Causes of Groin Pain and Treatment Options

Everything you need to known about groin pain

Groin Pain
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When people experience pain in their lower abdomen, where the lower extremity meets the pelvis, they often refer to this as groin pain.

Groin pain can be caused by a wide variety of medical conditions. For instance, problems in or around the hip joint, problems in the scrotum (in men), or problems with specific nerves can all lead to groin pain.

To decipher the "why" behind this unique type of pain, a comprehensive physical examination, as well as imaging tests, like an ultrasound or MRI, are needed.

In the end, once you have a diagnosis, your treatment plan may range from something as simple as rest and ice to something more involved, like physical therapy, or invasive, like surgery.

Causes

As stated earlier, there are a number of different causes of groin pain. For this discussion, we will separate these possible sources of groin pain into hip-related causes and non-hip-related causes.

Hip Related Causes of Groin Pain

You may wonder how a hip problem causes pain in the groin.

Just as patients with a heart attack may experience arm pain or patients with gallbladder problems may experience shoulder pain, patients with hip problems usually complain of groin pain. This is called "referred pain," and it is due to the organization of nerves in our body. 

Keep in mind, pain over the outside of the hip is usually not caused by a hip joint problem and is more commonly related to hip bursitis or a pinched nerve in the back. Instead, it is pain that is deep in the groin that is often a sign of a problem within the hip joint, which is located at the junction of the pelvis and the top of the thigh bone (the femur).

With that, here are a few hip-related conditions that commonly lead to groin pain:

Hip Arthritis

Arthritis of the hip joint occurs when the usually smooth hip joint is worn away. When the cartilage is worn away, leg movements become painful and stiff.

Femoral Acetabular Impingement

Femoral acetabular impingement, abbreviated FAI, is generally thought of as an early stage of arthritis in the hip joint. When bone spurs develop around the ball and socket of the hip joint, this leads to restrictions in mobility of the hip and pain at the limits of motion.

Osteonecrosis

Osteonecrosis, sometimes called avascular necrosis, is a medical condition that causes bone cells to die as a result of a lack of appropriate blood supply. When the bone cells supporting the hip joint lack a healthy blood supply, they begin to collapse, leading to deterioration of the hip joint.

Groin Strain

A muscle injury, called a strain, is probably the most common cause of groin pain. Groin strains typically occur as a result of an athletic injury or awkward movement of the hip joint. Usually, the onset is abrupt, and the cause of pain is clear.

Hip Labrum Tear

The labrum of the hip joint is a layer of cartilage that wraps around the ball of the "ball and socket" hip joint. Much like a meniscus tear in the knee, a hip labral tear can cause symptoms of pain, catching, and popping within the hip. Hip labral tears are often diagnosed as athletic injuries and can lead to difficulty with certain movements of the hip joint.

Non-Hip Related Causes of Groin Pain

There are other causes of groin pain that may not be related to the hip joint. These causes need to be considered when experiencing groin pain.

Inguinal Hernia

An inguinal hernia occurs in the groin area and occurs when fatty tissue or the intestines "herniates" or protrudes through a weak or torn area within the abdominal wall. Sometimes, an inguinal hernia causes no symptoms. If symptoms are present, people often report a tugging sensation in the groin area and/or a dull groin pain when coughing.

Kidney Stone

A kidney stone may cause waves of pain (called renal colic) as it passes through the urinary tract system. The pain can range from mild to severe, and often occurs in the flank area (between your ribs and hips) or the lower abdomen. In both cases, the pain frequently travels or "radiates" towards the groin.

Testicular Conditions

Several different types of testicular conditions may cause groin pain, such as infection, trauma to the testicles, or testicular torsion.

Nerve Problem

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

Likewise, nerve entrapment, such as obturator nerve entrapment, may cause groin pain or medial (middle) thigh pain.

Sports Hernia

A sports hernia is an unusual injury that is attributed to a subtle weakening of the abdominal wall. Sports hernias have been diagnosed mostly in soccer and hockey players and causes pain directly over the front of the lower abdomen/groin region. A sports hernia can be difficult to diagnose, and usually, the only treatment is rest or surgical intervention.

When to See a Doctor

Be sure to seek immediate medical attention if your groin pain is severe or persistent, or if you have fallen or experienced another form of trauma to your hip.

In the event of an inguinal hernia, if you cannot push the protruding tissue back into your body, be sure to call your doctor or surgeon. Seek emergency medical attention if you experience severe pain around your inguinal hernia (groin bulge), or symptoms of sickness like vomiting, diarrhea, or a swollen belly. This may indicate a "strangulated hernia," in which the herniated tissue becomes trapped without adequate blood supply (this requires emergent surgery).

In addition, if you are experiencing severe, one-sided testicular pain and swelling, seek emergency medical attention for a possible testicular torsion, which also requires emergent surgery.

Groin Pain in Children

It's important to keep in mind that joint problems in children must be considered slightly differently than in adults. While many children to experience groin pain when they have hip joint problems, children, in particular, also tend to experience pain going down the thigh and often into the knee.

A young child with a complaint of knee pain without a clear knee joint problem needs their hip carefully examined to see if that could be a source of pain. There are several childhood conditions of the hip joint including slipped capital femoral epiphysis or Perthes disease that can lead to these symptoms.

Diagnosis

Besides a detailed medical history upon which your doctor will inquire about the specifics of your groin pain, like when it started, what makes it worse or better, and whether you have any other associated symptom, your doctor will perform a thorough physical exam and often order imaging tests to clinch the diagnosis.

Physical Examination

To access the culprit behind your groin pain, your doctor will perform an abdominal exam, testicular exam (if male), neurological exam, and a musculoskeletal exam that focuses on your hip.

People with hip joint problems often complain of discomfort with maneuvers that involve flexion (bending) and rotation of the hip joint. This would be a maneuver such as resting your ankle upon your thigh while in the seated position to put on your shoes or socks. In medical terms, this is called a FABER maneuver (Flexion, ABduction, External Rotation), or 'Patrick's Test.'

Imaging

Different imaging tests can be performed to evaluate the source of your groin pain.

The most commonly performed imaging test is an x-ray. X-rays can be helpful at showing the bony anatomy and structure of the hip joint. An x-ray is the best test to determine the extent of cartilage damage and arthritis.

If groin pain is suspected to be related to the testicles or an inguinal hernia, an ultrasound may be ordered, or if a kidney stone is a potential culprit, a CT scan may be ordered.

An MRI is a test that is often performed to evaluate the soft tissues around the hip joint. MRIs can show muscles, tendons, ligaments, and labrum to help determine the source of groin pain issues. Sometimes the MRI is performed with an injection of a solution called contrast to better reveal subtle injuries of the cartilage and labrum inside the joint.

Injection

Finally, a diagnostic or therapeutic injection into the hip can be very helpful if the source of pain is unclear. A skilled physician, sometimes an orthopedic surgeon or radiologist, can guide a needle into the hip joint. This may be done with the aid of ultrasound or x-ray to ensure the needle is properly positioned.

Once the needle is in the joint, an anesthetic (lidocaine) or medication (cortisone) can be injected. The anesthetic is a very useful diagnostic tool—if the pain goes away temporarily the source is likely where the anesthetic was injected. The cortisone is often an effective treatment that may even provide long-term relief of symptoms.

Treatment

After a proper diagnosis is made, the next step is formulating a treatment plan.

Lifestyle Treatment Options

Some causes of groin pain require simple strategies that you can often do at home. For instance, for a groin strain from a sports injury, your doctor will likely recommend rest, icing the injured area, and wrapping the upper thigh with an elastic compression wrap to decrease pain and swelling.

Medications

In addition, self-care strategies are often used to manage hip arthritis and may include weight loss and taking an over-the-counter pain reliever like acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory (NSAID).

Physical Therapy

Physical therapy is a major treatment for most hip-related causes of groin pain; although, the timing of when to undergo rehabilitation depends on the underlying problem (for example, post-operative physical therapy after a hip replacement versus long-term physical therapy for hip osteoarthritis).

Surgery

Other conditions are more serious and may require surgery, sometimes emergently, as in the case of testicular torsion or non-urgently, as in the case of hip replacement surgery for advanced hip arthritis or an arthroscopic hip surgery for some labral tears.

A Word From Verywell

There was a time when orthopedic physicians understood groin pain to be limited to arthritis and muscular injuries. The understanding of sources of groin pain has expanded greatly, and while this can help to guide treatment, it can make for a challenging diagnostic evaluation.

Remain proactive in working with your physician to determine the source of your groin pain. Once the source is clearly understood, a treatment plan can be developed that should give you the relief you deserve.

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