The groin region is a portion of the body located between the flexion crease of the thighs and the abdomen; a pain referred to at this level, can recognize at the base of multiple clinical conditions of different severity and be accompanied by symptoms of varying intensity, depending on the case.
Identifying the underlying cause of the symptoms allows, in most cases, the resolution or reduction of the disorders reported by the patient through the adoption of a targeted therapeutic approach.
Review of anatomy
The groin is a body region between the flexion fold of the thigh and the abdomen in which it is possible to anatomically distinguish two different portions:
- The “inguinal-abdominal” portion, which includes the abdominal wall;
- The “inguinofemoral” portion, which includes the highest and inner area of the anterior aspect of the thigh.
Groin pain is preferentially localized in correspondence with these structures.
The localization to the right or to the left, which is important for setting up therapy, is not very important for the diagnosis, as, generally, most of the pathologies capable of causing pain in the groin, involve this region bilaterally (however pain involving the right groin occurs with a slightly higher frequency, probably due to the higher use of the corresponding lower limb); groin pain can also be found in women and men of any age.
The possible causes of groin pain are obviously extremely numerous and varied. But among the most common in clinical practice it is possible to include injuries to the musculoskeletal system, particularly widespread, especially among sportsmen :
- Muscle contracture: corresponds to the involuntary and insistent contraction of muscle fibers located at the hip level, which causes modest and widespread pain.
- Localized muscle strain at the hip: caused by excessive stretching of the muscle fibers. In this case, the pain is acute, sudden and often followed by a muscle spasm (which, however, does not always lead to suspension of activity).
- Pubalgia: it is a clinical condition characterized by pain in the inguinal and / or pubic area and / or in correspondence with the inner portion of the thighs which is generally traced back to a series of perpetuated microtraumas (mainly affects sportsmen who practice activities in requiring intense lower limb stress).
Although more common in those who practice sports, these forms of pain can nevertheless be experienced by anyone. For example as a result of efforts or abnormal movements; the onset of pain is sometimes perceived after some time, for example upon awakening in the morning, making it difficult to trace the triggering event.
Other common causes of groin pain include:
- Inguinal hernia: consists of the exit of a part of the intestine from its normal location, through a hernial gate which is included in the inguinal region.
- Kidney stones: stones are aggregations of mineral salts that form in the urinary tract, often associated with an inappropriate diet, as well as a genetic predisposition. They can be the cause of renal colic, caused by the passage of stones in the urinary tract, followed by dilation and spasms; it mainly manifests itself with abdominal pain, radiating to the lower groin.
- Pregnancy: groin pain in pregnancy is related to the stretching of the round ligament. One of the ligaments holds the uterus in its position. During gestation, in fact, this ligament tends to stretch and thin, causing, with its stretch. The appearance of a sharp and short-lasting pain along the bikini line, more often at the level of the right side of the groin
On the other hand, recurring pain may be the result of a more serious ailment; in these cases, the discomfort develops slowly over time, without specific injuries or trauma, and worsens when the hip is flexed. For example, while sitting in a low chair or when driving. Some stiffness and a reduction in the range of motion of the hip begin to appear, which tend to have an increasing impact on everyday life. Among the possible causes, we remember for example
Osteoarthritis of the hip (coxarthrosis): it is a degenerative process that affects the hip joint, causing wear of the articular cartilages; this pathology manifests itself with chronic pain referring to the hip. And groin region, associated with a reduction in the fluidity of movements.
Arthritis of the hip: it is an inflammatory pathology that affects the hip joint; it is generally associated with pain, joint stiffness, swelling, redness, and reduced motor capacity.
Traumatic injuries involving the hip include instead
- Hip fracture: it is a serious condition, especially if it affects older patients. And usually consists of the break of a specific part of the femur, the neck, which joins this bone to the coxo-femoral joint.
- Hip dislocation: this is a hip injury, usually of a traumatic nature (for example, in traffic accidents that cause the knees to hit the dashboard). In which the head of the femur exits the rounded cavity of the iliac bone (pelvis ) where it is located.
Although testicular pain and groin pain are different, an inflamed testicular condition can sometimes generate reflected pain in the groin, for example as a result of:
- Testicular torsion: it is determined by the rotation of the testicle on its spermatic cord. A movement that blocks the flow of blood to the testicle itself; it manifests itself with intense and sudden pain and, subsequently, swelling of the involved testicle.
- Varicocele: it is a varicose disease that affects the vessels of the testicle, characterized by incontinence and dilation of the testicular veins, which are used to drain blood to the testicle.
- Orchitis: infection of the testicles, often caused by a virus such as mumps; the testicle is swollen and painful and the pain radiates to the groin.
- Epididymitis: inflammatory process affecting the epididymis, a portion of the male genital system; it may begin with groin pain.
- Testicular tumor: male neoplasm is not particularly frequent; it is characterized by the presence of a hard and painless lump at the testicular level, an increase in testicular volume, a sense of scrotal heaviness; it can cause dull pain in the groin, sometimes extending to the lower abdomen.
Moving the attention to the female organism we remember instead:
- Cystitis: is defined as an inflammatory pathology that affects the mucous membrane of the bladder and affects both men and women (the latter with a higher percentage); symptoms include pain in the groin, difficulty urinating, a feeling of heaviness or pressure in the suprapubic region, blood in the urine, increased number of urinations.
- Polycystic ovary syndrome: female endocrine disorder, characterized by the presence of anovulatory cycles, oligo-ovulation, and an increase in androgen hormones; it can present, among other symptoms, also with pain in the groin.
- Ovarian cysts: they are particularly frequent but generally asymptomatic; only in some cases can they cause disorders such as pain in the groin, abdominal discomfort, pain during sexual intercourse. Or irregularity in the course of the menstrual cycle.
Less common causes include:
Piriformis syndrome: is caused by the compression of the sciatic nerve by the piriformis muscle (a flat muscle of the buttocks, located at the hip); causes pain in the buttocks and, sometimes, sciatica.
Swelling and inflammation of the inguinal lymph nodes, are usually due to a local infection (such as a sexually transmitted disease ).
Osteochondrosis of the femoral head: it is the result of a pathological process due to an insufficient blood supply that causes the death of the bone tissue and joint degeneration; pain, radiating to the groin region, is often the onset symptom.
Groin referred pain can occur on both right and left and be:
Acute: appears suddenly, even in subjects in good health. And can present itself in different ways (such as a sense of oppression, unbearable burning, or stabbing).
Chronic: it is a pain that lasts over time (generally, for a few months). And is perceived as continuous and recurrent; sometimes it can interfere with the performance of normal daily activities.
Extended to the buttocks, knee, limb, or thigh.
Associated symptoms, which vary according to the underlying cause, including among others
- Muscle weakness
- Mobility reduction
- Difficulty bending or maintaining a sitting position over time
- Muscle numbness
- Sense of oppression
As it is easy to guess, since it can be determined by a large number of different clinical conditions. The diagnosis of groin pain requires the execution of specific tests, depending on the case.
Once the medical history has been collected and after a thorough examination. If necessary, the doctor can make use of further tests to clarify the diagnosis, such as:
- Blood tests;
- Instrumental tests, such as
- Ultrasound ,
- Magnetic resonance .
Treatment varies according to the underlying disease; the treatment of the disease that causes the inguinal pain reported by the patient. In fact, allows the reduction or remission of the clinical picture, in most cases.
Among the remedies useful to counter this type of disorder in most cases we remember:
- Abstention from sports: on medical advice, it may be recommended. Especially in case of pain due to physical exertion, abstain from training for a period of about two weeks;
- Ice applications on the painful groin area: especially in the case of muscle injuries, such as bruises or musculoskeletal trauma. The application of ice helps to reduce the perception of pain. Since the hypothermia that the skin of the treated area undergoes reduces the transmission of painful impulses. Prolonged application at low temperatures, however, should be avoided, as it is not without complications.