Brief Answer:
Investigations, expert advice, self efforts help.

Detailed Answer:
Hi XXXX

Thanks for the query.

I understand your concern.

1) Your son has pelvic pain since 6 months. Pelvic pain can be on both the sides of the pelvic or in center.
- If it's on right pelvic bone-it can be,
- Some problem with right kidney, (infection, stones)-
-Appendicitis in sub acute form,
- Left sided pain can be due to-
- Left kidney problem, Amebiasis involving descending colon,
- Pain above center of pelvis indicates problem with urinary bladder - Inflammation, infection, stone, Vitamin D deficiency.

Many of these accompany vomiting with increase of pain. And to get rid of pain, it's necessary to pinpoint the diagnosis & advise of respective specialty I would order pathological tests like Urine/stools examination & other specific tests with a physician's advice. He will the refer you to gastroenterologist/kidney specialist as per need.

2) Constipation is your son's long standing complaint. Apparently with no specific cause as per his investigations previously done. In my view we should think of -
-Insufficient physical activities,
- Increased calcium in blood, Low thyroid hormone, diabetes,
- Local painful conditions like- anal fissure, inflammation of anal area, piles, weakness of pelvic floor
- Psychological cause- fear of pain, laziness, depression

He needs to be examined by specialists like physician, endocrinologist, and Anorectal surgeon. The investigations to follow are usually Blood sugar, thyroid function tests, serum calcium, and serum vitamin D

Management of constipation -
- By treating specific cause (for pelvic pain/ constipation)
-Diet -It's good that he is taking plenty of water, if he adds sufficient Fibers to it will help him. He should have a well balanced diet with sufficient proteins, vitamins, fibers, water/juices, soups, buttermilk.
- Avoiding spicy, oily food, fast food, aerated drinks, will help.
- Daily exercises with brisk walking & yoga exercises, special attention to exercises for abdominal muscles -is desired.
** A persistent & patient & positive efforts under expert's guidance will definitely relieve your son of his pain/constipation to be a healthy young man.
Respiratory exercises (Pranayama), Meditation help for +ve thinking.

I suggest you to follow the life style changes I suggested below. Plan the aforementioned tests with help of respective specialist. With help of multiple specialist, we can be able to address his concerns.

I hope the answer was informative & helpful for you. Any follow up query is welcome.
Thanks.

.

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Brief Answer:
Consult a urologist.

Detailed Answer:
Hi XXXX
Thanks for the follow up query.
The information given clears most of the possibilities I had stated before.
Still following possibilities remain. Let us work on them &try to pin point the causative factor for your son's pain.
1) In view of the acute cystitis( Painful urination with possibility of STD) he had in June-it seems to be urinary bladder causing the trouble.
- Urinary bladder is a hollow bag storing urine . It consists of muscles which relax to stretch it when urine collects in it & contracts to expel the urine out through urethra.
The muscles are protected By inner lining of thin mucus membrane,so muscles can not come in contact with urine.
* Now severe urine infection your son had might have caused -
- injury fibrosis,ulcers or chronic inflammation of urinary bladder ,which in turn gets irritated muscles, looses it's capacity to hold&void urine properly. It can also result in narrowing/weakning of outlet of bladder/urethra. All of these cause a permanent stretch/pain in bladder.( above pelvis).
_ such pain being increased with exertion while passing stools/ prolonged sitting posture-may cause fear to defecate leading to constipation.
* investigations I would suggest for this condition would include-
Urine routine & microscopic & Urine culture & sensitivity .
CT scan/MRI,
Cystoscopy. .
2) The supra pubic hernia ,as you had stated,seems to be less possible- as it's an incisional hernia & follows urologic surgical intervention (with incision in suprapubic ( above pelvis)area).Your son does not have such history.
3) If vitamin D is not tested for,please get it done- for Vitamin D deficiency causes loosening of pubic ligament ,making it more prone to be painful after stretched bladder.
For a careful local examination, assessing the results of investigations & arriving to an exact diagnosis you need to consult a Urologist ( Kidney specialist) . The specific treatment advised by the expert consultant would help your son in relieving his problems .
I hope the answer satisfies you. Any further query you have, I will be happy to help.
Thanks..

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