Differential Diagnosis for Left Inguinal Pain when Bearing Down with No Bulge Appreciated
- Single most likely diagnosis:
- Inguinal hernia (even without a visible bulge, the pain when bearing down is suggestive of a hernia, possibly a small or incarcerated one)
- Other Likely diagnoses:
- Strained inguinal canal muscles or tendons: This could result from overuse or sudden strain, leading to pain, especially when increasing intra-abdominal pressure by bearing down.
- Inguinal ligament sprain: Similar to muscle strain, a sprain in the inguinal ligament can cause pain in the inguinal area.
- Ovarian cyst or torsion (in females): Although more commonly associated with pelvic pain, an ovarian cyst or torsion can refer pain to the inguinal area, especially if the cyst is large or the torsion is causing significant irritation.
- Epididymitis or orchitis (in males): Inflammation of the epididymis or testis can cause inguinal pain, especially if the inflammation is severe or if there is associated swelling that might not always be visible.
- Do Not Miss diagnoses:
- Testicular torsion (in males): This is a surgical emergency that can present with sudden onset of severe testicular pain, which might radiate to the inguinal area. The absence of a bulge does not rule out this condition.
- Appendicitis: Although classically presenting with right lower quadrant pain, appendicitis can occasionally present with pain in other areas, including the inguinal region, especially if the appendix is retrocecal or in an unusual position.
- Ovarian torsion (in females): Like testicular torsion, ovarian torsion is a surgical emergency that requires prompt diagnosis and treatment to preserve the ovary.
- Rare diagnoses:
- Sports hernia (athletic pubalgia): A condition that occurs due to a weakness in the posterior inguinal wall without a visible hernia, often seen in athletes.
- Nerve entrapment: Entrapment of nerves in the inguinal canal can cause pain in the area, though this is less common.
- Inguinal canal lymphadenopathy: Enlarged lymph nodes in the inguinal canal can cause pain and might not always be visible as a bulge, especially if they are deep or small.