Alan, it's going to be okay! I got you covered!

By all means follow your doctor's advice, but if you find you're not getting better, or not getting wholly better, or if you get better and the monster comes back, I have got some ideas.

I'm no doctor, but you describe the CLASSIC symptoms of an inguinal hernia that irritates the genito-femoral nerve. Sometimes very small hernias are the ones that do that, and are the most difficult to detect. When that happens, the irritated nerve causes "referred pain." In other words, there may be nothing wrong with your balls -- the origin of the pain is elsewhere. Hernias can also cause scrotal swelling -- not from infection, but because of a bit of intestines poking where they don't belong.

The possibility that you have an inguinal hernia is suggested by:

- onset after lifting heavy objects;

- the pain pattern of no pain most mornings, and worse from activity, especially from sitting;

- perceiving the pain in the scrotum, which is the most common place for inguinal hernia pain to be felt (other places are possible too).

The inguinal hernia, if you have one, is a little hole in your abdominal sack -- a sort of bag that holds your guts in. The result is a little bit of your intestines poke out around the rings where your balls descend. My anatomy may not be perfect, but the reason you may feel better in the morning is while you lie down and sleep, your intestines pull back and no longer irritates your nerve and by morning it's recovered.

A FEW CAUTIONS

1. I have yet to find a urologist that knows anything about this - they'll feed you pounds of antibiotics for years instead. Too many hernia surgeons know nothing about this. And yet it is perfectly mainstream (see below).

2. If a hernia cannot be felt by the doctor, one possibility is to seek a "dynamic ultrasound" which can often find what the fingers cannot. The "dynamic" part means moving around as a tech instructs while they're scanning (a safe, quick, and cheap procedure). DO NOT let anyone talk you into a CT scan, which is USELESS for detection of hernias of this type.

3. Even less known is the possiblity with in inguinal hernia the invasion of the intestine can leak intestinal bacteria, so it's not impossible that you have an infection AND a hernia. If you think about it, that gets real confusing: the hernia causes infections, and even when the infections are cured you may feel better but still hurts because the referred pain of the hernia affects the same area.

(I've never seen this "hernia causes infection" idea confirmed in any article, but it makes sense, and others have reported here been diagnosed with a hernia that caused recurrent epididymitis. I definitely had an infection, and I almost certainly have a infection I expect to get repaired soon.

Hernias are easily fixed, but the fix takes surgery -- they never repair themselves. The key thing is to find a hernia surgeon -- someone who does hernia repairs and little or nothing else. You can get some leads on that by looking here.

http://members3.boardhost.com/NorthPennHernia/index.html

Lots of things can cause pain "down there" and for all I know your problem is only infection or isn't infection or heria. Those chances seem remote, and I wouldn't worry about them now. If you're getting better fast, which I doubt, you can always revisit the list of possibilities.

Below are...

1. Some links to "differentials" (lists of possibilities of pelvic pain)

2. Some links and quotes about the idea that pain that is low in the morning and that gets worse from sitting (etc) can be the sign of an inguinal hernia. If you think the quotes and things apply to you, you might want to show them to a receptive or open minded doctor.

Inguinal hernias don't often kill anyone, but they can cause miserable chronic pain. And if the hernia gets bigger, the intestines can get stuck (no longer pull in or out) which is a very serious emergency room condition.

best luck,

Spy

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EXAMPLES OF DIFFERENTIALS FOR GROIN PAIN

http://www.physsportsmed.com/issues/2000/01_00/lacroix.htm
A Complete Approach to Groin Pain

http://www.physsportsmed.com/issues/1998/04apr/ruane.htm
When Groin Pain Is More Than 'Just a Strain': Navigating a Broad Differential
Joseph J. Ruane, DO; Thomas A. Rossi, MD

http://www.injuryupdate.com.au/ISMJGroinPain.htm
Pathophysiology of Chronic Groin Pain in the Athlete

===========================
http://www.sages.org/sagespublication.php?doc=PI06
HOW DO I KNOW IF I HAVE A HERNIA?
You may feel pain when you lift heavy objects, cough, strain during
urination or bowel movements, or during prolonged standing or sitting.
The pain may be sharp and immediate or a dull ache that gets worse
toward the end of the day.

http://www.pelvicpain.com/diagnosis.html
The most common type of groin hernia is the indirect inguinal hernia.
Other types include the direct inguinal hernia, femoral hernia and the
obturator hernia. These hernias can cause pelvic pain, groin pain, leg
pain and even back pain. Repair of the hernia involves removal of the
hernia sac and repair of the defect with mesh

www.leistenbruch.de/PatientLeaflet.pdf
The inguinal region constitutes a weak point in the abdominal wall. The
weak point results from the fact that the so-called inguinal canal is
located in the groin... ..Pressure on the nerves passing through that
region – particularly the genitofemoral nerve – causes severe pain

http://www.physsportsmed.com/issues/2000/01_00/lacroix.htm
inguinal hernia... are common enough that every patient suffering from
groin pain should be examined to eliminate this possibility.... In most
cases, activities that significantly increase intra-abdominal pressure
or may involve repeated Valsalva's maneuvers, such as weight lifting,
cause or exacerbate the hernia. While the pain might initially occur
only after activity, it typically will increase in frequency to the
point of occurring during activity and even with simple trunk and hip
movements. The pain will often radiate into the proximal thigh or the
scrotum in males

BJU International (March 2003), 91.5
A small indirect inguinal hernia may irritate the genital branch of the
genitofemoral nerve. {the authority for which is Yeats WK. Pain in the
scrotum. Br J Hosp Med1985; 33: 101–3}

http://hernia.tripod.com/types.html
INGUINAL HERNIAS Sometimes only a mild pain, ache or burning in the
groin area may occur prior to the development of an obvious bulge. This
pain, again often described as
an ache or burning sensation, may not only be present in the inguinal
area, but may also radiate into the hip region, back, leg or even down
towards the genitalia region. Called "REFERRED PAIN", this discomfort
can be quite bothersome and at times severe. In addition, in the absence
of a bulge, the diagnosis of the cause of this pain may be delayed or
mistakenly and incorrectly ascribed to other causes such as muscular
groin strains, epididymitis, prostatitis or orchitis etc. These
diagnoses may be maintained erroneously until the bulge develops,
thereby heralding the real cause of the pain...a hernia. The discomfort
with hernias usually is initiated by or increases in severity with
activity, then becomes relieved, although not always completely, with
rest

Inguinal hernia in urological patients: the value of herniography.
Ekberg O, Abrahamsson PA, Kesek P.
Department of Diagnostic Radiology and Urology, University of Lund,
Malmo General Hospital, Sweden.
The value of herniography was reviewed in 45 patients with a variety of
urological symptoms (4 with flank pain, 20 with pain from the funicle or
scrotum, 11 with symptoms simulating prostatitis and 10 with ill-defined
symptoms from the small pelvis). In no patient was a groin hernia
palpable at physical examination. However, herniography revealed an
inguinal hernia in 6 patients who underwent herniorrhaphy, whereafter 5
became asymptomatic. We recommend herniography in patients with
long-standing obscure groin pain to reveal the presence of a nonpalpable
inguinal hernia.