Groin pain: 9 possible causes (and what to do?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

In some cases, groin pain can be severe and require urgent intervention (such as surgery). In other cases, they may pass spontaneously. Whatever the case, it is essential to identify the exact cause in order to better direct the treatment.

Do you suffer from right or left groin pain and want to determine the source? This article offers you 9 possible causes, as well as recommended treatments to reduce your symptoms.

Abdomen and groin anatomy

Before discussing the possible causes of groin pain, it is worth reviewing some basic anatomy to better understand the source of your symptoms.

Let's start with the lower abdomen and abdomen. The latter is located between the chest and the pelvis, and contains many organs of the body. Among these are the liver, stomach and intestines.

As for the groin, it represents the region of the body where the upper thighs meet the lower part of the abdomen. Normally, the abdomen and groin are separated by a wall of muscle and tissue. The only openings in this wall are small channels called the "inguinal canal" and the "femoral canal". These allow nerves, blood vessels, and other structures to pass between these two areas.

The groin has the following structures:

• Muscles and tendons, the main ones being the adductors, the psoas iliac, rectus femoris and sartorius
• Connective tissue (to connect muscles together)
• The inguinal canal (canal located at the level of the groin)
• The femoral canal (channel in the wall of the abdomen allowing the passage of blood vessels and nerves)
• The spermatic cord in men (It passes through the inguinal canal and connects to the testicle)

9 possible causes of groin pain

"Pain in the fold of the groin", "discomfort in the groin", "pain in the lower abdomen", "pain in the adductor for no reason", "pain in the lower abdomen", and even "urinary tract infection"... all these terms are used to describe discomfort in the inguinal region. But where do these annoying symptoms come from?

In the next section, we will discuss 9 possible causes of groin pain (in the form of differential diagnosis). To determine the cause of your groin pain, your doctor will perform a complete physical examination and, if necessary, order blood tests and/or blood tests.medical imaging.

1. Tendinopathy or muscle pain (pubalgia)

This is probably the most intuitive cause, and the most frequent. This type of injury usually occurs in athletes who play contact sports such as football or rugby. It also occurs during sports that require sudden and frequent changes in direction (such as tennis, athletics, dancing, etc.).

Often referred to as pubalgia, this injury sometimes occurs traumatically, or develops gradually. Essentially, micro-tears following over-stretching or violent contraction cause an inflammatory phenomenon. Depending on the grade of injury (1 to 3), more or less intense pain in the adductors may appear.

Symptoms are aggravated by movements involving muscle contraction of the muscles around the groin, or by stretching the area. A sensation of stiffness, and sometimes a localized edema, can be added to the clinical picture.

Initially, the pain may disappear after warming up, but seems to reappear and worsen with exertion. Without adequate treatment, these pains can become incapacitating and limit sports practice.

To know everything about the pubalgia, see the following article.

La psoas tendonitis can also cause pain that radiates to the groin. It occurs in athletes (especially footballers or runners), and his healing time is usually long.

2. Low back pain

Admittedly, low back pain comes from a problem located at the level of the spine (vertebrae, discs, facet joints, Etc.).

But pain in the lower back sometimes tends to radiate to the lower limb for several reasons (explained in this article). Areas affected include the groin.

Therefore, lower back involvement should not be excluded when investigating the source of groin pain.

3. Hip problems

A hip osteoarthritis (or other hip joint problem) sometimes radiates to the groin. Most often, this pain comes on gradually, and gets worse when the hip is stimulated (for example, sitting in a low chair or driving for a long time). It is the same for thehip osteonecrosis.

Certain clinical and medical imaging tests may confirm the presence of a hip dysfunction explaining the pain in the groin. In this case, the treatment will be concentrated at the level of the hip to remedy the causal factor.

For those who have a hip prosthesis, it is not uncommon to experience groin pain after surgery. Typically, symptoms should dissipate over time, especially if rehabilitation has incorporated adductor strengthening exercises and mobility exercises. On the other hand, it is important to communicate with your orthopedist if the pain persists for more than 6 months, especially if it affects daily life or wakes you up at night.

In addition, a pubic arthropathys can also cause groin pain.

4. Cruralgia

The term cruralgia can be separated into "crural" and "algia". Thus, cruralgia refers to pain in the region of the crural nerve (or femoral). Cruralgia mainly affects adults over the age of 50. It is a very general term, and does not take into consideration the potential causes as to why the crural nerve was irritated in the first place.

On the other hand, it causes pain in the groin which can radiate to the front of the thigh. The pain may be accompanied by tingling, numbness, and/or feeling of weakness in the leg.

To learn all about cruralgia, see the following article: AZ cruralgia: symptoms, duration, treatment

To benefit from physio exercises aimed at treating cruralgia (including videos), see the following article.

5. Kidney stones

Commonly called "kidney stones", kidney stones are crystals that form inside the kidneys. A kidney stone is usually not painful until it moves, either into the kidney or into the ureter (the structure that connects the bladder to the kidney).

Kidney stones can be felt as intense (and very intense!!!) pain. Although it is felt primarily in the lower back or flank, it sometimes radiates to the groin. Other symptoms of kidney stones may include:

• Nausea and vomiting
• A persistent need to urinate (often in small amounts)
• Pain when urinating
• Brown, reddish or pink colored urine

6. Inguinal hernia

It usually occurs when a portion of the peritoneum or small intestine breaks through the abdominal wall. A mass is sometimes seen in the groin or scrotum in men.

Sometimes asymptomatic, it can also be painful and cause discomfort during certain activities (such as walking, bending over, performing core exercises, etc.).

In some rare cases, a inguinal hernia can compress surrounding tissue and cause ischemia (this is called a strangulated hernia). This is a medical emergency. If your groin pain is accompanied by the following symptoms, consult without delay:

• Sudden redness or pain in the groin
• Inability to have a bowel movement or pass gas
• Nausea, vomiting
• Fever

To know everything about inguinal hernia and its treatment, see the following article.

7. Crural hernia

Also called femoral hernia, the crural hernia is more common in women than in men (especially in old age). It occurs when part of the digestive tract enters the femoral canal through a weak point in the abdominal wall. It has similar symptoms to an inguinal hernia, and can also become "strangulated".

To know everything about crural hernia, see the following article.

8. Prostatitis

It is a swelling or infection of the prostate gland in men. In addition to pain, it can also affect urination. Although the pain may go away on its own over time, it's best to see your doctor in case the prostatitis is caused by an infection that requires antibiotics.

9. Pregnancy

During pregnancy, pain in the groin can be explained in several ways:

• The uterus expands, which can cause pain in the surrounding areas, including the groin.

• In late pregnancy, if the baby's head presses on the pelvic area, it can cause constant or intermittent discomfort in the groin.

• Hormones called "relaxin" are secreted during pregnancy, causing the ligaments to loosen and decrease stability. This instability can manifest as pain in the groin.

• The center of gravity is modified during pregnancy, as well as the gait. Overuse of the structures surrounding the groin can therefore generate pain at this level.

To know everything about cruralgia during pregnancy, see the following article.

Groin pain: When to consult urgently?

In some cases, groin pain comes from a serious harm, and require urgent care. If you observe any of the following symptoms, do not delay in consulting:

• Sudden or intense pain in the testicle (in men)
• Pain that radiates to the back, abdomen, or chest
• Malaise accompanied by fever, chills and nausea
• Constant groin pain that does not improve despite rest
• Swelling or lump in a testicle
• Presence of blood in the urine
• Respiratory difficulties
• General weakness and dizziness

Treatment: What to do?

How to treat groin pain?

The first thing (and this is exactly the purpose of the article) is to clarify the diagnosis to identify the exact source of the problem. Once the diagnosis has been clarified, we can then determine whether it is preferable to rest the groin region, or on the contrary to stimulate it gradually to accelerate healing.

If the cause comes from an abnormality in a muscle, tendon or ligament, the treatment will consist in particular of specific exercises aimed at activating the circulation, toning up the muscles concerned and relaxing the tense muscles. A physiotherapist will be able to prescribe a home exercise program using equipment such as elastic bands, Pilates rings, etc.

In addition to exercises, a qualified therapist (such as an osteopath or physiotherapist) can apply manual techniques to correct dysfunctions and relieve pain. This includes massage, analgesic modalities (heat, ice, TENS machine), mobilizations and other manipulations.

It should be noted that manual techniques will not be limited to just the groin area, and may include lower back, hip joint, knee, pelvis, etc.

Indeed, the therapist will first make an exhaustive assessment to identify the imbalances and potential causes of the symptoms. As structures are interrelated and pain is multifactorial, the body must be treated as a whole.

In addition, a doctor may prescribe medication to control pain. These will be adapted according to your symptoms, your limitations, and your medical history.

For those who prefer to avoid medication, applying ice or heat to the groin can sometimes provide relief. The same is true for some natural products (such as certain products based on arnica, turmeric, etc.).

In more serious cases, however, these terms will not take effect. With this in mind, stronger analgesics will be considered, as well as a referral to a specialist to consider more “invasive” alternatives. Indeed, an infiltration and even surgery are sometimes indicated in certain cases.

In the case of hernia (inguinal or crural), surgery is also the only curative option (even more when it comes to strangulated hernia). Some supports can temporarily relieve symptoms and improve quality of life while a lasting solution is found.

Prevention of groin pain

Prevention is as important as treatment when it comes to groin pain. Here are some general tips that can prevent the onset (or aggravation) of your problem:

• Do an appropriate dynamic warm-up before sport, and appropriate stretching afterwards. You can use a massage gun (such as thereof) or massage roller in the muscles surrounding the groin.
• Drink enough water throughout the day to prevent kidney stones.
• Maintain a healthy weight (analyzed with body mass index (BMI)).
• Integrate a strengthening program aimed at toning the muscles surrounding the groin (adductors, abs, etc.).
• For athletes, improve your sports technique (bodybuilding, sports, etc.).
• For pregnant women, follow up during pregnancy and even after childbirth to facilitate postpartum.
• Do not wait to consult if the symptoms persist, because chronic pain is generally more complex to treat.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and grandmother's remedies are used to treat various body pains, in particular for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 

• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Resources

Massage gun: Opinion of a health professional

References

• https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-groin-strain
• https://www.physio-pedia.com/Groin_Strain
• https://pubmed.ncbi.nlm.nih.gov/23015943/