Testicular torsion is a medical emergency that occurs when the spermatic cord becomes twisted, cutting off the blood supply to the testicle. This can cause sudden, severe testicular pain along with nausea, vomiting, and abdominal pain. While testicular torsion classically causes pain localized to the testicle, abdominal pain can also occur in some cases. Here is a quick overview of whether testicular torsion can cause abdominal pain:
Quick Answer
Yes, testicular torsion can sometimes cause pain that radiates to the lower abdomen. The abdominal pain is referred to as “referred pain” and happens because the testicles develop in the abdomen during fetal development. The nerves supplying the testicles remain connected to the nerves supplying the abdomen. When the testicle twists and loses blood flow, pain signals can get confused and be felt in the lower abdomen as well as the testicle.
What is Testicular Torsion?
Testicular torsion refers to twisting of the spermatic cord, which provides the blood supply to the testicle. It is a medical emergency that most often occurs in adolescent males, though it can happen at any age. With testicular torsion, the spermatic cord becomes twisted, cutting off blood flow to the testicle. This causes sudden onset of severe testicular pain along with swelling and tenderness of the affected testicle.
Testicular torsion occurs because the testicles are not properly attached inside the scrotum. This allows the testicles to twist freely on the spermatic cord. Certain things can trigger testicular torsion, such as physical activity, trauma to the testicles, and anatomy that makes twisting more likely. Testicular torsion usually requires emergency surgery to untwist the spermatic cord and prevent loss of the testicle.
What Are the Symptoms of Testicular Torsion?
The classic symptoms of testicular torsion include:
- Sudden, severe testicular pain that comes on quickly
- Swelling of the scrotum on the affected side
- Abdominal pain, nausea, and vomiting
- Blood in semen
- Hard testicle filled with blood (swollen and tender)
- Abnormal position of the testicle
- Fever and inflammation
The pain usually starts very suddenly and is severe from the outset. The pain is persistent and does not improve on its own. The main symptom is pain localized to the testicle. However, abdominal pain can also occur.
Can Testicular Torsion Cause Abdominal Pain?
Yes, some patients with testicular torsion experience abdominal pain along with the classic testicular pain. The abdominal pain associated with testicular torsion is referred to as “referred pain.” Referred pain means pain that is felt in a part of the body that is distant from the actual source of the pain.
In the case of testicular torsion, the testicles originally develop inside the abdomen. During development in the womb, the testicles descend down into the scrotum. But the nerves supplying the testicles remain attached to the nerves supplying the lower abdomen.
When testicular torsion happens, the nerves in the twisted testicle fire pain signals. These pain signals can get confused and be perceived in the lower abdomen, even though the problem is actually in the testicle. So testicular torsion can cause pain signals sent to the same nerves that supply the lower abdominal area.
Radiating Pain
The abdominal pain associated with testicular torsion is often described as a radiating pain. Patients experience pain originating from the testicle that radiates upward into the lower abdomen. The pain may spread from the testicle into the lower abdomen, often on just one side.
Referred Pain
The abdominal pain associated with testicular torsion represents referred pain rather than true abdominal inflammation or injury. Because the nerves are shared, the pain is referred to the abdomen even though the problem is limited to the testicle. Treating the testicular torsion can resolve both the testicular pain and abdominal pain.
Why Does Testicular Torsion Cause Abdominal Pain?
There are a few reasons why testicular torsion can cause abdominal pain:
- Shared nerve supply – The nerves supplying the testicle also supply the lower abdominal area, so pain signals radiate upwards.
- Referred pain – The brain perceives pain signals from the testicle as coming from the abdomen since the nerves are shared.
- Sympathetic reflex – Pain signals from the testicle can trigger abdominal muscle spasms and nausea via neural reflexes.
The main mechanism is referred pain due to the shared nerve supply between the testicles and lower abdomen. Even though the problem originates in the testicle, the pain signals follow the same nerves and are perceived in the abdomen.
Additionally, pain signals from the testicles can trigger a sympathetic reflex that causes abdominal muscle spasms and nausea. This adds an element of true abdominal disturbance as a result of the testicular injury.
Differential Diagnosis
There are other medical conditions besides testicular torsion that can cause sudden testicular pain radiating into the abdomen. These include:
- Testicular trauma
- Testicular rupture
- Epididymitis
- Orchitis
- Hydrocele
- Inguinal hernia with incarceration
- Kidney stones
- Appendicitis
The key distinguishing factor is that testicular torsion causes sudden, severe pain without trauma and requires emergency surgery. Other conditions may improve with pain medication and do not necessarily require urgent surgery. Diagnostic imaging and laboratory tests can help differentiate testicular torsion from other possible causes.
When to Seek Emergency Care
You should seek immediate emergency care if you experience:
- Sudden, severe testicular pain that comes on very quickly
- Testicular swelling
- Nausea and vomiting
- Abdominal pain
Call 911 or have someone drive you to the nearest emergency room. Testicular torsion is extremely time sensitive. Permanent damage can occur within hours if the blood flow is not restored. Swift diagnosis and treatment are essential.
Physical Exam
The doctor will start by getting a full history of your symptoms. Details about the onset, location, severity, duration, and radiation of the pain are important. The physical exam will focus on the abdomen and testicles.
The doctor will look for:
- Swelling, redness, or bruising of the scrotum
- High riding testicle on the affected side
- Horizontal lie of the testicle compared to the normal vertical position
- Absence of the cremasteric reflex, which normally causes the testicle to rise up when the inner thigh is stimulated
Palpating the abdomen may reveal rigidity, guarding, rebound tenderness, and abdominal wall muscle spasms – signs of peritoneal inflammation. The doctor will also check for a bulge indicating a hernia.
Diagnostic Tests
Diagnostic tests that may be used include:
- Urinalysis – A urine sample is examined under a microscope to look for signs of infection.
- Scrotal ultrasound – Soundwave images of the testicles can show decreased or absent blood flow in the twisted testicle.
- Abdominal CT scan – Provides images of the abdominal area to rule out other possible causes.
These tests can help confirm the diagnosis of testicular torsion and rule out other conditions. However, diagnosis is mainly made based on the history and physical exam due to the need for urgent surgery.
Treatment for Testicular Torsion with Abdominal Pain
The only treatment for testicular torsion is emergency surgery to untwist the spermatic cord and alleviate the loss of blood flow. This is done through a procedure called orchiopexy, which detaches and reattaches the testicle to prevent twisting.
The goals of surgery are to:
- Save the testicle by restoring blood flow
- Relieve the testicular and abdominal pain
- Prevent future testicular torsion by properly attaching the testicle
Surgery is urgent and ideally performed within 6 hours of symptom onset before permanent testicular damage occurs. Surgery can successfully restore blood flow in the majority of cases if performed quickly.
Pain Management
Pain control will also be a priority. The doctor may administer:
- Narcotic pain medications
- Anti-nausea medications
- Sedatives for severe pain
These medications can help provide pain relief before and after the surgery while the testicular torsion is treated.
Recovery and Prognosis
With prompt surgery, the prognosis is often excellent for full recovery of testicular function. However, delay of surgery longer than 6-8 hours can cause permanent testicular damage from loss of blood flow.
After having surgery for testicular torsion, recovery includes:
- Wearing a supportive jock strap for 1-2 weeks
- Taking over-the-counter pain medication as needed
- Avoiding heavy lifting & strenuous activity for 2-4 weeks
- Following up with the urologist for monitoring
Most testicular function returns to normal after successful surgery to untwist the spermatic cord. The abdominal and testicular pain should fully resolve once the torsion is corrected. However, there is a risk of testicular atrophy or other permanent damage if torsion persisted too long before surgery.
Can Testicular Torsion Return?
Yes, it is possible for testicular torsion to recur after surgical correction. Recurrent testicular torsion occurs in around 5% of patients overall. The risk is higher in those initially suffering testicular torsion when they are under the age of 18 years old.
To help prevent recurrent testicular torsion, the surgeon will perform an orchiopexy during the procedure to untwist the testicle. This involves suturing the testicle in place within the scrotum so it cannot twist on the spermatic cord.
Symptoms of recurrent testicular torsion are the same as the initial torsion – sudden onset of severe testicular pain that may radiate into the abdomen. This would again require prompt surgical correction.
Can Testicular Torsion be Prevented?
There is no guaranteed way to prevent testicular torsion. However, the risk can be reduced by:
- Avoiding excess exertion or heavy lifting
- Wearing an athletic supporter with strenuous activity
- Avoiding trauma to the genitals
- Having a elective bilateral orchiopexy performed for those at high genetic risk
An elective orchiopexy to suture down both testes can be considered in adolescents at higher risk for torsion, such as those with family history of the condition.
Conclusion
In summary, testicular torsion can sometimes cause abdominal pain due to shared nerves supplying the testicles and lower abdomen. Any male with sudden, severe testicular pain and swelling should be evaluated emergently by a physician. Prompt diagnosis of testicular torsion allows for surgery to detorse the testicle and restore blood flow before permanent damage occurs. With rapid treatment, the prognosis for recovery is typically excellent after testicular torsion.
