Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, affecting up to 1 in 5 people worldwide. Common symptoms include abdominal pain or discomfort, bloating, gas, diarrhea, and/or constipation[1]. While typically confined to the abdominal region, many IBS sufferers report nonspecific pain in other parts of the body as well and this post explores if can IBS cause testicle pain.

Some anecdotal evidence and case studies point to a potential link between IBS and testicular discomfort[2]. However, a direct link has yet to be conclusively proven. This post explores the hypothesis that IBS may in some instances contribute to or cause pain in the testicles through various proposed mechanisms of action.

Can IBS cause testicle pain? (Other Causes)

Can IBS cause testicle pain

Testicular pain or discomfort can arise from several conditions affecting the testicles or surrounding structures. One potential cause is infection, such as epididymitis which involves swelling or inflammation of the epididymis tube that transports sperm. Direct blunt force trauma from an injury is another common reason for testicular pain, as the tissue is vulnerable to impact[3].

Testicular torsion involves twisting of the spermatic cord, cutting off blood supply, and potentially causing necrosis if not quickly treated. A varicocele refers to enlarged veins within the scrotal sac, common in up to 15-20% of adult men, which can sometimes lead to dull pain[4]. Distinguishing these potential anatomical or infectious causes from non-organic sources of pain is important in asking “Can IBS cause testicle pain” prior to considering potential links to functional disorders.

Pathophysiology of IBS

Brain-gut axis

While the underlying causes are still under investigation in asking “Can IBS cause testicle pain”, abnormal gastrointestinal function appears central to IBS. Heightened sensitivity of the gut-brain axis and visceral hypersensitivity occur in IBS patients, meaning they perceive non-painful stimuli as painful. Motility issues in alternating directions like constipation or diarrhea are also factors[5].

The mechanisms driving such gut hypersensitivity are complex but likely involve genetic and environmental triggers that alter pain-signaling pathways in the gut and brain[6]. A greater understanding of the pathophysiology helps build potential links between IBS and referred pain in other regions.

Potential Mechanisms

referred pain map

To answer “Can IBS cause testicle pain”, Referred pain is one proposed explanation for testicular discomfort in IBS patients. It occurs when a visceral pain stimulus activates shared neurological pathways, leading to the perception of pain in another region of the body innervated by related nerves[7].

There is an overlap between the nerves supplying the gastrointestinal tract and the genitourinary system which could allow for bidirectional referred sensations. The hypogastric nerve plexus transmits sensory information from the pelvis and lower abdomen up to the spinal cord. Simultaneously, splanchnic nerves conduct signals descending from the brain[8].

Heightened sensitivity throughout the gut-brain axis in IBS may lower pain thresholds in other body parts with interconnected innervation. Previous research has demonstrated increased reactive responses even to non-painful rectal distension in IBS, indicating widespread visceral hyperalgesia[9].

Differential Diagnosis

To answer “Can IBS cause testicle pain” it’s important to evaluate testicular pain, to first distinguish potential organic causes from functional etiologies like referred pain from IBS. Other infectious etiologies should be ruled out through physical examination and testing, as they may require specific antimicrobial treatment. Acute epididymo-orchitis or epididymitis can cause inflamed, tender orchitic testes and will commonly be associated with urinary tract infection symptoms like dysuria[10].

Chronic or intermittent testicular pain may indicate a structural issue like varicocele that requires imaging evaluation. Scrotal ultrasound is the initial recommended imaging modality to identify lesions, cysts, tumors, or varicoceles that need urologic management[11]. For cases of recurrent or persistent undiagnosed pain, a referral to a urologist is important to examine for occult testicular torsion, hydrocele, or other intra-scrotal abnormalities. Performing a physical exam under anesthesia allows thorough palpation of all scrotal contents.

If standard imaging and exploratory surgery rule out anatomical issues, functional causes like referred pain should be explored. Given a concurrent diagnosis of IBS, a trial of conservative therapies targeting the underlying bowel dysfunction may help determine the likelihood of an association between the two conditions.


Lifestyle modifications that can help alleviate IBS symptoms may also provide relief from associated testicular discomfort. A low FODMAP diet aims to reduce gut distension and fermentation by limiting certain poorly absorbed short-chain carbohydrates[12]. Stress management techniques like yoga and meditation can regulate the gut-brain axis involved in visceral hypersensitivity.

If dietary and lifestyle changes provide insufficient relief, medications may help reduce abdominal pain believed to be contributing to referred testicular pain. Antispasmodics like dicyclomine mitigate gut motility issues while tricyclic antidepressants can modulate visceral sensory pathways[13].

Pelvic floor physical therapy targets muscle tension and tenderness that may influence viscerosomatic referral patterns[14]. Myofascial release techniques and biofeedback train relaxation of overactive pelvic floor musculature[15].

Surgery should only be considered if pain persists after conservative options and if other anatomical pathologies have been thoroughly excluded by imaging and urological evaluation. Surgical intervention solely for assumed referred visceral causes would carry risks unsupported by conclusive evidence.


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[2] Ohlsson, Bodil. “Extraintestinal manifestations in irritable bowel syndrome: A systematic review.” Therapeutic advances in gastroenterology vol. 15 17562848221114558. 9 Aug. 2022.

[3] Velasquez J, Boniface MP, Mohseni M. Acute Scrotum Pain. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

[4] Leslie SW, Sajjad H, Siref LE. Varicocele. [Updated 2023 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

[5] Coss-Adame, Enrique, and Satish S C Rao. “Brain and gut interactions in irritable bowel syndrome: new paradigms and new understandings.” Current gastroenterology reports vol. 16,4 (2014): 379.

[6] Henström, Maria, and Mauro D’Amato. “Genetics of irritable bowel syndrome.” Molecular and cellular pediatrics vol. 3,1 (2016): 7.

[7] Jin, Qianjun et al. “Referred pain: characteristics, possible mechanisms, and clinical management.” Frontiers in neurology vol. 14 1104817. 28 Jun. 2023.

[8] Spencer, Nick J, and Hongzhen Hu. “Enteric nervous system: sensory transduction, neural circuits and gastrointestinal motility.” Nature reviews. Gastroenterology & hepatology vol. 17,6 (2020): 338-351.

[9] Kano, Michiko et al. “Influence of Uncertain Anticipation on Brain Responses to Aversive Rectal Distension in Patients With Irritable Bowel Syndrome.” Psychosomatic medicine vol. 79,9 (2017): 988-999.

[10] Rupp TJ, Leslie SW. Epididymitis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

[11] Kühn, Anna L et al. “Ultrasonography of the scrotum in adults.” Ultrasonography (Seoul, Korea) vol. 35,3 (2016): 180-97.

[12] Black, Christopher J et al. “Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis.” Gut vol. 71,6 (2022): 1117-1126.

[13] Lembo, Anthony et al. “AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea.” Gastroenterology vol. 163,1 (2022): 137-151.

[14] Newman, David P et al. “Successful Resolution of Chronic Testicular Pain With an Impairment-Based Treatment Program: A Case Study With One-Year Follow-Up.” Cureus vol. 13,3 e13850. 12 Mar. 2021.

[15] Zhu, Mingyue et al. “Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome.” Open medicine (Warsaw, Poland) vol. 19,1 20240936. 28 May. 2024.

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