Groin pain

Groin pain refers to pain in your lower abdomen where your legs meet your pelvis. It is usually caused by straining a muscle during physical activity. There are five muscles in your groin that can be injured: the adductor brevis, adductor longus, adductor magnus, gracilis and pectineus. 

However, there are many other conditions that can also cause groin pain, including an inguinal hernia, kidney stones, problems with your hip joints or nerves, or in men, problems with the scrotum. 

Depending on the underlying cause, groin pain can vary from mild to severe and can occur suddenly or gradually. It can feel like a burning, dull, sharp or throbbing pain.

What causes groin pain?

Most common causes of groin pain

Muscle strain

You can pull or strain a muscle in your groin through physical activity, such as sport or an awkward movement of your hip joint. This can also overly stretch or tear one of the ligaments or tendons of your inner thigh, causing sudden, sharp groin pain. You may subsequently experience spasms of your inner thigh muscles and weakness in your legs. 

In some cases, muscle strain can come on gradually eg if you often play contact sports, such as football, rugby or hockey and are repeatedly straining one of your groin muscles. 

Inguinal hernia

This occurs when part of your intestines or fatty tissue in your abdomen pokes out through a weakness in your abdominal wall via a passage called the inguinal canal. Around a quarter of men in the UK will develop an inguinal hernia at some point in their lifetime. Inguinal hernias are eight times more likely in men than women.

You may not have any symptoms, however, if you do, you may feel a dull or tugging pain in your lower abdomen and groin when you cough, sneeze or strain to lift something. You may also notice a bulge in your groin area or if you’re a man, in your scrotum, which may flatten out when you lie down.

If the tissue protruding through your abdominal wall gets stuck, its blood supply may be cut off. This causes a strangulated hernia, which is a medical emergency. Symptoms of a strangulated hernia include: 

• Fever
• Inability to open your bowels or pass gas 
• Nausea
• Redness or sudden pain near the bulge in your lower abdomen or groin
• Vomiting 

If you experience any of these symptoms, go to A&E.

Femoral hernia

This occurs when part of your intestines or fatty tissue in your abdomen pokes out through a weakness in your abdominal wall via a passage called the femoral canal at the top of your inner thigh. Femoral hernias account for one in 20 of all hernias and are more common in women than men. 

As with inguinal hernias, you may not notice any symptoms, but if you do, you may feel a dull or tugging pain in your groin and a bulge that may flatten out when you lie down. Femoral hernias can also become strangulated, which is a medical emergency.  

Less common groin pain causes

Kidney stones

Kidney stones are hard stones found in your kidneys and urinary system that can cause severe pain and other complications. If your kidney stone passes through your urethra (the tube through which you urinate) you may feel waves of pain called renal colic.

Pain varies from mild to severe. It usually occurs in your lower abdomen or on the sides of your body between your ribs and hips. This pain can then spread to your groin area and if you are a man, to your scrotum and tip of the penis. 

Other symptoms of kidney stones include: 

• Blood in your urine
• Frequent urge to urinate
• Nausea 
• Pain when urinating
• Vomiting

Treatment for large kidney stones may involve surgery. 

Kidney infection

Kidney infections are usually caused by a bladder infection that spreads to one or both kidneys, often from an infection with the bacteria E. coli. Symptoms include blood or pus in your urine, frequent urination and groin pain. Kidney infections are usually treated with antibiotics.

Urinary tract infection (UTI)

UTIs refer to infections of any part of your urinary tract, which includes your bladder, kidneys and urethra. They can cause moderate to severe groin pain, which worsens when you urinate. Other symptoms include:

• Brown, red or pink urine 
• Cloudy urine
• Frequent urge to urinate
• Strongly-coloured urine
• Urinating more often and in small amounts

UTIs often clear up on their own without treatment. However, your doctor may prescribe antibiotics if needed. 

Prostatitis

Prostatitis is infection or swelling of the prostate gland, a small gland found at the base of the bladder in men. It can get better on its own but if the cause is an infection, you may need antibiotics. Symptoms include groin pain and difficulty urinating.

Enlarged lymph nodes

Your groin contains several lymph nodes, also known as lymph glands: inguinal and femoral lymph nodes. Infection (lymphadenitis), injury and in rare cases, cancer can cause these lymph nodes to swell and cause groin pain or discomfort.

Hip osteoarthritis

Osteoarthritis is one of the most common forms of arthritis and causes joint pain and stiffness. If you develop osteoarthritis of the hip, the cartilage around your hip can wear away, causing stiffness and pain in your hip. Pain usually worsens with activity and improves with rest — sitting on a low chair or driving, in particular, can cause pain to increase. You may also notice a popping noise or feeling when moving your hip. 

Osteoarthritis can be treated with physiotherapy, anti-inflammatory medications and steroid joint injections. If these treatments aren’t effective, you may need surgery. 

Femoral acetabular impingement

Femoral acetabular impingement (FAI) is caused by the formation of bone spurs (protrusions) on the bones of your hip joint. This is often the early stage of osteoarthritis. It causes reduced movement of the hip joint as well as discomfort, which can range from a dull ache in your groin or the outer part of your hips to sharp, stabbing pain.

Hip labrum tear

The hip labrum is a layer of cartilage that covers your hip joint. A tear in this cartilage can cause sharp pain in your groin or bottom when you make certain hip movements. You may also notice a popping or catching feeling in your hip when you move it.

Hip fracture

Fracture of your hip refers to a break in the upper quarter of your thigh bone. Osteoporosis puts you at greater risk of a hip fracture but it can also occur due to a fall, a direct blow to your hip, a stress injury or cancer. Pain is usually felt in the groin or the outer part of your hips and worsens when you flex or rotate your hip. 

If cancer or a stress injury has weakened your hip bone, you may first feel an aching pain in your groin or thigh before you develop a fracture. 

Hip osteonecrosis

Osteonecrosis, also known as avascular necrosis, occurs when your bone cells do not get enough blood supply and consequently die. Hip osteonecrosis causes the hip joint to deteriorate. Symptoms include a dull, aching or throbbing pain in your groin or bottom. You may later develop a limp as your hip joint becomes less able to carry your weight.

Epididymitis

Epididymitis occurs in men and is inflammation of a tube connected to the back of the testes that contains sperm. It is usually caused by an infection. Symptoms include:

• Fever and chills
• Milky discharge from your penis
• Pain that comes on gradually and starts in the groin or scrotum, spreading down to the testicle
• Pain when urinating
• Swelling of the testicle

Testicular torsion

This occurs in men when the cord containing the nerves that supply a testicle becomes twisted. This causes sudden, severe testicle and groin pain. It is a medical emergency as it cuts off the blood supply to the testicle. Surgery is needed within hours to untwist the cord otherwise the testicle may die. Testicular torsion most often occurs in teenage boys.

Orchitis

Orchitis occurs in men and causes one or both testicles to swell. It is usually caused by an infection, often the same infection that causes epididymitis — both conditions can therefore occur at the same time. Orchitis can be caused by infection with the mumps virus.

Ovarian cysts

Ovarian cysts occur in women and are fluid-filled sacs that can develop on or in the ovaries. Ovarian cysts often don’t cause any symptoms, however, when they do, they can cause groin pain that spreads to the side of your body where the cysts are located. 

Other symptoms affecting the side of your body where the cysts are located include bloating, pressure and swelling. However, if a cyst bursts, you may feel sudden, severe pain. 

Nerve problem

If a nerve in your lower spine becomes pinched by the pressure of surrounding tissue, it can cause numbness, tingling and a burning, sharp pain in your groin. This is called lumbar radiculopathy.

If a nerve in your lower spine becomes trapped (eg your obturator nerve or ilioinguinal nerve) it can cause numbness, tingling and a burning pain in your groin and middle thigh.

Abdominal or pelvic conditions

Certain conditions that affect your abdomen (eg diverticulitis or an abdominal aortic aneurysm) or pelvis (eg ovarian cysts) can cause pain that starts in or spreads to your groin.

Osteitis pubis

Osteitis pubis is a condition that causes inflammation of the cartilaginous joint that sits in front of your bladder and connects your two pubic bones. It most often occurs in athletes, pregnant women or those with a history of inflammatory arthritis, pelvic trauma or pelvic surgery. Symptoms include a dull, aching or sharp pain in the groin and pelvis that worsens when climbing stairs, walking, coughing or sneezing. Other symptoms include fever and changes in the way you walk – causing you to waddle.

Infected joint

In rare cases, your hip joint can become infected, causing swelling, warmth and redness around your hip, fever and severe groin pain particularly when you move your hip. Infection of the hip joint most commonly occurs in people aged over 80 and those with a prosthetic hip joint or who have recently had hip surgery. However, it can also occur in people with diabetes and rheumatoid arthritis. 

Tumour

In very rare cases, groin pain can be caused by a tumour in a muscle or bone, particularly in the inner thigh. This pain doesn’t usually get worse with activity.

Getting a diagnosis for groin pain

Your doctor will ask you about your symptoms, including when your groin pain started, how often it occurs, what it feels like and what makes it better or worse. They will also carry out a physical examination, which may include examining your abdomen and in men, your testicles. They may also assess the muscles and bones in your hip and groin area and perform a neurological examination.

Your doctor may recommend that you have some further tests to confirm your diagnosis. This may include: 

• An X-ray to check for bone problems
• Blood tests to check for infection 
• Diagnostic or therapeutic injection into the hip joint to resolve pain 
• MRI scan to check for nerve problems eg a pinched nerve

Emergency groin pain symptoms

If your groin pain is severe or started after a fall or other trauma to your hip, see a doctor urgently. You should also seek urgent medical care if your groin pain is accompanied by: 

• An inability to bear weight on your hips 
• Blood in your urine
• Discomfort or pain in your abdomen or pelvis
• Fever, chills, nausea and/or vomiting
• Pain that spreads to your abdomen, back or chest
• Testicular pain that is sudden or severe and/or changes in your testicles (eg lumps or swelling) — you may need emergency surgery to treat a testicular torsion

If you have an inguinal hernia and you can’t gently push it back into your body, you should also see your doctor urgently. 

Groin pain treatments

Lifestyle treatments

If you have a groin strain, rest, applying an ice pack and wrapping your upper thigh in a compression wrap can help ease your pain and decrease swelling. Speak to your doctor before using a compression wrap as wrapping too tightly can cause further damage. 

Medications

Over-the-counter medications, such as paracetamol and ibuprofen can help reduce groin pain.

If you have more severe groin pain eg due to kidney stones, a hip fracture or a hip joint infection, your doctor may prescribe strong painkillers such as opiates or a steroid injection.

If your groin pain is caused by an infection, you may be prescribed antibiotics.

Physiotherapy

Physiotherapy can help groin pain caused by hip problems, such as hip osteoarthritis or recovery from hip replacement surgery. Depending on the underlying cause, you may need short or long-term physiotherapy. 

Surgery

Some causes of groin pain need urgent surgery, such as:

• Hip joint infection — surgery involves cleaning out the joint and removing infected tissue
• Testicular torsion — surgery involves untwisting the twisted cord that connects to the testicle

Other causes of groin pain need non-urgent surgery, such as: 

• Advanced hip osteoarthritis — surgery involves replacing the hip joint with a prosthetic joint
• Hip osteonecrosis — this is treated using core decompression surgery 
• Labrum tear — arthroscopic hip surgery is used to repair the tear

How to prevent groin pain

Straining or pulling a groin muscle can cause groin pain. To avoid this make sure you warm up your leg and groin muscles before performing any physical activity. Also make sure you gradually work your way up towards more intense physical activities and stop if you feel any discomfort, pain or tightness in your groin or inner thighs. 

Wear supportive, comfortable shoes when performing physical activities and try strengthening exercises for your thigh muscles, particularly if you have pulled your groin muscle before.

Losing excess weight, maintaining a healthy weight and making sure you carefully lift any heavy objects will also reduce your risk of straining your groin.