Lower abdominal and groin pain can occur with many medical conditions. Possible culprits include a variety of disorders involving the digestive, musculoskeletal, reproductive and urinary systems. Some of these conditions are common while others are relatively rare -- and some are more serious than others. Accompanying signs and symptoms, and the timing, nature, progression and duration of the pain help narrow the list of possibilities, along with a thorough physical examination. Blood and imaging tests may be needed to determine the cause of lower abdominal and groin pain.
Several musculoskeletal problems -- those affecting the muscles, bones and related tissues -- can cause lower abdominal and groin pain. Some occur acutely, meaning they have a sudden onset, and others develop more gradually. Inflammation of the pubic bone, or osteitis pubis, characteristically causes midline lower abdominal pain that often radiates into the groin, especially while walking. This chronic overuse injury frequently occurs in runners and soccer players. A sports hernia, or athletic pubalgia, also commonly causes slowly evolving lower abdominal and groin pain, due to weakening of the soft tissue in this area. Other possible musculoskeletal causes of lower abdominal and groin pain include:
-- strain of the rectus muscle of the abdominal wall
-- adductor muscle strain of the hip
-- hip joint problems, such as arthritis and bursitis
Abdominal Wall Hernias
An abdominal wall hernia describes a protrusion of abdominal organs through a weak point in the abdominal wall. Two types of abdominal wall hernias can potentially cause lower abdominal and groin pain -- inguinal and femoral hernias, both located in the groin region. Inguinal hernias are more common, especially in men. Both inguinal and femoral hernias manifest with a bulge in the groin. Although most hernias cause no pain, some people experience a heavy feeling in the lower abdomen and groin, especially after prolonged standing or straining. If the bowel becomes trapped in the hernia and its blood supply cut off, progressive and severe pain can develop, signaling a medical emergency.
Many bowel disorders cause lower abdominal pain that might radiate into the groin. The most immediately concerning ailment is appendicitis, which is a medical emergency. Appendicitis pain usually starts around the navel but then localizes to the lower right abdomen in most people. Accompanying symptoms may include fever, loss of appetite, nausea and vomiting. Other bowel conditions that might cause lower abdominal and groin pain include:
-- diverticulitis: inflamed outpouchings of the colon
-- ulcerative colitis: chronic inflammatory bowel disease
-- intestinal obstruction
-- ischemic colitis: colon inflammation due to decreased blood flow
Urinary Tract Disorders
Some urinary tract disorders can cause lower abdominal and groin pain, often accompanied by flank pain. Kidney stones are one such disorder. These solid deposits typically trigger severe pain when they pass from the kidney into the ureter, which carries urine to the bladder. Stones in the ureter cause inflammation and can obstruct urine flow, provoking symptoms and often blood in the urine. A kidney infection, or pyelonephritis, is another urinary tract disorder that can cause flank, abdominal and groin pain, typically accompanied by fever, chills, nausea and vomiting.
Female Reproductive Tract Disorders
Several female reproductive tract disorders can potentially cause pain in the lower abdomen and possibly the groin. Pelvic inflammatory disease (PID), an infection of the upper female reproductive tract, is one example. Ovarian cyst rupture and ovarian torsion, or twisting of the ovary, are other potential culprits of acute lower abdominal and groin pain. Ectopic pregnancy, in which a pregnancy implants outside the uterus, is another urgent consideration in women of childbearing age. Endometriosis -- a condition characterized by the growth of uterine lining tissue outside the uterus -- can cause pain in these locations, which tends to occur cyclically.
Male Reproductive Tract Disorders
Male reproductive tract disorders can also cause lower abdominal and groin pain. Testicular torsion describes twisting of the spermatic cord, which runs between the testicle and abdominal wall at the groin. This condition requires emergency medical attention as it can disrupt the blood supply to the testicle, which triggers sudden, severe, one-sided groin pain, which may be accompanied by lower abdominal pain. Other signs and symptoms include scrotal swelling, nausea and vomiting. Other male reproductive tract disorders that can potentially cause lower abdominal and groin pain include:
-- epididymitis: inflammation of the epididymis, located on the back of the testicle
-- orchitis: inflammation of the testicle
-- prostatitis: inflammation of the prostate gland
Next Steps, Warnings and Precautions
Lower abdominal and groin pain should not be ignored, as this discomfort could signal a serious medical problem. In addition to the causes discussed, other conditions must also be considered, including tumors of the organ systems noted, as well as certain nerve disorders. Seek immediate medical attention if your pain is related to a traumatic injury, severe or worsening, or is accompanied by any warning signs and symptoms, including:
-- fever, chills or clammy skin
-- sudden scrotal swelling
-- vaginal bleeding, especially if you might be pregnant
-- nausea or vomiting
-- bloody or black stools
-- inability to pass stool or gas
-- bloody urine
-- dizziness, lightheadedness or fainting
Reviewed and revised by: Tina M. St. John, M.D.