How to deal with lower right rib pain and tension and urinary incontinence?

Hello doctor,

I am a 37-year-old male and I have two main problems: lower right rib pain and tension and urinary incontinence.

1. Lower right rib pain.

I have been in deep pain and stress due to the pain in the lower right rib for the last 10 years. I had an X-ray and ultrasound recently and the results are normal. I have suffered from a phobia, anxiety, and major depression. It took a toll on my health and most importantly caused muscle tension and migraine headaches. I feel my lower right rib has been deformed due to continuous tension and panic attacks over the years. It has compressed more inside the body and I feel poky and painful while breathing and sitting. I feel those ribs have become very weak in strength. There is redness in that area. When I touch the right and left ribs, I can see the difference in their positioning. The left rib can be felt and seen in a normal position, whereas the right rib is compressed inside and I do not feel the rib bones as much as the left side. I am taking an SSRI antidepressant called Lexapro for anxiety and depression, and it helps 50 % in reducing tension but does not resolve the compressed rib issue. What should I do? I have taken Baclofen and it helps to some extent but makes me sleep for long hours and have some drowsiness. And it could be difficult to withdraw Baclofen later. Naproxen helps and reduces the spasms, but again my concern is taking it long-term. At times I feel like taking muscle relaxants to relax those lower right ribs but I know they can be addictive and harmful in the long term. Is there a surgery option to put the ribs back in place to fix this issue once for and all? Can CT scan and MRI find out the compression and deformed position of the right lower rib? I need to know what is happening right there or else I will suffer for the rest of my life. I seriously had enough of it, since this rib pain and tension causes me anxiety and even depressed feelings. I find it difficult to do physical exercises like jogging and gym due to this and stress makes it worse. Relaxation exercises only partially help for a very brief duration, like 30 minutes.

2. Urinary incontinence

For a year, I have developed urinary incontinence. I do not know the exact reason for it. It could be the Lexapro drug, but I have been taking Lexapro for the last seven years. For incontinence, I was advised to take Solifenacin (Solifenacin succinate) 10 mg, and it is 70 % effective. I cannot quit Lexapro because it is the only antidepressant that helped me significantly with anxiety and depression. I have relapsed into depression in the past due to Lexapro withdrawal. I will appreciate your advice and options (including surgery if possible for rib pain) so I can discuss them with a specialist doctor at my place.

Hello doctor,

Thank you for your reply. The issue is the compressed rib causes poking and pain and stresses me out very easily. After I get an MRI or CT scan, can there be a surgical option to resolve it? Every medication including Baclofen has some side effects, as Baclofen 5 mg for me causes too much sleep and I find it difficult to wake up in the mornings to go to work.

Hello doctor,

Thanks a lot for your prompt reply.

I will consult an orthopedic surgeon shortly. Generally how much is the cost for such a type of surgery where you described straightening it out with plates? Like what range it might be. Are these surgeries and medical treatments expensive? And what is the availability of such surgical procedures? Is it a rare procedure, or are there enough orthopedic surgeons who do this kind of procedure, so I do not have a hard time finding such a specialist? Baclofen is excellent as a temporary measure, it relaxes both the mind and the muscle tension and does help me with side tension headaches also. I take 5 mg as needed, I use it frequently though, but I feel it is not just a muscle tension issue but also the rib bent and digging into the soft tissues. As you said, only a proper investigation will reveal the actual scenario.

Hello doctor,

Thank you for the reply,

The amount should not be an issue considering that surgery is required and corrects my issue and brings relief. The whole aim is to be able to be free from medications if possible. I do have premium insurance, which may cover those costs. But I need to check with a specialist who is proficient in such procedures. If the surgical procedure is required, can I recover in a month? Or does it take longer? I need to plan for that possibility. I know you speak out of the experience, but there is a lot of pain in that area and not just muscle tension but significant compression of the lower right ribs that significantly affects my quality of life due to pain and stress. Let us see what happens with the tests.