A hernia is the protrusion of an organ, fatty tissue, or a section of the intestine through a weakened area in the muscle wall that normally contains it. While hernias are commonly associated with groin or abdominal discomfort, the pain can present far from the actual site of the defect. Many people with persistent hip pain assume the cause is a joint problem like arthritis. However, a hernia in the lower abdominal or groin region can cause pain felt in the hip area, a phenomenon known as referred pain. Recognizing this possibility is important for correctly diagnosing and treating chronic hip discomfort.
Understanding Hernias Near the Hip and Groin
Hernias most frequently linked to pain radiating toward the hip occur in the lower abdominal and upper thigh region. The most common is the inguinal hernia, where tissue pushes through the inguinal canal in the groin area. Inguinal hernias are categorized as direct, pushing through a general weakness in the posterior wall, or indirect, following a natural, but unclosed, passage.
Femoral hernias also occur in this region, pushing contents into the femoral canal near the upper thigh. This type is less common than the inguinal type but is more frequently seen in women. Due to its location near the hip joint, a femoral hernia can easily be mistaken for a hip joint issue, potentially delaying the correct diagnosis.
A third condition often grouped with hernias is athletic pubalgia, commonly called a “sports hernia.” This is not a true hernia because it involves a tear or strain of soft tissue, such as the adductor muscle, rather than an organ protrusion. Despite the lack of a true bulge, the resulting structural weakness and inflammation cause chronic pain that can be felt in the hip and groin.
Mechanisms of Pain Referral
Pain originating from a hernia is felt in the hip primarily through two mechanisms. The first involves direct nerve compression by the protruding hernia sac. Nerves like the lateral femoral cutaneous nerve and the genitofemoral nerve pass near the groin area where hernias develop.
When the hernia sac enlarges, it presses on these nerves, causing pain that radiates along the nerve’s pathway to the hip or upper thigh. This is referred pain, where the brain interprets the irritation signal as coming from the nerve’s destination point. The second mechanism involves chronic muscular tension and strain around the defect.
The compromised abdominal wall forces surrounding muscles, such as the psoas and adductors, to compensate for lost stability. This continuous tension leads to inflammation and muscle spasms that refer pain to the hip region. The resulting chronic strain on the musculature surrounding the pelvis manifests as deep, aching pain in the hip area.
Key Symptoms Indicating a Hernia Connection
Hernia pain often has specific characteristics that distinguish it from primary orthopedic hip conditions. A sign suggesting a hernia is pain that noticeably worsens with activities that increase intra-abdominal pressure. These activities include coughing, sneezing, straining during a bowel movement, or heavy lifting.
The discomfort may manifest as a burning, aching, or sharp sensation, frequently radiating downward from the groin into the inner thigh or hip. Unlike joint pain, which worsens with specific hip movements or weight-bearing, hernia pain can sometimes be relieved when lying down. This relief occurs because the tissue may fall back into the abdominal cavity.
While a visible bulge in the groin or upper thigh is the most common symptom, smaller or “occult” hernias may not produce an obvious lump. In these cases, the pain itself serves as the primary indicator, especially if accompanied by a feeling of pressure or heaviness that increases throughout the day. This presentation, without a clear bulge, is common with sports hernias or small femoral hernias.
Medical Confirmation and Differentiation
Diagnosing a hernia as the source of hip pain begins with a physical examination. The doctor checks for a palpable bulge while the patient is standing or during a Valsalva maneuver. This maneuver involves bearing down or coughing to increase abdominal pressure, temporarily forcing the hernia contents outward and making the defect easier to detect.
If the physical exam is inconclusive, especially when a sports hernia or small internal hernia is suspected, imaging tests confirm the diagnosis. An ultrasound is often the first tool utilized due to its non-invasive nature and high sensitivity in detecting groin hernias. More detailed imaging, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be ordered to visualize soft tissues and nerves more clearly.
Imaging also helps differentiate hernia-related pain from other causes of hip discomfort. X-rays may be used to rule out primary hip pathologies like arthritis or femoroacetabular impingement, which present with similar symptoms. This process ensures the pain is correctly attributed to the abdominal wall defect and not to a separate orthopedic issue.
Treatment Options for Hernia-Related Hip Pain
For a hernia confirmed to be causing persistent hip pain, surgical repair is the definitive treatment option. The goal of surgery is to return the protruding tissue to the abdominal cavity and reinforce the weakened muscle wall. This immediately relieves pressure on the adjacent nerves and muscles.
Surgical techniques include open repair, which uses a single incision, or a laparoscopic (minimally invasive) approach, which uses several small incisions. Laparoscopic repair often utilizes synthetic mesh to strengthen the defect, reducing tension on surrounding tissues and minimizing recurrence risk. Surgery is necessary for pain caused by nerve compression because the structural defect cannot heal on its own.
Addressing the hernia stops the mechanical irritation that generates the referred hip pain. For hernias that are small, asymptomatic, and not causing referred pain, “watchful waiting” may be appropriate, where the condition is monitored. Non-surgical options like pain medication or a hernia truss can temporarily manage discomfort but do not repair the underlying anatomical defect.
Once a hernia becomes symptomatic and interferes with daily function or causes referred pain, surgical intervention is typically recommended. This prevents complications and achieves permanent relief.