public nuisancealso known as a sports hernia, is an injury to the groin that most commonly occurs with sports or activities that involve a sudden change in direction or twisting motion.
This article will describe the causes and symptoms of pubic pain, how to diagnose and treat it.
pubic pain symptoms
This rectus abdominis The obliques and obliques, which are connected to the pelvis, are most affected by pubic pain. The adductor tendon on the inner thigh also attaches to the pubic bone and can be pulled or torn with pubic pain.
Symptoms of pubic pain include pain and tenderness in the affected area. The onset of pain is usually insidious, has no specific cause, increases over time, and occurs in the lower abdomen, groin, and upper adductors on one side of the body.
Pubic pain can also radiate to the inner thighs, testicles, and rectum, and usually improves with rest and worsens with activity, especially twisting, cutting, and kicking. Coughing and sneezing can also worsen symptoms due to increased abdominal pressure.
Unlike abdominal hernias, in which the muscles in the mid-abdomen tear and produce significant tissue protrusion, pubic pain usually does not produce any tissue protrusion into the tense area. Over time, however, pubic pain can lead to an inguinal hernia, where abdominal organs can press into the weak area and protrude into the lower abdomen.
Pubic pain is most common with sports and activities that involve rotational movements or sudden changes in direction with the foot pedal. This twisting motion of the lower body can cause a tear in the soft tissue that attaches to the pelvis in the lower abdomen or groin. This injury typically occurs with shearing forces on the pelvis due to strong pull on the adductors on the pelvis and a lack of abdominal strength that provides stability.
Running, kicking, and rapid acceleration and deceleration also increase the likelihood of injury. The most common exercises that can cause pubic pain include:
Pubic pain is also more common in men due to differences in pelvic anatomy.
Pubic pain is diagnosed by physical examination. Your healthcare provider will ask you to do sit-ups or lift your shoulders and upper torso from a lying position against physical resistance. For pubic pain, any of these exercises usually returns symptoms.
At least three of the five clinical symptoms should be present to confirm the diagnosis of pubic pain. These include:
- tenderness at the pubic tubercle at the attachment of the syndesmosis tendon
- The feel of the deep inguinal ring
- Pain in the outer groin ring without hernia signs
- Pain at the origin of the adductor longus tendon
- Dull, diffuse pain in the groin that can radiate to the perineum and inner thighs
MRI can also be used to confirm the diagnosis of pubic pain by showing a partial or complete tear of the rectus abdominis, syndesmotic, or adductor tendon. MRI can also rule out other types of groin pain, including:
- hip labrum tear
- Osteitis pubis
- iliopsoas bursitis
- avascular necrosis
Fluoroscopy or ultrasound-guided injection of an intra-articular anaesthetic (injected directly into the joint) into the hip can also help rule out other hip disorders that may cause groin pain. Pain from problems in the hip joint may improve after an intra-articular injection, but if pubic pain is present, the pain will remain the same.
Pubic pain is first treated with rest for the first 7 to 10 days after injury, along with ice packs and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Physical therapy usually begins after two weeks to improve the strength and flexibility of the abdominal, groin, and buttock muscles so they can return to normal function after injury.
In more severe cases of pubic pain that does not recover well, surgery may be performed to repair the torn tissue around the groin and abdomen.Occasionally one inguinal neurectomyIt is a surgical procedure to remove the inguinal nerve inside the groin and is used to relieve pubic pain.
Surgery may also be required in the case of a re-tear in a previously recovered case of pubic pain. If pain in the inner thigh persists after pubic pain surgery, an additional procedure called an adductor tenotomy may be performed. With an adductor tenotomy, the adductor tendon that connects to the pubis is severed, allowing the tendon to heal and increase in length, thereby releasing tension in the groin and improving range of motion and reducing pain.
Many cases of pubic pain recover within four to six weeks after physical therapy, but it can take up to 10 to 12 weeks to return to sports. Resting from exercise and weighting activities is essential to allow the injured groin area to heal properly, then gradually build up and adjust the exercise to return to physical activity. If obvious symptoms persist over time, cortisone can be injected into the affected area to reduce inflammation at the injury site.
Pubic pain, characterized by pain in the groin, is caused by a pull of the tendon of the abdominal muscles and sometimes the adductor muscle that connects the inner thigh to the pelvis. Pubic pain is most often caused by sports and activities that involve a rotational motion or sudden change of direction with the foot that causes tissue tears in the groin. The prognosis for pubic pain is good and can be cured well with rest and physical therapy, but surgery is sometimes required in severe or recurring cases that do not recover with conservative measures.
Pubic pain can be a frustrating diagnosis because most physical activity needs to be stopped for the tense or torn area to heal. Working with a physical therapist is especially important to gradually build your tolerance for physical activity and to help correct muscle imbalances between the abs and adductors that may be causing your injury. Patience is key, as careful rest and skilled recovery from activity can ensure that pubic pain will heal without further treatment.