Why you should not ignore groin pain

Do you notice a bulge or have dull pain below the belt? You may assume you have a pulled muscle, but your symptoms could signal a more serious problem requiring emergency care.

The muscles and tissues of your abdominal wall usually protect your organs by keeping them securely in place. However, a weak spot or tear in the muscle of your lower abdomen can allow some fat or a section of your intestines to push through. When this occurs in the area where your thigh meets your torso, it is called a groin hernia.

They are pretty common, but groin hernias shouldn’t be ignored. Here’s how to spot one — and how it should be treated to avoid potentially dangerous complications. 

How do they happen?

The development of a groin hernia depends on its type and the specific location of the weak point in the abdominal wall. Groin hernias fall into three categories: 

• Indirect inguinal hernia: This is the most common type. It’s caused by a birth defect on the upper end of a natural passageway in the lower abdominal wall called the inguinal canal. In men, this is the route the testicles take when moving down from the abdomen to the scrotum. In women, it contains the round ligaments that help support the uterus.

In baby girls, the inguinal canal typically closes naturally before birth. In boys, it may take several weeks to close. If it does not close properly, organs can slip into the space, leading to a groin hernia. This type of hernia is often diagnosed and repaired within the first year of life; however, if it goes undetected or untreated, it could lead to complications later.

• Direct inguinal hernia: This type is caused by muscle weakness around the inguinal canal due to ongoing strain or the effects of aging.
• Femoral hernia: The femoral canal, which sits just below the inguinal canal in the lower abdomen, houses blood vessels that run from your belly to your legs. A hernia there may appear as a lump or bulge near the top of your thigh. 

Are you at risk?

Hernias can affect anyone, but your risk increases as you age. Men are also more likely to develop a groin hernia than women.

Femoral hernias, which are more rare than inguinal hernias, are the exception to this rule. This type of groin hernia occurs more often among women, possibly due to strain from childbirth or the fact that women have a wider pelvis and tend to have less muscle than men. 

Weakness in the connective tissue of the abdominal wall due to issues with collagen — a protein that is essential for healthy skin, bones, tendons, ligaments and muscles — may also play a role.

Other risk factors that could increase your odds of developing a groin hernia include:

• A family history of hernia
• A weakness in the abdominal wall due to surgery or injury 
• Persistent strain on the abdominal wall from issues such as a chronic cough and strenuous exercise
• Heavy lifting 
• Straining during bowel movements or urination 
• Smoking 
• Older age 
• Obesity 
• Pregnancy
• Being born prematurely or having a low birth weight
• Previous inguinal hernia or hernia repair   

Spot the warning signs

Some individuals with a groin hernia may not be aware they have one, as it often does not produce noticeable symptoms. Typically, the first sign is a small lump on one side of the groin, although it can occur on both sides simultaneously. This bulge may grow larger over time and may flatten when you lie down.

Other symptoms may include:

• Pressure, a feeling of fullness or a tugging in the groin 
• Weakness, heaviness or a burning sensation in the groin
• A swollen or enlarged scrotum in men or boys
• Dull pain or achiness that worsens when engaging the groin muscles, including when coughing, bending or lifting things 

When to talk to your doctor

If you suspect that you have a groin hernia, don’t ignore it; see your doctor. 

In many instances, a groin hernia can be diagnosed quickly through a medical history review and a physical exam. You might be asked to stand and cough, as a bulge may appear in your groin during this action if you have a hernia. Occasionally, an ultrasound or other imaging tests may be required to confirm the diagnosis.

If you do have a lump in your groin area, your doctor may be able to gently massage it back behind your abdominal wall. But sometimes more serious complications arise. A groin hernia could cause a piece of the bowel to become stuck in the femoral canal, causing a bowel obstruction or the inability to have a bowel movement. 

Groin hernias could also become “incarcerated.” This occurs when a loop of intestine or other tissue gets stuck in the groin or scrotum and can’t be simply pushed back into the belly. If left untreated, an incarcerated hernia can become “strangulated,” which means the blood supply to this piece of the intestine has become blocked. If this happens, the trapped part of the organ could die unless immediate action is taken to restore blood flow. And while not common, a life-threatening infection could also develop.

How hernias are repaired

If a groin hernia causes pain or disrupts your daily activities, your doctor will likely recommend surgery to repair it and prevent complications, such as incarceration and strangulation.

Sometimes it’s possible to take a “watch and wait” approach to a groin hernia and put off surgical repair until your symptoms worsen. Eventually, however, you’ll need surgery. 

It’s important to remember that even if your groin hernia isn’t causing any symptoms, your doctor may still recommend surgery to repair it sooner rather than later. This is especially the case with a femoral hernia, as this type is more prone to complications. The best course of action is to discuss your options with your doctor to determine what is right for you.

When to go to the emergency room 

Go to the emergency room if you develop any of the following warning signs of bowel obstruction or an incarcerated or strangulated groin hernia:

• Severe abdominal or groin pain that gets worse — not better
• A bulge that has changed in color, has become painful or sore, or has become stuck and can no longer be pushed back in
• Inability to pass gas or have a bowel movement
• Nausea and vomiting
• Abdominal distention (a visibly bigger belly)
• Fever

Understanding the difference between a pulled muscle and a groin hernia, which could indicate a more serious issue, is an important step when deciding when to seek emergency care.