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Dr. Andrew Rynne

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Diagnosed with UTI. Experiencing severe pain in groin area. Which specialist should I consult?

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Mon, 11 Feb 2013 in Women's Health
Question: I have severe pain in my groin area. I am female. It started around Chritstmas. Actually left and right sides, but only once at the same time on 1/7. I am thinking of going to the ER, but cant afford it. I saw my OBG-YN today. I have a urninary tract infection. I am not sexually active and 56 years old. I take pain meds for my back. My chronic back doctor (who I saw the first time on 1/8 said it could be that my degenerative back disease has progressed to my SI joint, causing the pain in my hips and groin. My bowl movements are irradic. It hurts while I type this. Do you need more detail? I did not go to work on 1/7. I literally could not move out of bed. Today, the burning of the urnination was very painful. So I missed work again. She diagnosed UTI. The rest of the tests should be back on Friday. This pain is unbearable. My friend can see the pain in my face. The pain starts at the hip bone area and goes down the groin. I am almost vomiting sick with the pain. Perhaps I have blockage in that area from sitting 9 hours/day at my desk? I cannot move, except to go to the bathroom. I work a highly stress level job to a Sr. VP at a very well known bank. I am cramped up in that 'supposed ergo chair - for my back, for 9 hours. Then sit in rush hour and come home and sit. My feet are crippled, so I cannot walk far. I have abour 7 dessicated disks in my neck and lower back. What kind of doctor should I see? I am almost crying out in pain. Another colonsocopy? Pollup blockage? The pain is in the crease of my legs/body as I sit. It is hard to lift the leg that his hurting at the time. It took me 4 days to be able to get the left leg high enough (without me pulling it up) to get into the shower.
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Answered by Dr. Timothy Raichle 32 minutes later
Hello, I would be happy to help you with your question.

I am sorry that you are feeling so poorly!! The fact that you were seen today by your OB/GYN is a good thing. You were diagnosed with a UTI and I assume placed on antibiotics. This should help to some extent, but it seems unrelated to your main complaints. Also, given that you were seen today, these issues are unlikely to resolved in an ER setting. Obviously if you are in severe pain, you need to be seen, but if nothing has changed since you were seen by your OB/GYN, then I am not sure what you would gain out of going to an ER besides temporary pain control.

From what you are describing, you are sedentary. You sit for the entire day at work and your activity otherwise is limited by your back disease. The location of the pain and positions that exacerbate the pain suggest nerve impingement at the level of the groin. This is possible and we see it when patients are positioned improperly during surgery with prolonged flexion at the hip.

I think that your course of action should be as follows:
1. You need an appointment with a Physical Therapist - they can work with you in terms of musculosketal pain, range of motion, and mobility issues
2. You need a visit with a Primary Provider to assess for any vascular issues that would cause leg pain - given your age, this should be considered
3. You need a visit with a Podiatrist - based on your comment that your "feet are crippled". Perhaps orthotic shoes would help.
4. You need screening for osteoporosis and imaging of the hip joints - this has likely been done, but should be considered as a source of degenerative back and hip disease
5. You might eventually need followup in a Pain Clinic for managemet of chronic pain.

These are some ideas to get things going for you. Small changes will likely have a big impact.

I hope that this helps. Please ask if you have additional questions. Thank you for visiting this site!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Timothy Raichle 19 hours later
Thank you, Dr. Raichle for your response. You are spot on with everything. My chronic pain doctor has asked my PT (for my neck only) to incorporate PT for my SI joint. I have had 3 MRI's for my lower back 2007-2012. Had one for my neck (which I injured at work on XXXXXXX 20 managing my managers calendar with travel and 70-75 meetings/week, but will not be filing a worker's comp claim - you can't fight the big guys) this past August. PT was suggested by my epidural in my neck and get money out of me. Glad I am seeing a new chronic pain doctor.

As for my feet, I do wear orthodics and have a note since 2008 to wear tennis shoes at work. I have had several fractures in them, no surgeries. If the orthodics don't work, then it is fusion. I do not want this. It limits your mobility, especially in my feet and ankles. Trying to make it work. I do NOT want fusion. Never heard of any fusion in the feet that worked. Too many little bones that need to be fixed. I used to be very active - played good tennis and was a world champion equestrian. Now I can't even try to get a riding boot on my foot and running after a long return from the other side of the court is out of the question.

Starting to get bursitis in my outer thighs while walking at work for short stints. Had a wellness exam at work 2 weeks ago. Everything was good except my BMI index. I need to lose about 50 pounds. These are pounds that I put on after having so many epidurals on my lower back. Sleepless nights, increased appetite, shakiness. That is when my former spine doctor said enough of the epidurals and RFN's. My last one was 2/29/12. They only worked for about 2 weeks and he referred me to a chronic doctor after seeing him for 7 years.

I will see if the PT will help for the SI joint and rid me of this pain. Today was better. Maybe some of it has to do with my UTI? Yes, OB/GYN gave me 6 Bactrim ER for 2x/day. Not sure that is enough, but I see her again on Monday for an annual (could not do both at the same time yesterday due to insurance!).

My current chronic pain doctor said in my next appointment that we will talk about an epidural on the SI joint. I explained my reactions to the steroids, but he said this is a bit different. Can you please clue me in? Supposing I will need another MRI on this area first.

Now you have a pretty good history of a 56 year old in an 80 year old body!

BTW, my mother is 87 and is an invalid. My brother (bless his heart) quit his job in Florida and has been caring for her in her home for the past 5 years. She has bone degeneration. Thank you for the inheiritance Mom!

Thank you in advance for your response!!
doctor
Answered by Dr. Timothy Raichle 2 hours later
Here are some thoughts:

1. You need to lose weight - you might not be able to ride horses or play tennis, but you can go into a swimming pool. This would be a great way to exercise and it would take weight off of your back and feet. There is no excuse not to pursue this!

2. It is as important to cut calories as it is to exercise. A nutritionist or weight loss program would be another great place to turn.

2. The UTI can be felt as low back pain, or SI joint pain in some situations. I would finish the course of antibiotics before pursuing other treatments that are invasive (such as an epidural)

I really would have you consider avoiding these procedures. They are obviously not working for you long term. As I see it the only benefit would be for temporary relief so that you can start an exercise program. As far as the injection in the SI joint that might bre "different" in some way - I am not familiar with this. I would ask for an explanation of what medications they will use and try to do some research into how much longer of relief you can expect (or get a second opinion).

Finally, given the multiple joint related symptoms, the other specialist that might have some good input is a Rheumatologist (unless you have seen one already).

Good luck!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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