele and scheduled surgery. Pain continues to get worse and more limiting, pain in scrotum at this point, sometimes pain at base of penis.

June 2020 - Waiting for surgery, able to run better at this point but overall very painful.

July 10, 2020 - Surgery for bilateral varicocele. (Inguinal incision)

July 24 -2020 - Pain at urination, and pain in right testicle and around the incisions. Left leg groin numb from surgery. Prescribed Bactrim slight improvement afterwards where testicle pain was gone and just incision and numbness remained. Able to run after surgery with slight discomfort.

August 2020 - Pain in testicle returns after dose stopped. See doctor, manual inspection shows nothing wrong and instructed to wait 4 weeks for follow up. Still unable to sit cross leg as right leg groin is so tight . Start stretching it after running.

September 15 2020 - Follow up comes and only incision pain remains. Left leg still numb. Following weeks the left leg gains back some of the tingly pain. N ow able to fully move right leg without extra pain.

October 4 2020 - Ran first race after surgery. On ride home extreme pressure builds in left groin.

October 9 2020 - Pain in right ankle and swelling of my calves comes out of nowhere. Bruising is seen. Feet and ankles have swelling. Groin pain continues.

October 13 2020 - Saw doctor and scheduled ultrasound of both legs.

November 4, 2020 - Ultrasound shows low popliteal vein flow and varicose pelvic veins.

December 6, 2002 - Able to run 5k race with no complications. Pain in general better but still not good.

December 16 2020 - Venogram to look for pelvic reflux nothing found.

December 19 2020 - MRI ordered and shows no abnormalities in bones, vascular or soft tissues. Doctor says no muscular, hip, lymph node, or hernia observable.

If the hack squat injury was the beginning of all of this, then it seems to me that this was worse than you initially suspected; you did not let it heal and continued to aggravate it.

At this point, find exercises that you CAN do that don’t aggravate it and stick ONLY to those for a while. A “while” might be several months, or longer. Running can be very rough on the body- I suggest stopping that for now and switching to something that is low-impact.

Thanks for the feedback. I think I will take a step back and build back up slowly with what I can do.

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Just curious, have you ruled out a hip labrum tear? A friend of mine dealt with pain shooting in all directions that was finally fixed with hip endoscopy.

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I did not specifically ask about that from MRi I will try. Saw chiropractor today and said my SI joint was out of line and needs adjustments Praying that this is it

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