Abdominal wall & groin pain

Abdominal wall pain refers to pain arising from the muscles, fascia, or nerves of the abdominal wall, rather than from internal organs. It may be localised, reproducible on examination, and often worsens with movement, activity, or abdominal muscle tension. Common causes include nerve irritation or entrapment, previous surgery, trauma, or strain of the abdominal wall muscles. Groin pain with or without hernia repair is often severe, debilitating and life altering. It is often very complicated and may be related to nerve irritation or injury, mesh or tacks causing local irritation or unrelated to hernia repair. Expert assessment is essential.

• Nerve-related pain (e.g. anterior cutaneous nerve entrapment syndrome or groin nerve irritation)
• Postoperative pain following abdominal or groin surgery
• Previous hernia repair or abdominal wall procedures
• Muscle or fascial strain
• Scar-related pain

• Localised pain at a specific point on the abdominal wall
• Pain reproduced by pressing on a small area
• Pain worsened by movement, coughing, or tensing the abdominal muscles
• Normal or non-diagnostic imaging of internal organs

Assessment focuses on a detailed history and physical examination to distinguish abdominal wall pain from pain arising within the abdomen. Imaging and other tests may be reviewed to exclude alternative causes.

Not all abdominal or groin pain requires surgery, and identifying the correct diagnosis can help avoid unnecessary procedures.

Management depends on the cause and severity of symptoms and may include:

• Education and reassurance once the diagnosis is established
• Activity modification and conservative measures
• Targeted local injections where appropriate
• Referral to other specialists or allied health providers when indicated
• Surgical intervention in selected cases