What causes groin pain?

Pain in the groin (the junction where the lower part of the abdomen meets the upper thigh) is frequently caused by muscular strains, trauma, hernias, or visceral disorders of the kidneys or testicles. Let’s look at the various causes of groin pain in patients presenting to primary care.

What causes groin pain?

Strain

Groin strain is frequently seen in athletes, weightlifters, and bodybuilders, due to wear and tear of the muscles, ligaments, or tendons. They may experience pain when performing specific movements like hip extension, climbing stairs, or lifting the leg. Symptoms include groin pain and tenderness, weakness in the muscle, and difficulty performing targeted physical activities. Swelling and bruising may indicate a muscular tear. 

Tendon strain / Adductor tendinopathy

Longstanding injury to the tendons can lead to tendon degeneration, in which injured tendons become progressively weaker over time because of a lack of sufficient blood supply, which in turn hinders the repair process and can result in collagen fibre breakdown, increased stiffness, and persistent discomfort. If left untreated, tendon degeneration may significantly reduce mobility and increase the likelihood of complete tendon rupture.

Hip osteoarthritis

Hip osteoarthritis (OA) is highly prevalent. OA is a degenerative, “wear and tear” disease in which the joint cartilage breaks down over time. Groin pain is an initial indicator and common symptom of hip OA. The patient typically experiences dull ache or deep pain, worsening pain while performing certain activities, difficulty bending or spreading the legs, and clicking sounds from the hip joint.

Referred pain from the uterus

Groin pain can also be caused by uterine problems such as adenomyosis, fibroids, or endometriosis. Issues in the uterus can cause pain which spreads to the lower abdomen, lower back, and groin.

Hernia

Inguinal hernias are prevalent between the ages of 40 to 59 and are more common in males with an incidence rate of 27% as compared to females at 3%. Inguinal hernias occur when the abdominal contents (intestine or fat) protrude through a weak site in the lower abdominal wall, especially the inguinal canal. The herniated tissue exerts pressure on the nearby muscles and ligaments and can compress the nerves (ilioinguinal nerve, genitofemoral nerve, or iliohypogastric nerve). The patient may experience severe groin pain, numbness in the affected side, and gastric problems such as nausea, vomiting, constipation, bloating, and fever.

Infections

Urinary Tract Infections (UTIs) are common and mostly affect women. UTIs are primarily caused by Escherichia coli (E. coli) bacteria that enters via the urinary tract and causes infection and inflammation of the bladder, urethra, and kidneys. Groin pain may also occur due to increased pelvic floor muscle tension, and this type of muscular pain can continue even after the infection is cured due to lingering inflammation.

Prostatitis

The inflammation of the prostate gland (which produces seminal fluid and is situated behind the bladder in men) is known as prostatitis. It may cause sexual dysfunction, urinary problems, and discomfort including groin pain. Acute or chronic prostatitis can be a result of both infectious (E. coli, Klebsiella, Proteus species) and non-infectious causes (nerve damage, autoimmune condition, or pelvic floor muscle dysfunction).

Orchitis

Bacterial infections such as UTIs or STIs (such as chlamydia or gonorrhea) and viral diseases like the mumps can induce orchitis, which is inflammation of one or both testicles. Orchitis can cause groin discomfort, swelling, and long-term infertility problems if left untreated.

Epididymitis

Epididymitis is inflammation of the epididymis, a coiled tube that stores and transports sperm at the rear of the testicle. Patients with epididymitis experience scrotal pain, swelling, and discomfort. The condition can be caused by bacterial or viral infections or underlying medical disorders.

Clinical diagnosis

The cause of groin pain can be diagnosed in primary care with a combination of physical examination, blood work, urinalysis, and imaging (such as ultrasound, X-ray, or MRI).

In athletes, the clinical diagnosis is further established by the DOHA Agreement, which is a classification system for groin pain.

Treating groin pain

While rehabilitation and lifestyle modifications lower the chance of recurrence, early intervention is essential.

Groin pain arising from acute strain is usually treated with the RICE protocol (rest, ice, compression, and elevation).

Chronic or longstanding groin problems of musculoskeletal origin will require strengthening, stretching, and corrective muscle training.

Over the counter pain management may be prescribed. If the patient has pain of visceral aetiology, the root cause is treated with targeted medications.

In certain cases, such as hernias, surgical interventions may be necessary.

- Dr Humda, Physiotherapist

Learn more about this topic in the HealthCert Professional Diploma program in Musculoskeletal & Sports Medicine - fully online or with optional practical workshops.

References

• https://www.sciencedirect.com/science/article/pii/S2059775423004911 
• https://www.termedia.pl/Journal/-78/pdf-41429-10?filename=5_01510_Article_c.pdf 
• https://link.springer.com/article/10.1186/s13102-023-00684-6 
• https://www.sciencedirect.com/science/article/pii/S0021929019307249
• https://www.mdpi.com/2075-4418/14/8/814
• https://onlinelibrary.wiley.com/doi/abs/10.1111/sms.14248