A feeling of discomfort, up to a real pain in the inguinal region, could make you think of two disorders – in particular if you are someone who regularly practices physical activity: pubalgia or inguinal hernia. The location of the symptom is the common element between these two conditions: discomfort or pain arise at the base of the abdominal wall, near the circumference of the thigh. But how can suspicion lead to one disease or the other before the specialist gets to a precise diagnosis? We asked Dr. Stefano Bona, Head of the General Surgery and Day Surgery section of the Humanitas General Surgery and Digestive Unit.
Pubalgia
For athletes, as well as sports fanatics, this term will sound familiar: pubalgia is in fact a fairly common condition that can force athletes to stop physical activity. It is a painful syndrome that can occur in the inguinal or pubic region and generally involves the lower abdominal wall, the adductor muscles of the thigh and the pubic symphysis, to which these structures are anchored. It should be emphasized that the term pubalgia refers to a symptom and does not constitute a diagnosis itself. The causes of pubalgia are different and often overlap with each other, making diagnosis (and therefore treatment) even more difficult.
The hernia
The groin is just one of the points where a hernia can occur, which is where the viscera contained in the abdomen can escape from its location. Moreover, just like pubalgia, inguinal hernia can also be associated with physical activity: physical efforts, in fact, can act as a triggering factor.
In presence of inguinal pain, which elements can suggest the presence of a hernia and not pubalgia? ‘First of all, the doubt arises in the absence of an evident swelling, which in the case of inguinal hernia has typical visual characteristics’, replies Dr. Bona. ‘In the absence of this finding, it may be a small hernia not visible at the clinical examination or pubalgia. Pubalgia mainly affects athletes both at an amateur and professional level, especially football players, and to a lesser extent hockey players, rugby players and mid-distance runners’.
What is the examination that – besides the clinical evaluation – can definitively clarify the condition? ‘The examination to define whether we are in presence of inguinal hernia or pubalgia is ultrasound. This examination has the advantage of being able to be carried out under dynamic conditions, for example under stress, thus allowing to distinguish the true hernia (fatty tissue or visceral leakage through the inguinal orifice) from the “sport hernia” (simple weakness of the wall at the inguinal level, which is one of the main causes of pubalgia)’, concludes Dr. Bona
