There are many causes of testicle pain… some are more serious than others. As we all know, testicles are very sensitive, and even minor incidents can cause significant pain. And when it’s present, testicular pain can have a major impact on one’s quality and enjoyment of life. Physiotherapy is often helpful in treating testicular pain when joints, nerves or muscles are involved.
There are many medical conditions that can cause testicular pain: tumors, hernias, infections, kidney stones, etc. Some of these are very serious, making a visit to your doctor an important first step before a physical therapist gets involved. Sudden, severe testicle pain can be a testicular torsion – a twist in the spermatic cord that cuts off blood flow to the testicle. Seek emergency medical care for this … delayed treatment could result in permanent tissue damage. A trip to the Emergency Room is also wise if there is blood in your urine, nausea, fever or chills along with your testicle pain.
Swelling, lumps or persistent pain in your testicles or scrotal area are also a cause for concern. A visit to your doctor will allow him or her to examine you and perform appropriate tests to rule out serious problems and find the cause of your symptoms. This might include lab tests, imaging (your doctor might order an ultrasound test), or consultations with specialists.
Often, there are straightforward reasons for the symptoms, and the doctors know exactly what to do to help you. However, it is not uncommon for doctors to work through all the testing, rule out serious problems or medical issues (phew!), and you – the patient – is left without a solid explanation for your testicle pain. In fact, medical studies show that this is the case 20-25% of the time.
ILLUSTRATION © ANN PISIO, 2018
This diagram shows the main parts of the scrotum and its contents.
The testicle (testis) produces sperm cells. The epidermis, attached to the back of the testicle, collects and stores the sperm until ejaculation. During ejaculation, the sperm cells travel up a hollow tube called the ductus deferens (vas deferens) to the prostate where other fluids are added to the sperm to form semen.
There are other structures (not shown) that travel along with the ductus deferens to form the spermatic cord. These include nerves and blood vessels. The outer layer of the spermatic cord is a muscle layer called the cremaster. This muscle raises the testicle within the scrotum to keep it warm, or for protection when you are in “fight or flight” mode.
Sometimes testicle pain comes from muscle, joint or nerve issues that doctors’ tests can’t easily identify.
Let’s begin by thinking about the nerves. There are several nerves that run to the testicles and scrotum. Some of these originate in the low back, and some leave the spine at the tailbone.
If the spinal joints aren’t moving properly, the nerves can get irritated as they leave the spine, and cause pain in the testicles or elsewhere. Sometimes it is movement in the spine above or below where the nerves leave that is the problem. We carefully check the spine, and treat any stiff joints between the vertebrae to make sure they are moving properly.
Sacroiliac and hip problems are other frequent contributors to testicle pain that require treatment. The sacroiliac joints are the joints between the tailbone and the pelvic bones. If it’s not moving smoothly, there can be increased muscle tension in the pelvic floor (the hammock of muscles that stretches across the underside from tailbone to pubic bone). A pair of nerves that innervate the scrotum pass through these muscles and can become irritated by them. Hip issues can cause similar problems.
After leaving the spine, the nerves take different twisting and turning paths to get from the spine to the testicles. These nerves thread their way between and around various muscles, bones and ligaments. In fact, sometimes the nerves pass directly through the middle of a muscle. If there are tight muscles or other restrictions along the way, these can put pressure on the nerves, resulting in pain in the scrotum or testicles. Although the pain is felt at or within the scrotum, sometimes the squeeze is on the nerve several inches away, up in the back or abdomen, or between the scrotum and the tailbone.
When pressure on nerves is the culprit, muscles that may compress the nerve are stretched out to take the pressure off. Often, patients are taught how to stretch these muscles themselves, along with exercises to keep the back moving properly. Sometimes habits like sitting for too long at one time need to be adjusted to keep the nerves happy.
Muscles can contribute to testicular pain in several ways. As mentioned above, many muscles can put pressure on various nerves along their paths to the testicles or scrotum, causing pain. Additionally, tight or overused muscles can develop trigger points that can radiate or “refer” pain to the scrotum or its contents. Interestingly, the abdominal muscles can be a major culprit. This is why sometimes too many sit-ups are the real problem!
There is a muscle right inside the scrotum that can be part of the problem. The testicles are suspended in the scrotum by the spermatic cord. The cord has several layers, including a muscle layer called the cremaster. This is a muscle that raises or lowers the testicles to regulate their temperature (moving them closer to the body when stepping into a cold lake, for example). Like any other muscle, sometimes these muscles can go into spasm, causing major pain. This is called a “cremasteric cramp”.
Muscle trigger point release techniques are used to treat irritable spots in muscles. Several of the muscles that cause testicular pain are easily accessible externally. Others are only accessible on the inside, via the rectum. When possible, patients are taught how to treat these areas themselves.
Sometimes scar tissue is a source of the pain. Studies have shown testicular pain after vasectomy to be a problem for many men. There are several medical reasons for this that physiotherapy can’t help. However, in some cases, the surgical incisions in the scrotum and spermatic cord can heal with painful scar tissue, and can be a source of ongoing pain. Physiotherapists use a variety of techniques to mobilize and stretch scar tissue that can help reduce pain and irritability. Often, patients are taught to do these mobilization techniques themselves.
It’s been said that the pelvis is a “gossipy” area. It responds to the internal chatter going on in our bodies. Many of the muscles in this area are tied into the fight-or-flight part of the nervous system. If a person is feeling worried or overwhelmed about anything (not just about the testicular pain!), the pelvic muscles can become overactive, and contribute to the problems discussed above. This is particularly true of repetitive or prolonged periods of stress. Stress creates tension, and muscles under sustained tension anywhere in the body can become irritable. The pelvic area seems particularly susceptible to this, and many men report increased symptoms during times of stress. To help with this, we often teach patients particular exercises and techniques to help calm the nervous system and relax overactive abdominal and pelvic floor muscles in particular.
If you think that stress could be a component of your pain, setting aside a little time during the day for a mindfulness/meditation practice can make a significant difference. There are many smartphone apps out there that can get you started with this. “Headspace” is a free, commonly-recommended app, but there are many others. “Body-scan” style meditations are also often a great place to start.
If you are struggling with testicular pain, physiotherapy may help! No doctor’s referral is required to book with us. Call (403) 249-5253 to book an assessment.