Groin pain

Dr. rer. nat. Daniela Oesterle is a molecular biologist, human geneticist and trained medical editor. As a freelance journalist, she writes texts on health topics for experts and laypeople and edits specialist scientific articles by doctors in German and English. She is responsible for the publication of certified advanced training courses for medical professionals for a renowned publishing house.

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Groin pain (medical: inguinal pain) can be felt between the abdomen, hips and thighs. They can be acute or chronic, stinging, sharp or dull to the touch and have a variety of causes. Since they can be an indication of serious (secondary) illnesses, the cause of the groin pain should be clarified by the doctor and treated if necessary. Read more about the causes and treatment of groin pain here.

Brief overview

Causes of groin pain: e.g. B. inguinal hernia, torn muscle fibers, cartilage damage at the hip joint, nerve injuries, pregnancy, diseases of the urinary or genital organs
How can groin pain be treated? Therapy depending on the cause of the groin pain, e.g. an inguinal hernia is often operated on
Exercises for groin pain: Exercises that stretch and strengthen the joints and muscles can be helpful, v. a. Abdominal muscles, thighs and buttocks as well as the muscles around the spine (e.g. squat, lunge, stretching in the prince's position)

Groin pain: causes and possible diseases

The range of possible causes of groin pain is very wide. These include, for example:

Inguinal hernia, femoral hernia
Muscle or tendon injuries (e.g. athlete's groin)
Pelvic ring loosening (in pregnant women)
Joint diseases (e.g. hip osteoarthritis)
Inflammation of the nerves
Diseases of the urinary organs (e.g. urinary stones)

Diseases of the genital organs (e.g. testicular disease, ectopic pregnancy)
Lymph node swelling (caused e.g. by infections, in rare cases by tumors)

Inguinal hernia, femoral hernia

The inguinal region (regio inguinalis) forms the transition between the abdomen and thighs on both sides. In this region lies the approximately four to five centimeter long inguinal canal through which important muscles, nerves and blood vessels run - in men the spermatic cord also, in women the cervical ligament (leads to the uterus). Surrounding muscles, connective tissue and ligaments stabilize the inguinal canal and separate it from the abdomen. However, this soft protective structure represents a functional weak point:

If the internal pressure in the abdomen becomes too high (e.g. during exercise, coughing, sneezing, pressing to defecate, lifting heavy loads or during pregnancy), the connective tissue covering is sometimes damaged. The peritoneum (which surrounds the abdominal organs) and the abdominal organs themselves can then pass through the inguinal canal ("break"). If the hernial port is above the inguinal ligament, doctors speak of an inguinal hernia (inguinal hernia) - the most common form of all visceral hernias.

An increase in groin pain when coughing, sneezing and straining (when defecating) indicates an incipient or already existing hernia. It becomes dangerous when perforated abdominal organs such as a piece of intestine are trapped in the gap in the abdominal wall. This can cause severe groin pain and must be treated as soon as possible - under certain circumstances there is a risk to life!

If the hernial port does not run above the inguinal ligament (as in the inguinal hernia), but below it, it is a femoral fracture. While an inguinal hernia is more common in men, women are more likely to suffer from a thigh hernia. Overall, however, a thigh fracture is not as common as an inguinal hernia.

Injuries or overloads of muscles, tendons, nerves

Often, groin pain is a discomfort that is triggered by injuries and overuse during exercise. When muscles and tendons in the pelvic area, the hip region or the thigh flexors or adductors (on the inside of the thigh) are pulled or torn, the pain often radiates into the groin area. Such injuries mainly happen in contact sports such as soccer or hockey. Handball players, basketball players and endurance athletes such as marathon runners also often suffer from groin pain - one then speaks of the so-called athlete bar ("soft bar").

In addition to overstressing muscles and tendons, a permanent increase in internal abdominal pressure in athletes can irritate the nerves in the inguinal canal area and thus trigger groin pain. Constantly increased internal pressure in the abdomen can eventually lead to a fracture with dangerous consequences.

Misalignments of the feet, differences in leg length, general posture errors and asymmetrical development of the muscles often lead to relieving postures, which can lead to one-sided overloading of the muscles and thus cause groin pain.

Swollen lymph nodes

Infections, abscesses, or injuries to the genital organs, leg, or foot can swell the lymph nodes in the groin area and make the groin painful. In rare cases, the sexually transmitted disease syphilis, lymph gland cancer or metastases from tumors are also the cause of swollen lymph nodes.

Urinary stones, testicular disease

Larger urinary stones can cause drawing pain in the groin area if they are stuck in the renal pelvis. If they wander and graze the ureter walls, there is a risk of dangerous and very painful colic.

In addition, diseases of the testicles such as a twisted testicle or a pinched testicle hernia can also cause groin pain.

Hip joint problems

Another trigger for groin pain can be problems in the hip joint. The cartilage in the hip joint can wear out, causing hip arthrosis. Dull, stress-dependent groin pain can indicate such cartilage damage.

In addition, inflammation or tumors in the hip region, impingement of the hip (mechanical tightness between the acetabulum and the femoral head of the femur) or femoral head necrosis (dying bone tissue on the femoral head) lead to groin pain. Usually people with a hip disease take a relieving posture due to pain.

Groin pain in the woman

In addition to the femoral fracture mentioned above, gynecological diseases can also cause groin pain in women. In female patients, for example, inflammation in the ovaries or fallopian tubes, as well as fallopian pregnancies and ovarian cysts, are possible causes of groin pain. Endometriosis can also manifest itself in groin pain.

Groin pain is also widespread during pregnancy. Because during this, the connective and muscle tissue in the pelvic floor area loosens through hormonal changes in order to give the growing child more space and later to make it easier for him to pass through the birth canal. The same applies to the pelvic ring, these are the ligament structures in the pelvic area around the pubic symphysis and the sacrum and iliac joint.

The loosened muscles and the loosened connective tissue cause complaints in the back, the pelvis and the groin. This is particularly noticeable when walking, climbing stairs and some movements while lying down. And even if the pelvic ring expands or the uterine ligament in the inguinal canal stretches because the uterus enlarges and displaces, the woman can feel this in the form of groin pain. For some women, this pain does not appear until after the child is born.

As mentioned above, the increased internal pressure in the lower abdomen during pregnancy can promote an inguinal hernia. The risk of a hernia can also increase during labor and straining during delivery.

Groin pain treatment: what does the doctor do?

In order to be able to treat groin pain, the doctor must first clarify its cause.

Groin pain: examinations

First, the doctor will collect your medical history (anamnesis) in conversation with you. For example, he asks whether the pain is acute or already chronic and how the pain feels (stabbing, sharp, dull). He also inquires about any previous illnesses (such as inguinal hernia), previous injuries (e.g. dislocated hip joint, broken bones, spinal injuries), occupational and sporting loads (such as golf, soccer, gymnastics, dancing, ice hockey, skiing).

The physical examination follows the patient interview. It consists of the

Inspection: Here the doctor examines the body for relieving postures and misalignments of the spine or pelvis. He also checks whether your right and left legs are the same length.
Palpation: The doctor palpates muscles, tendons and ligaments and checks whether a point is sensitive to pressure. Above all, he examines the posterior wall of the inguinal canal and, in men, the testicles in order to feel for possible fractures.
Functional examination: Here the doctor will test your physical mobility, usually while standing, in a supine, lateral and prone position. A neurological examination is also included. For example, it can reveal inflammation of the nerves as the cause of groin pain.

The extended examination includes imaging procedures such as ultrasound diagnostics of the abdominal and pelvic organs and the inguinal canal. Sometimes more complex procedures (x-rays, computed tomography, magnetic resonance imaging) are necessary to identify the cause of the groin pain.

Groin pain: therapy

The treatment of groin pain depends on its cause. Some examples:

An inguinal hernia is often treated surgically. Such an operation is generally recommended for children and women; In men, an inguinal hernia is operated on if it causes symptoms. If parts of the viscera are trapped in the hernial port, an operation must be performed in any case, and as quickly as possible.

If the groin pain is due to an "athlete's bar" (athlete's hernia), surgical intervention is also often necessary.

If misaligned feet or unequal leg lengths are the trigger for groin pain, it is sometimes enough to wear specially adapted insoles in the shoes or orthopedic shoes. In more severe cases, surgery is usually carried out.

Groin pain: exercises

Some patients benefit from exercises for groin pain, provided they are done correctly and regularly. Such exercises can often help to prevent groin pain - for example, those that are caused by overloading muscles, tendons and joints or by an inguinal hernia. Such exercises can, for example:

train and stabilize the abdominal muscles (they can then counter increased internal abdominal pressure more)
train the thigh and gluteal muscles to stabilize and relieve the joints (knees, hips) and to avoid relieving postures.
Strengthen and build up the core muscles (abdominal and back muscles), which relieves the spine.

You can do something preventive against groin pain with the following exercises, for example. It is better, however, to have an expert (e.g. physiotherapist) show you the exercises that are right for you.

Wide squat: Place your feet 50 to 80 cm apart, point your toes about 45 degrees outwards, lower your body until your thighs are almost horizontal, knees are brought out slightly (over the toes, not straight forward). The back remains straight or in a slightly hollow back the whole time. The squats strengthen the inner thighs and abdominal muscles.
Side lunge: Stand upright, bring your hands together in front of your chest. Shift your weight onto your left foot, extend your right leg to one side and bend your left knee a little. Stand up and repeat on the other side. This exercise strengthens the front thigh muscles.
Diagonal lunge: In the diagonal lunge, you do not place the “falling” leg on the side, but diagonally to the standing leg, the rest of the execution is the same as for the side lunge. Make sure that the knee does not protrude beyond the toes in the bent position so as not to put unnecessary strain on it. This exercise works the front thigh muscles, glutes, and the muscles on the inside of the thighs (adductors).
Stretching: The so-called prince's stand, for example, is suitable for this. Kneel on the floor and put one foot forward. Slowly shift your weight onto your front leg, pushing your pelvis forward and down. You should feel a slight pull in the hip area of the back leg. For a more stable position, you can sit on a stool or something similar. prop up.

Groin Pain: What Else Can You Do?

Diet and body weight: Being overweight puts additional strain on the joints and muscles, including the abdominal muscles (being overweight promotes a hernia!). Therefore, in addition to exercise, a balanced, healthy diet is very important. Drink enough fluids and eat plenty of fruits, vegetables, and whole grains. Be careful not to eat too much meat, or you will become more prone to uric acid stones (kidney stones) - another possible cause of groin pain.

Stable joints: Problems in the joints can cause pain in the groin, among other things. The following tips help to protect the joints:

Wear good shoes and, if necessary, insoles to correct misalignments of the feet and the leg axis.
Do not put excessive strain on your joints while exercising. Make sure that your muscles move evenly and do general and special strength training in preparation for intense loads.
Use the right lifting technique for heavy loads: When lifting the object, first bend your knees and then slowly straighten yourself with a straight back. You should absolutely avoid jerky movements. If necessary, use lifting aids, carrying straps or lifting carts that take over part of the load.

Groin pain: when should you see a doctor?

You should see a doctor for acute groin pain because there may be a serious cause that should definitely be treated. For example, a pinched hernia is an emergency that needs urgent medical attention!

Persistent or chronically recurring groin pain should also be clarified by a doctor and treated if necessary.

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