Medically reviewed guide · Last updated: 1 September 2026 · Reading time: approx. 11 min

Groin Pain: Hernia, Hip or Sportsman's Groin?

The most common causes compared

The causes in detail

This article covers pain right in the groin, that is, where the abdomen meets the thigh. If the pain is more at the side of the hip or in the buttock, the article on hip pain will help; if it comes from the side of the back, the article on flank pain. The condition itself, with all the details of surgery, is described in the article on inguinal hernia.

Inguinal hernia: when the abdominal wall gives way

In an inguinal hernia, the lining of the abdomen (peritoneum) — sometimes with fat or a loop of bowel — pushes outwards through a weak spot in the abdominal wall. Typical is a soft bulge that becomes more noticeable when you cough, strain or stand for a long time and disappears when you lie down, together with a pulling sensation or pressure that is often worse in the evening. Men are affected much more often. Femoral hernias, which sit just below the groin, are more common in women than in men — they are small, easily overlooked and more likely to become trapped.

In adults, a hernia does not heal by itself. According to the international guideline, watchful waiting can be acceptable for men with few symptoms; with pain and with femoral hernias, surgery is usually performed. The first step is an examination by feeling the area while you are standing and lying down, supplemented by ultrasound if the findings are unclear.

Trapped hernia: the emergency

If the contents of the hernia become trapped in the gap (incarceration), they no longer receive an adequate blood supply. The bulge then suddenly becomes hard, tense and very painful and can no longer be pushed back, and the skin over it may turn red. Nausea, vomiting, a bloated abdomen and no bowel movements often follow. This is an emergency for the emergency department. Do not force the hernia back, and do not eat or drink anything until a doctor has assessed you, in case surgery is needed.

The hip: pain that arrives in the groin

The hip joint lies deep beneath the groin. That is why hip pain is often felt not at the side but at the front, in the groin, sometimes radiating as far as the knee. In hip osteoarthritis (coxarthrosis, see osteoarthritis), pain when you start moving, stiffness and difficulty putting on socks or shoes are typical. In young, sporty people, the cause is more often hip impingement (a narrowing between the femoral head and the socket), sometimes with a tear of the joint lip (labrum): pain when bending deeply or sitting for a long time, occasionally a clicking or catching sensation.

Less common, but important: in avascular necrosis of the femoral head, bone tissue in the head of the thigh bone dies, especially after high-dose cortisone or heavy alcohol use; at an early stage, often only an MRI scan shows it. With osteoporosis, a fall can lead to a fracture of the femoral neck, and a very high running volume can lead to a stress fracture. The first step is an orthopaedic examination with an X-ray.

Muscles, tendons and "sportsman's groin"

Sprints, shots and changes of direction put heavy strain on the groin. Most often, the adductors (the muscles that pull the thigh inwards) are irritated where they attach to the pubic bone; other culprits are the hip flexor (iliopsoas), the abdominal wall at the inguinal canal without a true hernia, or the pubic bone itself. Because "sportsman's groin" is used inconsistently, an international expert consensus classifies the symptoms by the structure affected.

Typical is pain at first after sport and later during it as well, a clearly localised tender spot, and pain when tensing the muscles against resistance. First step: adjust the load instead of stopping completely, then actively build up the adductor, hip and core muscles, ideally with the support of a physiotherapist.

Lymph nodes in the groin

The lymph nodes in the groin filter lymph from the leg, buttock, lower abdomen and genital area. Small, soft, movable lumps can often be felt and are normal. They are usually painfully swollen when there is inflammation in the area they drain: an infected wound on the foot, an ingrown toenail, athlete's foot with cracked skin, erysipelas (a bacterial skin infection) or a sexually transmitted infection. You should have hard, firm, painless or growing lumps that last longer than three weeks checked — more on this under swollen lymph nodes.

Ureteric stone: pain that comes from above

If a kidney stone moves into the ureter, it causes severe colic that comes in waves and radiates from the flank into the groin, testicles or labia. People affected are restless and cannot find a comfortable position, often with nausea and blood in the urine. If fever or shivering fits come on top, infected urine may be backing up — then go to an emergency department immediately.

Testicles, spermatic cord and female organs

In testicular torsion, the testicle twists on the spermatic cord and its blood supply is cut off — mainly in teenagers and young men. Typical is sudden, severe testicular pain that radiates into the groin and lower abdomen, often with nausea. Children sometimes complain only of abdominal or groin pain, which is why the testicles should always be examined in boys. The testicle can die within just a few hours. Inflammation of the epididymis, on the other hand, tends to begin gradually, often with fever or a burning sensation when passing urine. Testicular cancer usually shows up as a painless hard lump, sometimes with a feeling of heaviness that extends into the groin.

In women, the stretched round ligaments of the womb often cause a harmless pulling sensation in the groin during pregnancy. One-sided pain can also come from an ovarian cyst, endometriosis or inflammation of the fallopian tubes. Sudden, severe pain with nausea (twisting of the ovary on its stalk) or severe pain in early pregnancy (ectopic pregnancy) are emergencies.

Nerves, blood vessels and abdominal organs

After inguinal hernia surgery, an irritated nerve can cause persistent burning or shooting pain. Burning and numbness on the outside of the thigh point to a trapped skin nerve beneath the inguinal ligament (meralgia paraesthetica), for example from tight trousers or being overweight. The upper lumbar spine can also radiate pain into the groin. After a cardiac catheter procedure through the groin, bruising is common, but a pulsating, growing swelling must be looked at immediately. And appendicitis often starts around the navel and moves to the lower right abdomen.

Self-tests: first clues at home

These tests do not replace a diagnosis; they only point you in a direction. With sudden, severe testicular pain or a hard, trapped bulge, the rule is: do not test, go straight away.

• The cough test: standing up, lay your fingertips flat on the painful groin and cough hard. A noticeable impulse against your fingers or a bulge that disappears again when you lie down suggests a hernia. Do not press hard while doing this, and do not force anything back.
• The hip check: lying on your back, pull your knee towards your chest and turn it inwards so that your lower leg moves outwards. Deep groin pain during this points to the hip joint.
• The adductor test: lie on your back with your legs bent, put a fist between your knees and squeeze it hard. Pain on the inner thigh or at the pubic bone points to the adductors.
• The tender-spot search: where exactly does it hurt? At the pubic bone or a tendon attachment on the inside (muscles, tendons), over the inguinal canal (hernia), at pea- to bean-sized movable lumps (lymph nodes) or more at the flank (kidney)?
• The activity log: for one week, note down when the pain comes on: pain when starting to move fits the hip, pain after sport fits muscles and tendons, a pulling sensation in the evening after standing for a long time fits a hernia, and attacks that come in waves fit a stone.
• The medication timeline: in the past few weeks, have you taken an antibiotic from the fluoroquinolone group, or are you taking cortisone, an osteoporosis medicine or a blood thinner? Note down the start date and dose.

Warning signs: when not to wait

• A bulge that becomes hard and painful and can no longer be pushed back, especially with nausea, vomiting, a bloated abdomen or no bowel movements
• Sudden, severe pain in the testicle or scrotum — in children, even if they only complain of abdominal or groin pain
• Colicky pain together with fever or shivering fits
• After a fall: you cannot put weight on the leg, or it looks shortened or turned outwards
• Severe one-sided pain in early pregnancy or with a missed period, especially with bleeding or dizziness
• On blood thinners or after a cardiac catheter procedure: increasing swelling, a large bruise, a pulsating lump, or numbness and weakness in the thigh
• Hard, firm, growing lumps for more than three weeks, a hot, red swelling with fever, or unintentional weight loss

The treatment pathway: step by step

Without warning signs, the assessment usually moves from the simple to the more elaborate.

1. Assess and ease off sensibly. For one to two weeks, reduce the load, but do not rest completely. With a fresh sports injury, cool the area during the first few days. At the same time, keep a short pain log.
2. Examination at the GP practice. Feeling the area while you are standing and lying down, hip mobility, the testicles in men, lymph nodes, a urine sample and often an ultrasound scan.
3. Specialists depending on the findings. Hernia: surgery. Hip: orthopaedics with an X-ray, and an MRI scan if the findings are unclear. Stone or testicles: urology. One-sided lower abdominal pain in women: gynaecology.
4. Conservative treatment. For sportsman's groin and hip impingement, active strengthening over several weeks with the support of a physiotherapist is the basis; for hip osteoarthritis, exercise, strengthening and — if necessary — weight loss.
5. Surgery if necessary. An inguinal hernia is closed in an open or minimally invasive (keyhole) procedure, usually with a synthetic mesh. For hip impingement, an arthroscopy (keyhole surgery on the joint) may be considered, and for advanced osteoarthritis, a joint replacement. Whether and when to operate is always decided by the practice treating you, together with you.

The medication angle: when treatment pulls at the groin

Some medicines damage tendons or bones, others increase the risk of bleeding. If groin pain begins without a clear reason, it is worth taking a look at your medication plan.

Fluoroquinolones: tendons under stress

Antibiotics from the fluoroquinolone group, such as ciprofloxacin, levofloxacin or moxifloxacin, can cause tendon inflammation and tendon rupture — most often in the Achilles tendon, but in principle in other tendons too. The symptoms can start within the first few days, but also months after the end of treatment. The risk increases with age, with simultaneous cortisone treatment and with reduced kidney function. For this reason, the BfArM (German Federal Institute for Drugs and Medical Devices) restricted their use in 2019. At the first sign of tendon pain while taking a fluoroquinolone: avoid strain and talk to your practice straight away.

Cortisone: femoral head and bones

High-dose or long-term cortisone such as prednisolone is one of the most important risk factors for avascular necrosis of the femoral head, and it encourages osteoporosis with fractures of the femoral neck. New, deep groin pain during cortisone treatment should therefore be assessed by a doctor early, often with an MRI scan. Never stop cortisone abruptly after taking it for a long time — your practice will plan how to taper it off.

Osteoporosis medicines: a rare but known warning sign

With bisphosphonates such as alendronic acid and with denosumab, unusual fractures of the thigh bone (atypical femoral fractures) can rarely occur after long-term use. They are often preceded by weeks of pain in the thigh, hip or groin; the summaries of product characteristics advise reporting such pain. The benefit of treatment usually clearly outweighs the risk — denosumab in particular must not simply be left out, because stopping it without follow-on treatment increases the risk of vertebral fractures.

Blood thinners and statins

Blood thinners such as apixaban, rivaroxaban or phenprocoumon can encourage bleeding into the groin or the hip flexor muscle (see the warning box above). Statins for raised blood lipids occasionally cause muscle pain, usually on both sides in the thighs and calves. Very rarely, serious muscle damage occurs with weakness and dark urine — report this to a doctor immediately.

Painkillers: limited benefit, limited duration

For pulled muscles or a flare-up of osteoarthritis, anti-inflammatory painkillers such as ibuprofen, naproxen or diclofenac can help in the short term. Without medical advice, the package leaflet usually says: no longer than three to four days in a row. Together with blood thinners, the risk of bleeding increases, and caution is needed with kidney, stomach or heart problems. And a hernia that becomes increasingly painful despite tablets should be examined. The painkiller comparison gives an overview; which treatment is right for you is always decided by the practice treating you.

How to prevent groin pain

• Strengthen your adductors — targeted strength training for the muscles that pull the thigh inwards, such as the Copenhagen adduction exercise, can help prevent groin problems according to studies in football. Warm up well before sprints and shots.
• Increase the load gradually — raise training volume and intensity step by step, and do not train through warning signs.
• Reduce pressure in the abdomen — treat constipation and a chronic cough, lift heavy loads using your legs while breathing out, and become smoke-free.
• Keep your hip moving — regular, joint-friendly exercise such as cycling or swimming and a healthy weight take strain off the hip joint.
• Keep your medication plan up to date — record a fluoroquinolone or a course of cortisone in it, and do not miss check-up appointments for osteoporosis medicines.

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