Groin Pain - Causes, Diagnosis, and Treatment

What Is Groin Pain?

Pain is a feeling of discomfort that might occur in any human body organ. The junction of the lower abdomen and thighs is known as the groin. When the patient feels pain or discomfort in this area, it is known as groin pain. Sometimes people get confused between testicular pain and groin pain. Though the testicular pain might radiate into the groin, there is a huge difference between both causes. In simple words, the groin is the area where the abdomen ends, and the legs begin. There are five muscles in the groin that work together to move a person’s legs. These muscles are listed below:

• Adductor Brevis (main adductor muscles of the hip).

• Adductor Longus (allows the inward and the sideways movement of the thigh bone).

• Adductor Magnus (contracts and pulls the hip towards the midline of the body).

• Gracilis (allows the adduction of hips and flexion of knees).

• Pectineus (flexion and adduction of the thighs).

What Are the Causes of Groin Pain?

The intensity and severity of groin pain vary from person to person. Some people might experience slow or sudden pain, while some might experience dull, sharp, and throbbing pain. Mostly, groin pain results from a strain in the muscles, ligaments, or tendons. Therefore, people involved in sports activities experience groin pain to a large extent. Sometimes, the pain might begin spontaneously or build over time. If the patient continues the sport or the activity that causes the pain, the situation might worsen. The other conditions that might cause groin pain are listed below:

• Inguinal Hernia - An inguinal hernia occurs when a loop or part of the intestine protrudes through the weak muscles in the lower abdominal wall. The patient might see a bulge in the scrotum or the groin. When the fat or the intestine blocks the abdominal wall, its blood supply gets reduced, resulting in a condition known as a strangulated hernia. People suffering from inguinal hernia might experience nausea, inability to pass gas, fever, redness near the bulge, and dull groin pain.

• Prostatitis - Prostatitis or inflammation of the prostate gland might be one of the reasons for pain in the groin.

• Kidney Stones - Nephrolithiasis or kidney stones occur due to the precipitation of minerals and salts in the urine. These stones might travel from the kidneys to the ureters and bladder and get stuck there. As a result, the patient experiences difficulty in passing urine, hematuria, and pain near the hips, abdomen, lower back, and sometimes groin.

• Hip Osteoarthritis -The hip joint is located between the pelvis and the thigh bone. Arthritis occurs when this smooth hip joint is worn out. It becomes stiff when the joint is worn out, making leg movements difficult. A popping sound is heard due to the stiffness of the hip joint, and pain is felt in the groin.

• Hip Labrum Tear -A hip labrum is a thin layer of cartilage that wraps around the hip joint. Sharp pain in the groin and the buttocks is seen when the hip labrum is torn. Some patients might feel a popping sensation in the hips.

• Hip Osteonecrosis - Hip osteonecrosis or avascular necrosis is a condition when the bone cells die because of the reduced blood supply. The hip joint breaks down due to the collapse of the bone cells. A dull aching or throbbing pain might be felt due to osteonecrosis.

• Epididymitis - Epididymis is a part of the male reproductive system and the storage site for sperms. The inflammation of epididymis is known as epididymitis, and the patient might experience the following symptoms:

  1. Scrotal pain.

  2. Dysuria (painful urination).

  3. Fever.

  4. Milky discharge from the penis.

• Testicular Torsion - It is a condition when the testicles twist around their position. As a result, the blood supply of the testicle is lost, leading to severe and sudden groin pain.

• Lumbar Radiculopathy - It is a condition that causes numbness, tingling sensation, and groin pain due to the compression of the nerve supplying the lower spine. Nerve entrapment or direct pressure on the nerve might cause stabbing or burning pain in the groin.

• Abdominal Conditions - The abdominal conditions that might cause groin pain are listed below:

  1. Diverticulitis - It is a condition when the bowel becomes inflamed.

  2. Aortic Aneurysm - It is a condition when the major blood vessel, the aorta, becomes enlarged.

When Must the Patient Consult the Doctor Regarding the Joint Pain?

The patient must consult the doctor if the patient has fallen or injured his hip. Consult the doctor if the following symptoms are present along with groin pain:

• Fever.

• Hematuria (blood in the urine).

• Nausea, chills, and malaise.

• Pain in the testicles.

• Abdominal pain or groin pain radiates to the chest and lower back.

• Diarrhea and vomiting.

• A feeling of a bulge in the groin.

• Testicular swelling.

• A groin pain that does not improve even after home remedies.

How Is Groin Pain Diagnosed?

Groin pain might occur due to several causes, so the doctor might take a thorough medical history to know in-depth about the pain. The following methods help diagnose groin pain:

Medical History - A medical history gives an idea about the patient's general health, the symptoms, onset and duration of progression, and family history. The doctor might ask the following questions about the medical history:

• When did the pain start?

• Did the patient experience any injury?

• What things make the pain worse and better?

• Does the patient experience any other symptoms?

Physical Examination - During a physical examination, the doctor might perform the following examinations:

• Abdominal exam.

• Testicular exam (in males).

• Neurological exam.

• Musculoskeletal examination to check for a hip injury.

Imaging Tests - If the doctor thinks the groin pain is due to hip injury, they might recommend the following imaging tests to detect the problems:

• X-rays - X-rays are one of the best imaging methods to determine the extent of cartilage damage. They can also help to detect other hip injuries like hip osteoarthritis, bone spurs, and narrowing of the joint space.

• Ultrasound - Ultrasound is usually recommended when the doctor suspects the groin pain is related to the testicles or inguinal hernia. Ultrasound is a simple imaging procedure in which the sound waves reach the body through a transducer, and the images are obtained on the computer screen. This test can be safely carried out in children and pregnant females as the patient is not exposed to X-rays.

• Computed Tomography (CT) Scan - CT scan is mainly recommended when the groin pain is due to a kidney stone. It provides three-dimensional images of the body’s internal organs and helps to detect stones, tumors, and cysts that might cause groin pain.

Diagnostic Injection Test - It is a procedure where an anesthetic solution known as Lidocaine is injected near the hip joint. If the pain subsides temporarily after the injection, it is confirmed that the injected site is the source of pain. But this procedure must only be done by an orthopedic surgeon or a radiologist.

How Is Groin Pain Managed?

After the patient has been diagnosed with groin pain and the cause is known, the following treatment options are usually recommended:

Lifestyle Modifications - Changes in lifestyles help overcome groin pain in mild cases. For example, if the patient has groin pain due to groin strain, the patient might recommend the following to ease pain and swelling:

• Apply ice over the affected area.

• Take enough rest.

• Wrap the affected part of the upper thigh with compression stockings.

• Limit the activities that increase pain.

Medications - Medications or over-the-counter drugs like Acetaminophen and Ibuprofen help relieve pain and inflammation if the groin pain is due to the following conditions:

• Groin strain.

• Hip labrum tear.

• Osteoarthritis.

• Lumbar radiculopathy.

• Hip fracture.

• Kidney stones.

Some people might benefit from the Cortone Acetate (cortisone) injection. For example, a steroid injection might be injected in people suffering from hip osteoarthritis. In addition, people having lumbar radiculopathy might receive an injection in the lower back.

• Physiotherapy -Physiotherapy includes stretching and strengthening exercises that help overcome groin pain due to hip injury. Some patients might need physiotherapy after hip replacement, while some might need long-term physiotherapy after hip arthritis. Physiotherapy helps improve the range of motion and flexibility of the body.

• Surgery - Patients might need surgery if the groin pain is due to serious conditions like testicular torsion and hip joint infection. During the surgical procedure, the affected area of the hip joint is flushed with saline solution, and the infected tissue is removed. Antibiotics might be administered after the surgery to prevent infection.

How to Prevent Groin Pain?

Groin pain might be traumatic for some patients as they cannot do their daily activities. However, the following methods help prevent pelvic pain:

1. Do warm-up exercises before starting any physical activity, as they help elevate the body temperature and lower the chances of muscle strain.

2. Wear comfortable shoes so that you get good support.

3. Avoid doing vigorous exercise initially. Start with low-intensity and then proceed to high-intensity ones.

4. Do not exercise if you feel tightness or pain in the groin, and take enough rest.

Conclusion:

Groin pain is a common condition, and it is the biggest misconception that only males experience groin pain. Women might have it, too, for several reasons. Studies have reported that 10 to 15 percent of males tend to experience pain in the groin due to hip osteoarthritis or labrum tear. Sometimes, the patient tends to ignore the pain and consider it a part of the aging process, which is wrong. People involved in sports activities and suffering from testicular problems are more likely to experience groin pain. However, the patient need not worry as simple home remedies and medications help treat groin pain.