Reasons, Treatment, and When to Contact a Healthcare Provider

When people experience pain in the lower abdomen, where the leg meets the pelvis, they often refer to it as groin pain. While muscle sprains are the most common cause of groin pain in adults, a variety of other conditions can be to blame, such as an inguinal hernia, kidney stones, or problems in or around the hip joint in the scrotum. (in men). , or with specific nerves. Depending on the underlying cause, groin pain can be mild or severe, occur gradually or suddenly, and vary in quality (dull, sharp, throbbing, or even burning).

To determine the cause of your groin pain, your healthcare provider will perform a complete physical exam and, if necessary, order blood tests and / or imaging tests. Ultimately, your treatment plan can range from something as simple as rest and ice, to something more complex, such as physical therapy, or invasive, such as surgery.

Note: pain in the groin is evaluated differently in children than in adults; This article focuses on the latter.

Illustration by Alexandra Gordon, Get Meds Info

Causes

Due to the many unique causes of groin pain, it is important to see a doctor for an evaluation.

general

Less commonly, pain in the groin can cause disease of the testicles, abdomen, pelvis, and nerves.

Muscle tension

A groin strain, also called a groin strain, is usually the result of a sports injury or an awkward movement of the hip joint that stretches or tears the inner thigh muscles .

Usually the pain when stretching the groin is acute, the onset is sudden, and the cause of the pain is clear.

In addition to pain, tension in a person can develop spasms of the inner thigh muscles and weakness in the legs.

Inguinal hernia

An inguinal hernia occurs when fatty tissue or a hernia of the intestine bulges (protrudes) through a weak or torn section of the abdominal wall. Sometimes an inguinal hernia is asymptomatic. If there are symptoms, people often report a pulling sensation in the groin area and / or a dull ache in the groin when coughing or lifting things. There may also be a noticeable lump in the groin.

Kidney stones

A kidney stone can cause a wave of pain (renal colic) as it travels through the urinary tract . The pain can range from mild to severe and often occurs in the lateral area (between the ribs and thighs) or in the lower abdomen. … In both cases, the pain often extends to the side of the groin. In addition to pain, a person may experience blood in the urine, nausea or vomiting, painful urination, and the urge to urinate.

Osteoarthritis of the hip joint

Arthritis of the hip joint (located between the tip of the femur and the pelvis) occurs when the normally smooth hip joint wears out. When cartilage is depleted, leg movements become painful and stiff. As with other forms of osteoarthritis, pain increases with physical activity and decreases with rest. In addition to pain, you may hear hip stiffness and a clicking or sensation during movement.

Femoral-acetabular stroke

Femoral acetabular impact (FAI) is generally considered an early stage of hip arthritis. When bone spurs develop around the neck and the hollow of the hip joint, there is limited mobility of the hip and pain in the joint. groin (or outer thighs) at the limit of motion. Pain can range from a dull sensation to a sharp stabbing.

Tear of the upper lip of the thigh.

The upper lip of the hip joint is a layer of cartilage that surrounds the ball of the hip joint. A tear in the upper lip of the thigh can cause symptoms of pain (usually sharp) in the groin or buttock that are felt with certain movements of the thigh. Sometimes the grabbing and popping sensation is felt in the thigh as well.

Hip fracture

A hip fracture, a bone fracture in the upper quarter of the femur, can result from a fall or direct blow to the thigh, as well as osteoporosis, cancer, or stress injury.

Pain from a hip fracture is often felt in the groin and is greatly aggravated by any attempt to flex or twist the hip.

Osteonecrosis of the hip joint.

Osteonecrosis , sometimes called avascular necrosis, is a disease in which bone cells die due to a lack of an adequate blood supply. When this happens to the bone cells that support the hip joint, they begin to break down, making the condition worse. hip joint. A dull or throbbing pain in the groin or buttocks is usually the first sign of this condition. As a person develops, they may limp due to difficulty transferring weight to the hip.

Sports hernia

A sports hernia is a rare injury that is most commonly diagnosed in soccer and ice hockey players and is associated with a slight weakening of the abdominal wall. Causes pain directly in the front of the lower abdomen / groin area. A sports hernia is difficult to diagnose and usually rest or surgery is the only treatment.

Used less frequently

Less commonly, pain in the groin can cause disease of the testicles, abdomen, pelvis, and nerves.

Testicular conditions

Several different types of testicular conditions can cause groin pain, for example:

  • Epididymitis: Epididymitis is an inflammation of the epididymis, a tube located at the back of the testicles. Pain with epididymitis can start in the groin and then progress to the testicle. Testicular edema, fever, and chills may occur (although less frequently).
  • Testicular torsion: Testicular torsion is an emergency surgery that occurs when the structure that carries the nerves to the testicles (spermatic cord) twists on its own, resulting in sudden, severe pain in the groin and testicles.

Nervous problems

A pinched nerve in the lumbar spine (lower spine) can cause pain, numbness, and tingling in the groin. This condition is called lumbar radiculopathy.

Also, a pinched nerve, such as a pinched obturator or ilio-inguinal nerve, can cause burning or shooting pain in the groin and mid-thigh , as well as other neurological symptoms such as numbness and tingling.

Diseases of the abdomen or pelvis.

Certain abdominal conditions, such as diverticulitis or abdominal aortic aneurysm , or pelvic conditions, such as an ovarian cyst , can cause pain that spreads or is felt to be in the groin.

Osteitis pubis

Osteitis pubis is an inflammatory disease of the symphysis pubis, the cartilaginous joint that connects the two pubic bones. It can cause a dull ache in the groin and pelvis. This condition can occur in both athletes and non-athletes, especially those with a history of inflammatory arthritis , pregnancy, pelvic injury, or pelvic surgery.

Rare

These two conditions are rare, but they can be a source of groin pain and will therefore be addressed by your healthcare professional:

Infected joint

In rare cases, the hip joint can become infected . It is more common in the elderly (people over the age of 80), as well as people with diabetes, rheumatoid arthritis, recent joint surgery, and hip or knee replacement. In addition to severe pain in the groin, especially when the legs are moved, the person may have a fever, as well as swelling, warmth, and redness around the thigh.

Tumor

In very rare cases, a swelling in a muscle or bone, especially in the area of the inner thigh muscles, can cause pain in the groin. Unlike a groin sprain, pain in the groin due to swelling does not usually get worse with exercise.

When to contact a healthcare provider

Get immediate medical attention if your groin pain is severe or persistent, or if you fall or have experienced another form of hip injury.

Groin pain associated with fever, chills, blood in the urine, abdominal or pelvic discomfort, nausea or vomiting, or the inability to bear weight or walk also requires immediate medical attention.

In the case of an inguinal hernia , if you can't push the protruding tissue into your body, be sure to call your doctor or surgeon. Seek emergency medical attention if you experience severe pain around an inguinal hernia (lump in the groin) or symptoms such as vomiting, diarrhea, or bloating. This may indicate a strangulated hernia, in which the hernia tissue is pinched without an adequate blood supply (this requires urgent surgery).

Lastly, if you experience severe pain on only one side and swelling of the testicles, seek emergency medical attention due to possible testicular torsion, which also requires immediate surgery.

Diagnostics

After receiving a detailed medical history, your healthcare provider will ask you about the specifics of your groin pain, such as when it started, if you experienced an acute injury or trauma that worsens and relieves pain, and if you have any other symptoms. companions. … Then your healthcare professional will perform a complete physical exam and will often order imaging tests to confirm the diagnosis.

Physical exam

To identify the cause of your groin pain, your doctor will do an abdominal exam, a testicle (if you are male), a neurological exam, and a musculoskeletal exam with an emphasis on the hip.

People with hip problems often complain of discomfort with flexion (flexion) and rotation of the hip joint. This can be a maneuver, such as placing the ankle on the thigh in a sitting position to put on shoes or socks. From a medical point of view, this is called the FABER maneuver (flexion, abduction, external rotation) or Patrick's test.

Display

While a groin sprain can only be diagnosed by a physical exam, other causes of groin pain generally require imaging.

The most common imaging test to access groin pain is an X- ray , which can be helpful in demonstrating the anatomy and bony structure of the hip joint.

It is the best test for determining the extent of cartilage damage and other signs of hip osteoarthritis, such as bone spurs and narrowing of the joint space.

If groin pain is suspected to be related to a testicle or an inguinal hernia, an ultrasound may be done. If a kidney stone is a possible culprit, your healthcare provider may opt for a computed tomography (CT) scan . An abdominal / pelvic ultrasound or CT scan may also be done if a bowel or other abdominal / pelvic process is suspected of causing groin pain.

Magnetic resonance imaging (MRI) is often done to evaluate the soft tissue around the hip joint. An MRI can show muscles, tendons, ligaments, and the upper lip to determine the source of groin pain. Sometimes an MRI is done with an injection of a solution called a contrast agent to better reveal minor cartilage and upper lip damage within the joint.

MRI can also be used to access nerve disorders, such as a pinched nerve in the back that transmits pain in the groin.

Injection

Finally, a diagnostic or therapeutic injection can be very helpful if the source of the pain is unclear. An experienced physician, sometimes an orthopedic surgeon or radiologist, can insert a needle into the hip joint. This can be done with ultrasound or X-rays to make sure the needle is positioned correctly.

Once the needle is in the joint, an anesthetic (lidocaine) can be injected. This is a very useful diagnostic tool: if the pain temporarily subsides, the source is likely where the anesthetic was injected.

Watch out

Once the correct diagnosis has been made, the next step is to come up with a treatment plan.

Lifestyle treatment options

Some causes of groin pain require simple steps that you can often do at home. For example, if your groin was sprained due to a sports injury, your healthcare provider will likely recommend resting, applying ice to the injured area, and wrapping the upper thigh in an elastic compression bandage to reduce pain and the inflamation.

Similarly, for hip osteoarthritis, your healthcare professional may recommend minimizing activities that make your pain worse, such as climbing stairs. For epididymitis or other sources of testicular groin pain, lifting the scrotum and icing can help.

Medicines

Medications such as Tylenol (acetaminophen) or over-the- counter non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve groin pain in many conditions, such as a groin strain, osteoarthritis, upper lip rupture of the thigh, pubic osteitis, or a pinched nerve in the back.

Stronger pain relievers, such as opioids, may be needed to treat the more severe groin pain associated with kidney stones, a hip fracture, or an infected hip.

Sometimes a steroid, such as cortisone, is injected into the thigh to relieve pain in the groin, especially in the case of osteoarthritis of the hip, or in the lower back, such as a pinched nerve.

Finally, depending on the underlying condition, antibiotics may be needed to treat the infection, as in the case of epididymitis. Antibiotics are also used after surgery on an infected hip joint.

Physiotherapy

Physical therapy is the main treatment for most causes of groin pain associated with the hips. At the same time, the rehabilitation time depends on the underlying problem (for example, postoperative physical therapy after hip replacement versus long-term physical therapy for osteoarthritis of the hip joint).

In addition to exercises that help strengthen your leg and hip muscles and improve range of motion and flexibility, if you have a hip problem, your physical therapist can provide you with an assistive device for walking, such as a cane, crutches. or a walker.

Operation

Other conditions are more serious and may require surgery, sometimes urgent, as in the case of a testicular torsion or a hip infection. A hip infection is treated with emergency surgery, which includes irrigation and wound cleaning followed by antibiotics in the postoperative period.

Examples of minor but necessary surgeries include hip replacement for advanced hip arthritis, arthroscopic hip surgery for some lip tears, and decompression surgery for hip osteonecrosis.

Prophylaxis

Groin pain is a common complaint with many potential causes.

To prevent hip problems (a common source of groin pain), here are some simple strategies you can follow:

  • keep a healthy weight
  • Play low-stress sports, like swimming or cycling, with less stress on your hips.
  • Talk to your doctor about strategies like balance training or tai chi to prevent falls, the most common cause of hip fractures.
  • Get moderate exercise every day to reduce bone loss and maintain muscle strength.

For causes of groin pain other than the hip joint, it is important to visit your healthcare professional regularly for regular checkups and examinations (for example, to identify sexually transmitted diseases , which are a common cause of epididymitis).

Get the word of drug information

There was a time when podiatrists understood that groin pain was limited to arthritis and muscle injuries. The understanding of the sources of groin pain has expanded significantly and, while it can help guide treatment options, it can make diagnostic evaluation difficult.

Please continue to actively work with your healthcare provider to determine the source of your groin pain. Once the source is clearly identified, a treatment plan can be developed that will give you the relief you deserve.

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