Groin Pain

1 Groin Pain Summary

Pain or discomfort in the groin, the area between the folds at the end of abdomen and beginning of the leg, is referred to as groin pain. Also known as inguinal area, groin includes the upper parts of the inner thigh.

Groin, when affected, may appear swollen, reddish in color, and be warm to touch. Groin pain may cause considerable pain and discomfort to the person. Many minor causes of groin pain may resolve on its own without any specific treatment. Home treatment helps to relieve the symptoms of this condition.

Some of the commonly associated symptoms of groin pain include:

  • A lump in the groin region
  • Difficulty in performing physical activity
  • Loss of appetite
  • Lower back pain
  • Pain or itching in genital area
  • Pain while urinating
  • Rectal or vaginal discharge
  • Difficulty in walking
  • Weakness in hip muscles
  • Symptoms of flu including fever, sore throat, headache and cough

Medical attention is warranted if the pain persists for more than few days.

It is important to inform the doctor if:

  • There are swellings or lumps on the testicles
  • Urine contains blood cells
  • Pain radiates to lower back, abdomen or chest
  • Patient develops high-grade fever and has nausea
  • Testicular pain has sudden onset

These symptoms may indicate more serious conditions like testicular torsion, testicular infection, or testicular cancer.

It may be caused by injuries related to sports and other causes. It may be due to inflammation, injury or a disease that affects any of the tissues in the region. The area has five different muscles that work together to move the legs.

These are adductor Brevis, adductor longus, adductor Magnus, gracilis, and pectineus. It is more commonly seen in athletes and people who are involved in contact sports like football, rugby, or hockey.

The strain of ligaments, tendons, and muscles in the region is the most common cause of groin pain. An inguinal hernia is another cause of pain in the groin. In an inguinal hernia, tissue bulges out through a weak spot in groin muscles.

Groin pain may also be caused by kidney stones and bone fractures in the region. Some of the less common causes of pain include inflammation of intestine, testicular inflammation, enlarged lymph nodes, ovarian cysts, pinched nerves, and urinary tract infections.

Diagnosis is based on an evaluation of symptoms, review of medical history and physical examination. Information on recent sports or physical activity also will help in diagnosing the problem.

Imaging techniques like x-ray, ultrasound, and complete blood count are also useful diagnostic tools. Imaging studies are used to identify and locate bone fracture, testicular mass, and ovarian cyst. Complete blood count is used to determine infection.

As groin pain is caused by different causes, treatment depends on the specific cause. Complete rest, ice compress, and anti-inflammatory medications are indicated in tendon and ligament injury. Pain medications may be used to relieve pain.

Surgical repair is suggested for groin pain caused by the bone fracture. Surgery is also indicated in case of an inguinal hernia. When conventional treatment does not give relief, physical therapy may be suggested.

2 Causes

Groin pain may result from multiple causes and is common in athletes.

The most common causes of groin pain in athletes include: 

  • Femoroacetabular impingement – this is a bone-on-bone condition that caused joint damage. It may be caused by the abnormal shape of the acetabulum or its placement in the pelvic joint. This causes injury to the joint, leading to pain.
  • Sports a hernia – this is characterized by tearing of soft tissue in the groin region.
  • Problems with tendons – injury to pubic symphysis ligament or the symphysis itself lead to pain in the groin.
  • An inguinal hernia – this is characterized by the bulging of tissues through the weak abdominal wall. Pain caused by this bulging may increase with a strenuous activity which puts stress on abdominal muscles.
  • Labral tear – a tear in the labral region may lead to pain in the groin.

In women, the groin pain worsens with time, as in overuse injuries and repetitive activity that uses the tissues of the groin area. Direct blow, fall, or turning a leg abnormally may result in groin pain in women.

Certain medical conditions are also implicated in groin pain in women. This includes an inguinal hernia, kidney stones, urinary tract infections, sexually transmitted infections, pelvic inflammatory disease, ringworm, yeast infections, cellulitis, and arthritis.

Radiating pain from the weakened hip ligaments may also cause groin pain. Iliolumbar syndrome is a condition characterized by inflammation of the ligament and can cause a radiating pain in pelvis and groin.

Iliopsoas tendon injury is another cause of groin pain. Acute injury, overuse injury, and quick movements are related to iliopsoas tendon injury. Pain and discomfort are also caused by laxity of a ligament in pubic symphysis.

It is usually experienced during activities like running, squatting, and sit-ups. Osteitis pubis, a chronic condition that affects the pubic symphysis is also implicated in the development of groin pain. Pain due to hip bursitis may radiate to the groin region. Bursitis refers to the inflammation of the bursa, the sac that cushions the hip joint.

Many infections lead to groin pain including abscess, cellulitis, epididymitis, leg infection, and sexually transmitted infections. Several non-infectious conditions also result in groin pain. This includes allergic reaction, hip arthritis, drug reaction, and surgery.

Avascular necrosis refers to the death of bone tissue due to lack of adequate blood supply to the bones. It may lead to tiny breaks in the bone and also a pain in the groin region. A hydrocele is a fluid-filled sac surrounding the testicles.

Inflammation and injury to hydrocele may lead to swelling in the scrotum, a condition that causes pain in the groin. A viral infection that affects parotid glands, called mumps, is a less common cause of groin pain.

Orchitis or inflammation of one or both testicles can cause discomfort and pain in the groin region. A retractile testicle is a condition in which the testicle may move between scrotum and groin. This condition may cause considerable pain in the groin. Enlargement of veins in the scrotum is another cause of the condition.

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3 Diagnosis and Treatment

Most cases of groin pain may resolve without any specific treatment. Evaluation of the current condition, review of symptoms and medical history, and physical examination are the steps in the diagnosis of groin pain. Information on certain specific questions is of help in determining the probable cause of pain.

This includes queries on:

  • Onset of pain
  • Whether the pain had a sudden onset or gradual
  • Is there a swelling or lump in groin region?
  • Factors that improves the pain
  • Factors that worsens the pain
  • Other accompanying symptoms
  • Recent illnesses
  • Current medications
  • Other medical conditions
  • Surgeries, if any
  • Family history
  • Dietary supplements

Evaluation of symptoms and recent physical activity is also helpful in identifying the cause of pain. Physical examination of the groin provides clues for confirmatory diagnosis. During the physical examination, a hernia test may be conducted to check for the presence of an inguinal hernia.

Imaging studies including x-ray and ultrasound aid in identifying bone fracture, testicular mass, and ovarian cyst. The presence of infection is checked using complete blood count. Urinalysis also may be recommended depending on the suspected cause of the condition.

Home treatment helps to promote healing after an injury to the groin. It may also be helpful in groin pain caused by non-injury causes. The first step in the treatment is resting the injured area for one to two weeks.

Rest from any activity that causes soreness and pain in the region will help in easy healing. The second step in the treatment is applying of ice compress in the injured region. The ice pack is applied for 10-20 minutes for 3-4 times.

Once the swelling reduces, warmth can be applied to the region to relieve pain. Support to the groin region while the injury heals is equally important. Snuggly fitting underwear or workout accessories may be of help. A healing period of 4-6 weeks should be followed by stretching and strengthening exercises. This will help to improve the range of motion of the tissues in the region.

Other treatment methods vary with the actual cause of pain. Special medical attention is required for cases that cause severe pain. Prolotherapy or proliferation therapy is a treatment procedure in which an irritant solution is injected into the ligaments and tendons to relieve pain.

This is usually combined with surgery for femoroacetabular impingement treatment. Surgery is suggested for treating inguinal hernia as well. Ligament and tendon injuries are common causes of groin pain and are treated with anti-inflammatory medications, ice pack, and rest.

Steroids are recommended in some cases. If conventional medications and treatment methods are not effective in relieving pain, physical therapy is suggested.

Many types of groin pain can be prevented. Gentle stretching is a simple way to prevent groin pain. Slow, the steady warm-up is recommended before doing any physical activity. This reduces the chances of strain and injury in the groin region.

Maintaining a healthy body weight reduces the risk of an inguinal hernia. Precautions and good posture while lifting weights also help in reducing the chances of a hernia. If left untreated, groin pain may lead to complications like decreased athletic performance, disability, fertility issues, and removal of testicles.

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