Groin Pain - Symptom Evaluation

What is Groin Pain?

Groin pain is discomfort or pain in the area at the junction of the abdomen and thighs. It is more often due to pulled or strained muscle, tendon or ligament near the hip.

Sometimes the groin pain is a radiated pain from other areas for example a stone in the lower ureter or from testis.

What are the Causes of Groin Pain?

It is a common symptom among athletes. It is due to various causes like injury, infection, tumors, inflammation or nerve related.

The most common causes of groin include –

• Pulled or Strained Muscle, Tendon or Ligament of the Leg: It is due to excess stress on the muscles in the groin and thigh. It happens as a result of sudden or excessive force on the muscles. It is sometimes referred to as sports hernia.

It is more commonly seen in sports that involve constant running and jumping like football, hockey and soccer. Careful and thorough physical examination helps in diagnosing the condition.

Rest, muscle strengthening exercises and analgesics are the frequently suggested treatment options.

• Hernia is due to a weak spot in the muscle, which leads to the abnormal protrusion of the internal organs.

An inguinal hernia is seen both in males and females. The weakening of the abdominal wall muscles leads to the protrusion of the fatty tissue or intestines out through the inguinal canal. It causes pain in the groin.

A thorough examination and surgical treatment are essential to prevent complications due to hernia.

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Femoral hernia too can cause similar pain but is seen more in women. The bulge of the hernia is below the inguinal canal region.

• Disease of the Hip Joint: Injury to the hip joint, bursitis (inflammation of the jell-like sac near the hip joint), avascular necrosis (decrease in the blood supply to head of the long bone of thigh called femur leading to the death of bone tissue), fracture and osteoarthritis of the hip joint can cause groin pain.

The less common causes of groin pain are -

• Orchitis: The bacterial or viral infection leading to the inflammation of the testicles is called orchitis. The bacteria like chlamydia and gonococci, mumps causing virus cause orchitis. Bacterial orchitis is frequently associated with epididymitis.

It is seen usually in young men or sometimes older men.

• Intestinal Causes: Inflammation, infection or ischemia of the small or large intestine can cause groin pain.
• Ovarian Cysts: Cystic lesions in the ovaries can cause groin pain in females.
• Testicular Torsion: It is observed in newborns and adolescents. The torsion of spermatic cord leads to the loss of the blood supply to the testicle. It is an emergency.

Early surgical intervention to save the testicle to preserve the fertility is essential. The child should be in the hospital within an hour of such a pain and will require almost immediate surgery.

• Inflammation of the Inguinal Lymph Nodes: The infections like syphilis, chancroid and malignancies involving legs can involve inguinal lymph nodes. Careful evaluation to diagnose the underlying cause is crucial in the management of the condition.
• Stone in the Ureter: Mineral deposits that accumulate to form stones in the urinary tract are called renal calculi.

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The pain due to renal stones is sometimes severe and is called a renal colic. Stone that descend down from the kidney to the ureter usually gives rise to pain that starts in the back and radiates to groin region as the stone moves down.

• Urinary Tract Infection (UTI) is more common among females. The most common causative organism of UTI is E.coli. Infection of the urinary tract can be associated with groin pain.
• Testicular Tumors: Benign or malignant lesions in the testicles cause testicular and groin pain in men.

• Infection of the Skin: Topical skin involvement in the groin can cause groin pain.
• Nerve-Related: Nerve entrapments can cause groin pain. The genitofemoral nerve and obturator nerve entrapment cause groin pain.
• Sexually Transmitted Diseases (STDs): Sexually transmitted illness can cause groin pain due to the involvement of lymph nodes or the lesions in the groin.
• Pelvic Inflammatory Disease (PID): Infection of the female reproductive organs is PID. It is usually due to Chlamydia or Gonococcal infection. It can cause infertility, ectopic gestation and chronic abdominal pain if not attended in time.

How to Diagnose Groin Pain?

Groin pain can be due to many possible causes. The patient history of probable abdominal, infectious, urological or hip joint-related pathology is important in deciding the etiology of groin pain. Physical examination also plays a crucial role in evaluating groin pain.

The investigations ordered depend on the probable diagnosis made after assessing the history and clinical examination. The diagnosis can be made from the following investigations.

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• Complete Blood Count (CBC): Complete blood examination helps to find the presence of infection in patients with groin pain.
• X-ray: In patients with groin pain due to renal calculi, X-ray helps in the diagnosis. X-ray of the hip joint is useful to diagnose hip joint related pathology.
• Ultra-sonogram (USG): It is a safe and quick test to find the soft tissue abnormalities.In patients with groin pain due to renal calculi, hernia, intestinal causes, female pelvic causes and testicular causes, ultrasound is ordered.
• Magnetic Resonance Imaging (MRI): It is a powerful tool to define the soft tissues like muscles, tendons, cartilage, etc.In patients with hip injuries during sports, avascular necrosis of femur or nerve entrapments, MRI aids in diagnosis.
• Urinalysis: It is a very simple test. In patients with the urinary tract infection leading to groin pain, urinalysis helps to find the presence of infection.

• Hip Arthroscopy: It is a test to see the interior of the hip joint through a small port. In patients with groin pain due to vague hip joint pathology, it helps to diagnose as well as treat the condition.
• Nerve Conduction Studies (NCS): NCS is the best diagnostic tool to detect nerve entrapment.