Groin nerve pain: Overview and treatment options

When people experience pain in the lower abdomen where the leg meets the pelvis, we often call it groin pain. Pain in the groin can also move backwards to the perineal or sitting area and the buttocks or upwards towards the abdominal muscles. Generally, many conditions can cause groin pain, including osteitis pubis, inguinal hernia, and hip joint problems. However, pain can sometimes be due to a pinched nerve in the pelvis or groin. It is usually challenging to diagnose groin nerve pain as imaging often does not detect it. So, how do we diagnose groin nerve pain, and what are the treatment options?

Common nerves causing groin pain 

Generally, pelvic or groin nerve pain symptoms depend on the nerve affected. The common nerves causing pelvic or groin pain include: 

Pudendal neuralgia

The pudendal nerve runs between the buttocks muscles close to the sacral bone and into the perineum. Think of the perineum as the part of the buttock that touches the bicycle seat. Pudendal neuralgia, or pudendal neuropathy, is caused by nerve trapping, generating pain in the perineal area.

Usually, pudendal neuralgia is caused by pronged sitting, leading to pressure on the nerve. It is so common in cyclists that it’s often called cyclist’s syndrome. If you are a cyclist with perineal pain, you should seek help changing your bike set-up and seat position.

Generally, people describe burning pain in the perineal or hamstring area. In men, pain can radiate to the penis or scrotum. In women, pain can move to the vagina or vulva. Often, pain is worse with sitting and almost instantly relieved on standing. Sometimes, pain can occur with intercourse or bowel or bladder movements. Sometimes, pudendal neuralgia can be confused with hamstring tendonitis.

Obturator nerve pain

The obturator nerve forms in the lower part of the spine and travels through the large hip flexor or iliopsoas muscle. Then, it enters the inner thigh and groin by passing through a hole in the pelvic bone called the obturator foramen. It then divides into two branches in the inner thigh. The obturator nerve supplies the inner thigh with adductor muscles and skin in the inner thigh.

Usually, pinching of the obturator nerve causes pain in the inner thigh. In general, pain occurs with activities such as running or sports. Sometimes, pain may be accompanied by numbness, pins and needles in the inner thigh or weakness of the adductor muscles.

Overall, pinching of the obturator nerve is rare. However, we commonly see obturator nerve pain involving twisting or changing direction in sports. It is often associated with pubic overload or osteitis pubis. Less commonly, it may be due to tumours in the pelvis, surgery in the pelvis, or trauma to the inner thigh.

Ilioinguinal nerve pain

The ilioinguinal nerve comes from the lower spine and passes across the abdominal muscles. Then it travels with other structures in the inguinal canal to supply the skin at the inner groin and the base of the penis or labia.

Hernia and abdominal surgery can pinch or damage this nerve. Sometimes, blunt trauma to the inguinal region aggravates the nerve.

Generally, people experience sharp, throbbing, or burning pain in the inguinal or inner groin. Sometimes, numbness and pins and needles are also felt across the groin. Pain is made worse by extending the lower back, causing friction of the ilioinguinal nerve. It can be confused with osteitis pubis.

Genitfemoral nerve damage

The genitofemoral nerve comes from the spine and travels through the large hip flexor muscle. It splits into two nerves – the genital nerve, which supplies the vulva or scrotum and the femoral nerve, which supplies the front of the thigh.

Generally, damage or trapping of the nerve can occur due to various problems such as abdominal surgery, direct trauma to the pelvis, and pregnancy.

Usually, genitofemoral nerve damage causes sharp, stabbing, or throbbing pain in the vulva or scrotum, between the legs, or front of the thigh. Often, it is confused with other conditions of the groin, such as iliopsoas tendonitis or in the perineal area.

How to diagnose a pinched nerve causing groin pain

Overall, nerve pain in the groin is challenging to diagnose as it overlaps with many other conditions in the groin and perineum. Generally, we should suspect a pinched groin nerve if investigations are normal.

Sometimes, tapping the nerve at the site of pinching can bring on pain.

In general, we use tests to confirm a diagnosis, including:

• Nerve conduction studies to establish how and why entrapment has occurred. Sometimes, however, these studies may be normal.

• MRI scan 

• Blood tests rule out other causes of nerve dysfunction, such as nerve inflammation occurring in diabetes, an underactive thyroid, or immune system problems.

• Ultrasound can follow the course of the nerve.

• A nerve block using a local anaesthetic and directed by ultrasound can help. If an injection settles pain, then the likelihood of a trapped nerve increases.

It is essential to rule out other causes of groin or pelvic pain, such as pelvis growth, pubic overload, or nerve trapping from the spine.

Treatment of nerve pain in the groin

If you suspect a pinched nerve in the groin, there are several treatment options:

Medications 

Generally, we recommend certain medications for neuropathic pain. These include anti-depressants and anti-convulsants. For example, amitriptyline is an anti-depressant but, at low doses, also works well for neuropathic pain. Another option is duloxetine. We think they operate by changing the brain and spinal cord pain receptors.

Procedures 

In addition to medications, specific procedures can help pelvic or groin nerve pain.

• Injections directing cortisone and local anaesthetic to the trapping site can lower pain. Often, the injections are directed by ultrasound. Examples of nerve blocks include pudendal, ilioinguinal, or obturator nerve blocks. Sometimes, the nerves can be burnt by radiofrequency ablation, giving relief for months or years.

• Occasionally, surgery to remove the trapping or release the nerve can be effective. However, we suggest you exhaust other options before considering surgery.

Other commonly asked questions about groin nerve pain:

What does ilioinguinal nerve pain feel like? 

Patients often report burning pain starting at the lower abdominal muscle wall and spreading to the inguinal region (the crease line between the lower abdomen and upper thigh). Usually, pain is aggravated by movements of the hip or abdomen, such as abdominal twists or hip flexor stretches. 

Ilioinguinal nerve pain: How do we treat it?

Generally, we start with simple treatments such as nerve medications, including amitriptyline or duloxetine. Sometimes, we perform an ultrasound-guided ilioinguinal nerve block that targets the ilioinguinal nerve as it passes between the abdominal wall muscles. If the nerve block relieves pain, we consider a longer-lasting radiofrequency ablation procedure.

Can the ilioinguinal nerve heal itself? 

Yes. Although relatively uncommon, ilioinguinal nerve pain can suddenly disappear and may not need treatment. 

What spinal nerves cause groin pain? 

Trapping spinal nerves in the upper lumbar spine can cause groin pain. Often, trapping is secondary to a disc bulge in the upper lumbar spine. 

Hip and groin pain map

Click on your pain site to identify possible causes. Then, click on specific causes to find out more about each condition:

Final word from Sportdoctorlondon about nerve pain in groin

Overall, we need to consider a pinched nerve as a cause of unexplained pelvic or nerve pain, especially if common investigations are normal. You should see a doctor who is experienced in diagnosing and treating nerve entrapment in the pelvis or groin.

Other related conditions 

• How to treat a pinched nerve
• Burning pain in the front of the thigh: is it a pinched nerve? 
• Nerve pain in the thigh
• Pinched nerve in calf
• Sural nerve entrapment 
• Pinched nerve in foot
• Hip and groin pain causes
• Amitriptyline for pain
• Duloxetine for pain