Groin strain vs. hernia pain: How to tell the difference

The pain is similar, but hernias often create a telltale lump beneath the skin.

If you’re an active person, you may attribute pain in the lower abdomen or groin to a muscle strain, especially if you experienced that kind of injury when you were younger.

Once you’re older, it’s more likely that groin pain is the result of a hernia — abdominal fat or part of the intestine poking through a hole in the abdominal wall. "In the vast majority of older adults, it’s usually a hernia," says Dr. David Berger, a colorectal and gastrointestinal surgeon at Harvard-affiliated Massachusetts General Hospital.

You may have a hard time telling the two apart. "There’s very little difference in symptoms. You may have a dull ache in the groin or burning pain or a heaviness when you stand," Dr. Berger says.

Groin strain

The groin area includes your lower abdomen and upper thighs. Here, about 30 muscles, tendons (which attach muscles to bones), and ligaments (which support organs or connect bones) come together at your pelvis. A sudden, twisting move or change in direction, such as a quick turn while aggressively playing tennis, can overstretch or tear one of the groin muscles or tendons.

Groin strains commonly occur in the upper thigh muscles, such as the adductor longus muscle that helps your thigh move from side to side, or in one of the tendons that attaches the adductor to the pelvis. Also vulnerable are the abdominal muscles that attach to the pelvis, such as the internal oblique muscle.

You typically notice when a strain occurs, and you may even feel a popping sensation with immediate pain that can last for days or weeks. Eventually it gets better.

These kinds of injuries are sometimes called "sports hernias." But that’s a misnomer. "It’s not a hernia; it’s a strain., and it usually occurs in high school, college, or middle-aged athletes," Dr. Berger notes.

Inguinal hernia

The abdomen is covered by a wall of muscle. A hole in this muscle wall is called a hernia. This can occur near an incision, the belly button, the upper stomach, or (most often) the groin area.

When a structure from inside the abdomen — typically fatty tissue or a loop of intestine — protrudes through a hole in the abdominal wall into the groin, it’s called an inguinal hernia. The displaced part feels like a lump in the groin area (something you won’t feel with a groin injury).

Hernia pain may come and go, but the hole in the abdominal wall won’t heal on its own.

Prevalence and causes

The idea of body parts poking out of your abdomen may be unsettling, but hernias are quite common. "One in three men will get an inguinal hernia, and one in 10 women will get one," Dr.  Berger says. "If you have an inguinal hernia on one side of your body, the chance is just as high — one in three for men, one in 10 for women — that you’ll get a hernia on the other side, too."

You may hear that heavy lifting contributes to the formation of this kind of hernia, and Dr. Berger says that’s sometimes true. "But hernias can also just happen over time from wear and tear. It doesn’t mean you did anything wrong," he points out.

Other factors that can play a role in inguinal hernia development include

• a family history of hernias
• genetics
• frequent coughing.

Inguinal hernia risks

Sometimes you can push a hernia back into place, but that won’t fix the hole in the abdominal wall. Fat or intestine will poke out through the hole again when you stand up.

Over time, the hernia will continue getting larger. It may cause more discomfort and perhaps keep you from being active.

The biggest risk from an inguinal hernia is strangulation — a condition in which the tissue or intestine poking through the abdominal wall becomes trapped and squeezed, cutting off its blood supply.

"This is an emergency. The bowel caught in the hernia can die, and this could be life-threatening. It causes severe groin pain, nausea, and vomiting, and you need to call 911," Dr. Berger warns. "You’ll need surgery quite soon."

Groin pain treatment

If you experience groin pain or feel a lump in your groin area, report it to your doctor. You may need to go in for a visit. In the doctor’s office, you can expect a physical exam and questions about your medical history. Your doctor might order an imaging test.

If your doctor determines that you have a groin strain, he or she may prescribe rest, ice, and compression wraps. You may need anti-inflammatory medications. Once you feel better, you may benefit from a course of physical therapy to strengthen the abdominal and thigh muscles.

If your doctor determines that you have a hernia, don’t assume that you’ll need surgery. "Unless the hernia is trapped, you don’t have to have it fixed. We can observe it, and we may never have to operate," Dr. Berger explains. "But ask yourself if it limits your activities or keeps you from exercising. If it does, it may be better for you to have the hernia repaired so you can continue your activities."

Hernia surgery

Hernia repair can be done with traditional "open" surgery (through an incision large enough to enable the surgeon to see the hernia) or with a minimally invasive procedure (in which the surgeon works using long, thin tools and a miniature camera inserted through tiny incisions). Dr. Berger says both approaches are equally effective. The type of surgery you have depends on your circumstances and your doctor.

During the operation, the doctor will close the hole in the abdominal wall by either stitching it shut or by placing a mesh patch over the opening. Mesh patches pose some risk of infection, "but the mesh is pretty safe," says Dr. Berger. And patching has advantages: "The likelihood of a hernia recurrence after a mesh repair is 1% to 3%. If mesh is not used, the recurrence rate is 5% to 8%. I encourage most people to have mesh," he says.

Recovering from surgery takes a few days to two weeks. Your doctor will want you to get up and move around as soon as possible. "You can move right away and get back to your normal routine. The more you do, the faster you’ll get better," Dr. Berger says.

Be proactive

To prevent groin strain, exercise regularly and keep your abdominal and leg muscles strong. It is important for older people to remain as limber as possible. Stretching and yoga are good activities.

While you can’t prevent hernias, you can be aware that they are a common cause of groin pain and something you should report to your doctor if you experience symptoms.

"There are more undiagnosed hernias in older adults than in young people, because in older age, we tend to downplay things," points out Dr. Berger. "But like any medical issue, it’s important to take it seriously."

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