Age 65+: what can cause right testicle and lower abdominal pain?

Age 65+: Possible Causes of Right Testicle Pain and Lower Abdomen Pain

As men age, new health issues can arise. Right testicle pain and lower abdomen pain in someone over 65 may have many causes, some benign and others requiring urgent care. Below is an overview of common and uncommon conditions, how they’re diagnosed, and when to seek help. If you’re worried about symptoms, you might consider doing a free, online symptom check to guide your next steps.

1. Epididymitis and Orchitis
   • Description: Inflammation of the epididymis (epididymitis) or testicle (orchitis), often bacterial.
   • Risk factors: Prostate enlargement, urinary tract infections, catheter use.
   • Symptoms: Gradual onset of scrotal pain that may radiate to the lower abdomen, swelling, tenderness, possible fever.
   • Diagnosis: Scrotal ultrasound (per Dogra & Bhatt, Radiographics 2003) to assess blood flow and rule out torsion; urinalysis and urine culture.
   • Treatment: Antibiotics (often covering E. coli or sexually transmitted pathogens), anti-inflammatories, scrotal support, rest.

2. Inguinal Hernia
   • Description: A loop of intestine protrudes through a weak spot in the abdominal wall into the inguinal canal, sometimes reaching the scrotum.
   • Symptoms: A bulge or fullness in the groin, pain worsened by coughing, lifting, or standing; may cause dull ache in lower abdomen and testicle.
   • Diagnosis: Physical exam (standing and coughing), ultrasound if exam inconclusive.
   • Treatment: Surgical repair (usually recommended to prevent incarceration or strangulation).

3. Kidney Stones (Urolithiasis)
   • Description: Hard mineral deposits formed in the kidney or ureter.
   • Symptoms: Severe, cramping flank pain radiating to the groin or testicle, possible blood in urine, urinary urgency.
   • Diagnosis: Non-contrast CT scan or ultrasound of kidneys and bladder.
   • Treatment: Pain control, hydration, medical expulsion therapy; urology referral if stones are large or obstructing.

4. Testicular Torsion (Less Common in Older Men)
   • Description: Twisting of the spermatic cord cuts off blood supply to the testicle.
   • Symptoms: Sudden, severe testicular pain, swelling, nausea or vomiting.
   • Diagnosis: Emergency Doppler ultrasound to assess blood flow.
   • Treatment: Surgical detorsion within 6 hours to save the testicle.
   • Note: Although rare after puberty, torsion must be ruled out urgently in any age group with acute scrotal pain.

5. Testicular Tumor
   • Description: A growth or cancer in the testicle; more common in younger men but can occur at any age.
   • Symptoms: A painless lump or swelling, sometimes dull ache or feeling of heaviness.
   • Diagnosis: Scrotal ultrasound and blood tests for tumor markers (AFP, β-hCG, LDH).
   • Treatment: Urologic surgery (radical inguinal orchiectomy) and possible chemotherapy or radiation.

6. Hydrocele and Varicocele
   • Hydrocele: Fluid collection around the testicle causing swelling but usually not pain.
   • Varicocele: Enlarged veins in the scrotum, often described as a “bag of worms.”
   • Relation to Liver Disease: Men with advanced cirrhosis can develop hydroceles and varices in the scrotum due to increased portal pressure (Tsochatzis et al., Lancet 2014; Castéra et al., Hepatology 2008).
   • Diagnosis: Physical exam and scrotal ultrasound; transient elastography may assess liver stiffness if cirrhosis is suspected.
   • Treatment: Observation if asymptomatic; surgical repair or drainage if painful or large.

7. Prostatitis and Lower Urinary Tract Symptoms
   • Description: Inflammation or infection of the prostate gland.
   • Symptoms: Perineal or lower abdominal pain, urinary frequency, urgency, weak stream, pain radiating to testicles.
   • Diagnosis: Digital rectal exam, urinalysis, sometimes prostate secretion cultures.
   • Treatment: Antibiotics, alpha-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), prostate massage in chronic cases.

8. Referred Pain from Abdominal Causes
   • Appendicitis: Rarely in older adults, but right lower quadrant pain can radiate toward the groin or testicle.
   • Diverticulitis: Left-sided more common, but right-sided in some populations; may cause lower abdominal discomfort.
   • Abdominal Aortic Aneurysm (AAA): Can irritate nearby nerves causing back, abdominal, or groin pain; life-threatening if ruptured.
   • Diagnosis: Abdominal ultrasound or CT scan.
   • Treatment: Depends on cause—surgery for AAA or complicated appendicitis; antibiotics for diverticulitis.

9. Trauma and Sports Injuries
   • Description: Direct blow or strain to the groin may injure testicular tissue, spermatic cord, or inguinal canal.
   • Symptoms: Localized pain, possible bruising or swelling.
   • Diagnosis: Clinical exam and ultrasound to rule out rupture or hematoma.
   • Treatment: Ice, scrotal support, rest; surgery if significant testicular damage.

10. Nerve Entrapment and Musculoskeletal Causes
    • Description: Compression of ilioinguinal or genitofemoral nerves; osteoarthritis or hip pathology may refer pain to groin.
    • Symptoms: Burning, tingling, or sharp pain; often associated with activity or certain positions.
    • Diagnosis: Clinical exam, nerve block tests, imaging of hip or spine.
    • Treatment: Physical therapy, nerve blocks, pain management.

Diagnosis and Imaging
• Scrotal Ultrasound: First-line tool to distinguish torsion, epididymitis, tumors, hydroceles, varicoceles (Dogra & Bhatt, Radiographics 2003).
• Abdominal Ultrasound or CT Scan: Helps identify hernias, kidney stones, appendicitis, diverticulitis, AAA.
• Transient Elastography: Non-invasive assessment of liver stiffness and fibrosis (Castéra et al., Hepatology 2008). Useful if cirrhosis is suspected due to portal-hypertensive complications in the scrotum.
• Laboratory Tests: Urinalysis, urine culture, blood counts, inflammatory markers, tumor markers, liver function tests.

When to Seek Immediate Medical Attention
• Sudden, severe testicular pain, especially with nausea or vomiting (rule out torsion).
• Signs of infection: High fever, chills, redness, severe swelling.
• Bulge in the groin that cannot be pushed back, worsening pain (possible incarcerated hernia).
• Blood in urine or inability to urinate.
• Severe, tearing abdominal or back pain (possible AAA).

General Management Tips
• Rest and scrotal support (wear a jockstrap).
• Apply ice packs to the scrotum for short periods to reduce swelling.
• Over-the-counter pain relievers: acetaminophen or NSAIDs.
• Stay hydrated, especially if kidney stones are possible.
• Avoid heavy lifting or straining until you know the cause.

Next Steps
If you’re experiencing right testicle pain and lower abdomen pain that persists, worsens, or is accompanied by fever or urinary issues, speak to a healthcare provider. Early evaluation—often starting with a primary care doctor or urologist—can prevent complications and guide effective treatment.

Always discuss any symptom that could be serious or life threatening with a doctor as soon as possible.