Differential Diagnosis for Left Lower Quadrant and Inguinal Pain
Single Most Likely Diagnosis
- Inguinal Hernia: The symptoms of intermittent left lower quadrant and inguinal pain, worsening with bearing down (which increases intra-abdominal pressure), and associated left testicle discomfort are highly suggestive of an inguinal hernia. Hernias can cause discomfort or pain, especially when coughing, lifting, or straining during bowel movements, which aligns with the worsening of symptoms when bearing down.
Other Likely Diagnoses
- Epididymitis or Orchitis: Inflammation of the epididymis or testis can cause testicular pain and may radiate to the inguinal area. The intermittent nature and association with testicle discomfort make this a plausible diagnosis.
- Left Varicocele: A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins. It can cause aching or discomfort, especially when standing or straining, and might be associated with left testicle discomfort.
- Prostatitis: Although more commonly associated with urinary symptoms, chronic prostatitis can cause referred pain to the inguinal area, lower back, and testicles.
Do Not Miss Diagnoses
- Testicular Torsion: Although typically presenting acutely, a partial or intermittent torsion could potentially cause intermittent pain. This is a medical emergency requiring prompt intervention to save the testicle.
- Appendicitis (Atypical Presentation): While appendicitis usually presents with right lower quadrant pain, an atypically located appendix or a retrocecal appendix might cause left lower quadrant pain. The severity and potential for perforation make this a critical diagnosis not to miss.
- Diverticulitis: Inflammation of a diverticulum in the sigmoid colon can cause left lower quadrant pain. Although less common, it's a significant condition that requires proper management to prevent complications.
Rare Diagnoses
- Spermatocele or Epididymal Cyst: These are benign cysts that can cause testicular or inguinal discomfort but are less likely to cause the described pattern of pain.
- Lipoma or Soft Tissue Tumor: Rarely, a lipoma or other soft tissue tumor in the inguinal region could cause localized pain and discomfort.
- Nerve Entrapment Syndrome: Conditions like ilioinguinal neuralgia could cause chronic pain in the inguinal region and testicle, but these are less common and typically have specific characteristics or triggers.