Classification and Types of Groin Pain
Groin Pain Is Classified By Its Underlying Cause:
- Acute/Traumatic: Acute pain occurs due to a specific injury like muscle strains, contusions, hip subluxation or dislocation, intra-articular pathology or a fracture.
- Chronic/Overuse: Chronic pain is characterized by gradual onset of pain mostly seen in competitive athletes. Pain is usually muscle and/or tendon-related, bursitis, inguinal-related as in hernia, osteitis pubis, snapping hip or stress fracture.
- Degenerative Inguinal Pain: This is due to degenerative conditions such as osteoarthritis.
- Congenital/Anatomical Inguinal Pain: This is seen in conditions like slipped capital femoral epiphysis, hip dysplasia and femoroacetabular impingement.
- Referred Groin Pain: Inguinal or groin pain is referred or radiated due to medical conditions in other parts of body, e.g. GI related conditions such as appendicitis, diverticulosis and inflammatory bowel disease. GU conditions like UTI, prostatitis and nephrolithiasis. Neuroradicular conditions like problems in sacroiliac joints or lumbar disc pathology. All these conditions may cause pain to radiate into the inguinal region.
- Unilateral Groin Pain: Pain or discomfort occurring on one side of the inguinal is unilateral groin pain. This can be caused due to ureteral calculus, chronic lymphadenitis, infected vaginal cysts, penile ulcers or tumors.
- Bilateral Groin pain: Pain or discomfort occurring on both sides of groin is bilateral groin pain. It may be caused due to chronic lymphadenitis, infected vaginal cysts, penile ulcers or tumors.
Pathophysiology of Groin Pain
Degenerative changes or chronic inflammation in the hip joint may cause groin pain. Lesions in the muscle, the tendon, or the enthesis also cause groin pain. The changes present in the pubic bone and around the pubic symphysis manifest the amount of stress exerted due to a sport or other strenuous physical activities. However these changes may not be a definite sign of pathology, but could also be a sign of a repair reaction. Femoroacetabular impingement (FAI) in the hip joint can be caused by a variety of dysplasia related to the acetabulum and by abnormal growths of the bone. This may be have been perpetrated in puberty or due to excessive loads from sports. Femoroacetabular impingement (FAI), trauma or overuse are some of the reasons causing intra-articular lesions of the labrum, cartilage, and the ligamentum teres.
Signs And Symptoms of Groin Pain
Other symptoms may accompany inguinal pain depending on underlying causes, e.g. inguinal or groin pain due to an infection is accompanied by fever, redness, and warmth around affected area.
Symptoms Occurring Along With Inguinal or Groin Pain:
- A bulge or lump in groin area or scrotum.
- Difficulty with activities like running, swimming etc.
- Symptoms like tiredness, fever, sore throat, headaches, cough etc.
- Appetite loss.
- Low back pain.
- Pain or itchiness in genital area.
- Pain with urination.
- Pelvic pain.
- Pain in the lower abdomen.
- Discharge from the rectum or vagina.
- Swelling of lymph nodes in groin or other areas.
- Difficulty with ambulation.
- Weakness of muscles of hip.
Serious Symptoms Which Can Pose A Potential Threat To Life:
- Blood in urine and stools.
- Abnormal rectal discharge.
- Confusion or alteration of consciousness.
- Difficulty in breathing, or dyspnea.
- Genital ulcer.
- High fever.
- Urinary changes.
- Acute abdominal pain.
- Nausea with or without vomiting.
- Redness with warmth in inguinal area.
- Swelling in scrotum.
- Yellow discharge from penis or vagina.
- Swelling and bruising in groin area.
- Dull or sharp pain in groin region which is intermittent or constant and getting worse with activity.
Causes And Risk Factors of Groin Pain
Groin pain may be as a result of a variety of reasons like infectious process, trauma, cancer, or other abnormalities. Groin pain as a result of problems in other areas is termed as "referred groin pain." There are cases in which groin pain may be symptom of some serious condition and patient should seek medical attention instantly.
Inguinal or Groin Pain Due To Injuries:
- Arthritis or fracture of hip.
- Trauma to pelvis or injury to hip.
- Trauma to groin area to include testicles.
- Muscle/ligament/tendon pull.
Inguinal or Groin Pain Due To Infections:
- Skin infections.
- Inflammation of testicle.
- Infection in legs.
- STDs like chlamydia, gonorrhea etc.
Groin Pain Due To Other Non-Infectious Causes :
- Allergic reactions.
- Arthritis of hip.
- Cancer of testicles or lymphoma.
- Medication reaction.
- Renal stones.
- Low back injury.
- Pinched nerve.
- Surgical procedures.
- Testicular torsions.
Treatment for Groin Pain
- Treatment depends on underlying cause and findings from the work-up. When an obvious reason such as hernia is present then treatment is hernia repair. Pain could be due to nerve entrapment, especially with hernia and is treated by hernia repair, however, if pain continues then further treatment may be necessary.
- Physical therapy (PT) with stretching and strengthening is effective in treating ligament and muscle strains involving the adductor muscle and tendon, or iliopsoas strain.
- If the adductor tendon strains continue and become chronic then treatment is done by the way of release of the adductor tendon and repair of the pelvic floor with a hernia patch.
- Treatment may also include ice and non-steroidal medications.
- Local steroid injections provide relief in conditions like osteitis pubis.
- Open or laparoscopic inguinal hernia repair can be done in sports hernias. Surgery involves placement of a polypropylene or biologic mesh over the area of the strain or defect leading to relieve of the pressure and improving inflammation.
- Nerve entrapment syndromes may be treated with nerve blocks.
- RICE treatment involves Rest, Ice, Compression and Elevation.
- Exercise, massage and manipulation help to alleviate groin pain, but this treatment method does not repair the lax and/or injured ligaments and is not helpful in alleviating chronic pain.
- Cortisone shots and anti-inflammatory drugs provide short-term pain relief, but result in long-term loss of function and increased chronic pain due to slow healing of soft tissues and increased cartilage degeneration. Long-term use of these drugs can lead to osteoarthritis and other degenerative conditions.
Investigations for Groin Pain
- Medical history and physical examination.
- Urine analysis to identify urologic problems.
- Blood tests such as a complete blood count (CBC) or blood differential test.
- Plain hip-series x-rays to identify bony or joint abnormalities as the cause of pain.
- Provocation ultrasound for detection of possible occult hernia.
- Magnetic resonance imaging (MRI) helps in identifying adductor tendon muscle abnormalities, iliopsoas strains, tendonitis, bursitis, avulsion fractures, osteitis pubis and stress fractures.
- MRI arthrography for evaluation of acetabular labral pathology.
- Ultrasound for detecting avulsion fractures.
- Bone scan is also helpful for detecting cause of groin pain.