Groin Pain: Causes, Symptoms, Treatment

The groin, inguina and regio inguinalis in Latin, is the term describing the inguinal region, i.e. the groin area.

This is a soft area serving as the junctional area between the abdomen and the thigh on either side of the pubic bone

Inguinal canal

The Latin term for the inguinal canal is canalis inguinalis. It is an approximately 5 centimeter slit located on the lower side of the abdominal wall.

The length of the canal in adulthood reaches approximately 5 cm. It has an inner and an outer gate. They are surrounded by numerous abdominal, pelvic muscles, ligaments and tendons.

The inguinal canal is significant in several respects.

In men, the inguinal canals convey the spermatic cords. The testicles descend through this duct into the scrotum. In women the cords represent the round ligament of the uterus that clasp and fix the uterus in its place.

Blood vessels penetrate this area towards the lower limb. Of particular importance is the femoral artery (arteria femoralis), which is the main vessel carrying oxygenated blood and nutrients to the lower limb. The other is the femoral vein (vena femoralis), which carries deoxygenated blood back towards the heart.

A nerve, specifically thefemoral nerve (nervus femoralis) also goes thorugh this area. The inguinal lymp nodes are also located in this region.

This area is made up of diverse structures such as muscles and tendons. These are a solid barrier between the abdominal cavity and the lower limb. However, the canal forms a weakening that is prone to herniation.

A hernia is a pathological dislocation or protrusion of a part of an organ through a weakened spot, for example, in the abdominal wall.

What is behind the pain in the groin area?

The pain may originate in the groin or radiate into it from another area.

Injury and overload, more common in athletes

A common cause of pain in this area is injury or overexertion - the pelvic and groin areas. Overtraining occurs especially in untrained people who have suddenly and excessively loaded the muscular parts of the pelvic region and lower limbs.

Sports hernia

In sports, oru bodies are susceptible to large forces, pressures and loads. There are certain types of sporting activities where extremely high pressure, forces, and loads are exerted on the body.

These include:

• football/soccer
• hockey
• rugby

High loads on the groin and pelvis are mainly caused by rapid changes in movement, acceleration, deceleration or kicking.

Sports hernia, a term first used in 1980 by O.J. Gilmore, is also known as athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, Gilmore's groin, or groin disruption.

Sports hernia is defined as persistent pain in the groin area, without the presence of a hernia or other known cause. The pain may radiate to the groin, i.e. the scrotum, and the lower abdomen.

The onset of groin pain takes place over a long period of time. In most cases, it is not a consequence of a traumatic movement. Approximately 20% of those affected report a link to sporting activity. About 50% of those affected say that the pain sets in 24 to 48 hours after increased physical exertion, training.

Groin pain intensifies when running and sprinting, when rotating the trunk and the pelvis. It is also aggravated by coughing or sneezing.

Strained muscle, tendons and injuries

Another type is pain resulting right after an injury, such as a groin strain. Similarly, this happens with excessive strain, for example, when weight training or carrying heavy loads. People who are untrained and overuse the muscles and other structures in the area suddenly and inappropriately are especially susceptible.

The risk is damage to muscles, tendons and ligaments. Injury is followed by an inflammation. The person feelpains which is aggravated by movement.

Fracture of the femoral neck

The specific cause is a fracture in the hip area. A bone fracture can occur at any age. However, the most susceptible are the elderly with osteoporosis.

The femur can fracture after a fall. Pathological fractures without a physical force occasionally happen, too.

If the femur is fractured in the area of the femoral neck, the pain often radiates right into the groin.

Abdominal hernia, hernia inguinalis

This type of hernia is also known simply as a hernia. Basically, a hernia is the abnormal exit of tissue or an organ through the wall of the cavity in which it normally resides.

Approximately 80% of hernias are in the inguinal region, and are more common in males.

The intestine is literally pushed through the weakened area, technically referred to as the peritoneum. At this point, a bulge appears in the abdomen. The hernia can be pushed back into place.

This happens after physical exertion, with constipation, but also after a long-lasting cough, for example.

There is a sharp, stabbing, or burning pain at the site of the hernia, radiating to the groin, or the scrotum.

If this hernia is strangulated, the intestine behind the gate does not have sufficient blood supply. The pain escalates. If professional examination and treatment are not undertaken at this stage, there is a risk that part of the intestine will die off (necrosis).

This condition is also technically referred to as an incarcerated hernia. The intestine cannot be pushed back.

Associated with difficulties such as increased body temperature, vomiting. The risk is the development of shock. The health and life of the affected person is at risk.

A hernia, that is, a dislocation of the intestinal crank, can affect the scrotum in men and the labia majora in women.

Painful joints

Pain in the hip joint often moves to the groin area. Joint pain can have a variety of underlying causes. Arthrosis is common in the elderly.

This type of hip arthrosis is referred to as coxarthrosis.

At first, the sufferer may not experience more severe problems. Subsequently, pain, later limitation of movement and overall impaired quality of life due to the inability to perform normal life activities are associated.

Leran more in the article Face your arthrosis.

Osteoarthritis has various symptoms, such as:

• limitation of joint function
• limping
• joint stiffness after inactivity, especially in the morning after waking up
• restriction of movement to loss of joint mobility
• pain
• pain after inactivity
• exertional pain
• pain on passive movement
• in the late stage feels pain at rest
• nocturnal pains
• pain can also be aggravated by the position of the limb or the weather
• numbness
• creaking, squeaking, feeling of sand in the joint
• joint deformity
• swelling in the joint area
• local increase in skin temperature
• redness of the skin at the joint site
• in the late stage the muscle is also affected
• muscle wasting - muscle atrophy to shortening
• shortening of the limb
• joint stability

Lymph nodes as a cause of pain

A completely different situation occurs when lymph nodes are enlarged. Lymph nodes are distributed throughout the human body. Their enlargement is more visible in thin people.

Enlarged lymph nodes in the groin area may indicate an infectious disease or even a more serious oncological disease,but also various other lymphadenopathies.

A painful and possibly reddened nodule may signal the presence of an infection. Examples are chlamydial infection caused by sexual transmission or infectious mononucleosis. 

Lymphatic vessels from the external genital organs and the surrounding area pass through the lymph nodes.

Enlargement also occurs for a variety of other reasons. We discuss this topic in more detail in the separate articles Enlarged lymph nodes or Painful lymph nodes.

Sexual, reproductive and urinary system

In addition to this, in infectious diseases, regional lymph nodes may enlarge, pain radiates to the lower abdomen and groin area.

Table: radiating pain by gender

Excretory system

A common cause of pain transfer to the groin area is a kidney stone. The pain is located in the groin, continues up the ureters and radiates to the groin, thigh, or the rectum.

The reason for this is irritation of the inner lining of the ureters by a foreign object.

The pain is unpleasant and of high intensity. The medical term is renal colic.

The pain is accompanied by general symptoms such as pallor, cold sweat, a feeling of vomiting and even the presence of blood in the urine, i.e. haematuria.

Some factors that increase the risk of developing urinary stones:

• reduced fluid intake, dehydration 
• excessive intake of highly mineralised carbonated beverages
• genetic predisposition
• lack of exercise and sedentary lifestyle
• urinary tract infections
• geographical factors affecting the composition of drinking water 

Elevated body temperature may be present with inflammation. Inflammation of the kidneys, urinary tract or bladder is referred to as cystitis. It is more common in women than in men. The main cause is the smaller length of the urethra.

The female urethra is shorter and pathogens from the external environment pass more easily into the bladder.

In severe cases, the pain is provoked by oncological disease, which can affect any part of the urinary system.

Reproductive system

The reproductive system is equally close to the groin area. Therefore, it is not exceptional that difficulties are reflected in that area.

In women, reproductive system diseases include:

• ovarian cysts
• endometriosis
• endometritis - inflammation of the uterus
• deep inflammation of the pelvis
• inflammation of the cervix
• inflammation of the vagina
• inflammation of the ovaries and fallopian tubes - adnexitis
• muscle stenosis, spasm of the muscles of the vagina
• dysmenorrhoea, painful menstruation or premenstrual pain

In men, this happens, for example, with inflammation of the testicles or epididymis. Prostatitis is another example.

Oncological diseases are generally high risk for both sexes.

Sexually transmitted infectious diseases, such as genital herpes, chlamydia infection, are a special group.

Testicular torsion in men and ovarian torsion in women. In both cases, the problem arises because of the restriction of blood supply to these parts. If the affected part is not blooded for a long time - it dies.

Testicular torsion can occur with sports and violent movement. In young girls, ovarian torsion occurs, for example, during sports activities such as basketball or volleyball.

Pain in the groin during pregnancy

Also during this delicate period, for the woman or fetus, inflammatory diseases occur. These are especially serious from the point of view of the developing baby. Because they are a risk for the development of birth defects.

Genital herpes is risky. Adnexitis, an inflammation of the ovaries or fallopian tubes, occurs during this period. Early diagnosis and treatment are important.

Constipation is unpleasant, but not serious. The uterus, along with the fetus, enlarges and takes up space in the abdominal cavity. This results in impaired digestion and passage of contents in the intestines.

Digestion is also affected by hormonal changes.

The pressure of the uterus on the pelvic area causes pelvic pressure. Pain can also radiate from a loaded spine. Pelvic exercises or prenatal massage help.

In case of persistence of unpleasant discomfort, an examination is advisable. It is important to distinguish changes that are normal for pregnancy from pathological processes.

The digestive system may also be the cause

The example given is a hernia. However, we know of other cases where pain radiates to the groin area. Often occurring is appendicitis or diverticulitis, even there can be in hemorrhoids, also known as piles.

Alternatively, it may be chronic constipation, the worse alternative is intestinal obstruction, i.e. ileus or tumour.

Spine and nervous system

Another large group is the spine and nervous system. Low back pain is often transferred to the lower limb or groin. This happens with various pathological or oncological processes in the LS area.

The LS region denotes the lumbo sacral part of the body, i.e. the lumbosacral region.

Examples are conditions such as:

• herniated disc
• spinal stenosis
• sciatic nerve inflammation, ischias
• coccydynia - pain in the coccyx
• SI-joint block - sacroiliac joint block
• acute lumbago, sharp lower back pain
  • colds of the lumbar and sacral spine, muscles and tendons
  • after unreasonable physical stress
  • sudden movement
  • muscle stretch
• nerve oppression due to trauma, bleeding, abscess, tumor
• injury
• postoperative condition
• Inflammation
• herpes zoster, shingles

Psychogenic pain?

This kind of pain has no physical basis. The problem emanates from psychological difficulties. About 10% of people with a psychiatric diagnosis report pain affecting the lower abdomen, genitals or groin. The prerequisite is mainly a lowered pain threshold, the person's emotional state and their overall personality.

What else increases the likelihood of this pain occurring?

Certain factors are also put together in connection with this problem, such as:

• hormonal disorders
• tight underwear
• sexual abstinence
• poor lifestyle and lack of exercise, sedentary lifestyle
• bad habits
• prolonged stress and psychological strain