During pregnancy, many women experience discomfort or pain in the groin area, which is most often associated with a sprained ligament.
In uncomplicated pregnancy, this condition is physiological and does not require correction. However, severe pain may indicate other causes of pathology that require referral to a specialist.
General concepts about the groin area
The groin is the connecting part between the abdomen and the thigh, depicted in the shape of a triangle. The key role here is played by the Poupartian (fallopian) ligament (ligament inguinale). It limits the groin area from below and from the outside. The groin is separated from above by a line passing between the anterior superior iliac spines; inside the separator is the lower edge of the rectus abdominis muscle. The groin area is not fully covered by muscles, so it is quite vulnerable.
Anatomy of the Poupartian ligament
The Pupartian or inguinal ligament is a cord that runs between two components of the pelvic bone, the pubic tubercle and the anterior superior iliac spine. This tendon arch looks like a groove with a length of 11 to 13.5 cm. This part of the body is a steam room. The Pupart ligament includes the ligament itself and the iliopubic tract, which runs deeper but in the same direction. A very narrow gap forms between them.
Under the tendinous arch passes the iliopsoas muscle and the neurovascular bundle, which includes the femoral nerve, iliac artery, and iliac vein. Here is the femoral fascia, a tunnel through which the femoral vessels and lymph nodes pass.
Density and tension are signs of the normal condition of the fallopian ligament. Sometimes stretching of this cord is observed. The ligaments in the groin area in men suffer due to physical activity, which puts enormous pressure on the perineum. Sprained inguinal ligaments in women occur most often during pregnancy. In this case, swelling, hematoma, and redness appear. Also, pain in the groin area in both sexes can be caused by inflammation of the lymph nodes located in the groin. In this case, the area of the inguinal ligament is enlarged.
The fallopian ligaments in the groin area have some differences in men and women. According to statistics, the inguinal ligaments in men are more susceptible to injury, while in women they are stronger, since they are better strengthened by the muscle and tendon layers.
Diagnostics
To detect a sprain of the Poupart ligament, the doctor will carefully collect an anamnesis of the course of the disease, and then begin conducting diagnostic studies.
A general examination and palpation in the groin area on one or both sides is characterized by compaction or swelling of the subcutaneous tissue, reflex muscle spasm; a hernial protrusion may be detected in the openings of the inguinal canal with severe sprain of the ligament.
Ultrasound examination of the groin area will help to supplement and clarify the diagnosis.
Using ultrasound, you can check the integrity of the fibrous structures and the symmetry of the length of the ligaments on both sides. The technique allows you to detect an inguinal hernia, assess its condition, and the presence of complications.
Differential diagnosis
If during pregnancy there is a pulling in the groin area, the pain increases, and the ability to work at work and at home is impaired, it is necessary to ascertain the nature of the disease in order to begin treatment in a timely manner. In addition to a sprained inguinal ligament, the following conditions can cause symptoms:
- Hypertonicity of the uterus. This condition is characterized by increased excitability of the uterine muscles. The condition is dangerous for the fetus and the reproductive health of the mother and requires correction. Therapeutic and breathing exercises often help to cope with pathology.
- Pathology of nerve fibers. Increased abdominal pressure during pregnancy can put pressure on the sciatic nerve, which is located at the back of the pelvis. Characteristic is an increase in the intensity of symptoms when walking, irradiation of pain into the lower limb. After delivery, the condition goes away on its own.
- Symphysitis is a violation of the integrity of the pubic symphysis, the junction of the two pelvic bones. The pelvis can become unstable due to a lack of calcium, other trace elements and important vitamins. The condition manifests itself as severe pain when moving the legs away from the midline and is confirmed by ultrasound.
- Infections affecting the pelvic organs and regional (local) lymph nodes. Developing inflammatory and edematous syndromes can provoke pain in the groin area.
- Intestinal dyspepsia in the form of constipation syndrome. Under the influence of various mechanisms, including mechanical compression of the intestines by the growing uterus, constipation occurs. Increasing intra-abdominal pressure excites pain receptors in the pelvis and groin area.
- Varicose veins of the pelvis. A disease characterized by incompetence of the walls of venous vessels and the development of their dilations. Stagnation of blood causes pain and disruption of nutrition of surrounding tissues. The pathology requires complex treatment with the use of drugs that tonic the venous wall.
- Herpes infection is a severe viral disease that has a pathological effect on the life of the fetus. Infection of the genital organs causes pain in the groin, itching, and pathological discharge. Symptoms should be a reason to consult a doctor as soon as possible to prevent serious complications.
Formation and location of the poupart ligament
The beginning of the arch is the edge of the tendinous part of the external oblique muscle of the abdomen. The external oblique is a muscle of the anterior abdominal wall, ending in tendons or aponeuroses of white-silver color, consisting of collagen and elastic fibers. They give stability to the entire abdominal space. The aponeurosis is less perfect in men, so hernias in the perineal area are more common in them.
At the ends the tendon arches branch. The fibers involved in the formation of the tendon cord itself give rise to the lacunar (lig. lacunare) and wrapped ligament (lig. reflexum). The first formation is directed downward, the second upward.
From the base lig. lacunare the pectineal or Cooper's ligament (ligament pectineale) is stretched. It runs along the crest of the pubic bone. It is important during operations on hernias in the groin area: to strengthen the tissues in the area of the gap, very often surgeons stitch this pectineal formation and grab the pectineus muscle.
Treatment
Therapeutic measures depend on the degree of stretching of the fibrous elements, the presence of complications, and the stage of pregnancy. Often, when choosing a tactic, an obstetrician-gynecologist makes a decision together with a surgeon or traumatologist.
The general rules of treatment are changing lifestyle and creating functional rest. It is necessary to exclude physical activity that causes a sharp increase in intra-abdominal pressure.
Conservative treatment
With a low degree of stretching of the Pupart's ligament, calcium supplements, vitamin D, and a diet with a high content of dairy products are prescribed. Breathing exercises and special exercises for the abdominals are acceptable. The exercise therapy complex is compiled by a specialist and approved by the attending physician.
Treatment is complemented by physiotherapeutic procedures that relieve muscle spasms and increase blood flow to the pelvic organs.
Sometimes massage is used, which enhances and complements the effects of physiotherapy. The use of folk remedies is a controversial method of treatment. Any procedure must be agreed with the attending physician.
The structure of the inguinal canal and sexual characteristics
In the same direction as the Poupart ligament, stretches the inguinal canal or interval (canalis inguinalis), a gap located between the broad abdominal muscles and above the tendinous arch. This is also a paired formation; it is expressed only when the internal organs emerge from the peritoneal cavity.
The length of the gap in men is approximately 4-5 cm. In women it is longer, but narrower. It is believed that the ring, located at the beginning and end of the gap, normally only accommodates the tip of the index finger. The size of this gap determines the stability of the groin.
The topography of the slit-like gap in men is more complex. Here is the spermatic cord (funiculus spermaticus), and it contains: the vas deferens, spermatic artery, vein, nerve, lymph nodes and processus vaginalis. The space of the inguinal passage in women is occupied by the round ligament of the uterus (lig. teres uteri) and the vaginal process, reaching the labia majora. This physiological difference between the sexes causes the risk of hernia formation. In men it is much higher.
A predisposing factor to the formation of hernias is non-fusion of the processus vaginalis. It can cause congenital hernias, and in women it can provoke the appearance of labia majora cysts.
The structure of the gap can be represented in the form of a cylinder, the ends of which are designated by the deep and superficial inguinal ring. The passage is formed by four walls:
- upper – internal oblique and transverse abdominal muscles;
- lower - fallopian ligament;
- anterior – aponeurosis of the external oblique muscle of the abdomen;
- posterior – transverse fascia of the abdomen.
The superficial inguinal ring is formed by fibers of the tendinous edge of the external oblique muscle, the lateral crus and the medial crus. This passage also contains loose fiber and vascular bundles that supply blood to the genitals.
Direct and oblique hernias form in the cavity of the inguinal canal. An inguinal hernia is an organ (such as the ovaries or intestines) that extends from the abdominal cavity and enters the gap through the internal inguinal ring.
With an oblique hernia, the hernial sac passes through the gap under the spermatic fascia and extends beyond the canal. It can move further to the scrotum, and in females, to the fiber of the labia majora. Such a hernia increases the size of the fissure passage, in particular, stretches the deep ring and makes the aponeurosis of the external oblique abdominal muscle weak. The prolonged existence of a hernia can provoke soldering of the spermatic cord and hernial sac in some places. Indirect hernias can be congenital.
A direct inguinal hernia, on the contrary, bypasses the spermatic cord and does not descend to the genitals and formations. In this case, it moves through an anatomical formation called the internal inguinal fossa. This pathology is acquired and is found more often in older people.
If there is a hernia, the patient complains of pain, a protrusion is detected in the groin area, which increases with physical activity. Surgery in this area involves strengthening the canal walls.
Inguinal ligament sprain
Under the influence of a force that increases intra-abdominal pressure, stretching of the tendon elements of the inguinal ligament may occur, leading to symptoms. The cause of the pathology may be:
- Pregnancy. The amniotic sac that forms in the uterine cavity in late pregnancy can put pressure on the tendon elements of the pelvis. Hypovitaminosis and asthenic body type contribute to the pathology.
- Sports, industrial and domestic loads. Lifting weights causes the abdominal wall muscle fibers to contract and increases pressure on the Poupartian ligament, causing it to stretch.
- Lymphadenitis. Inflammation of the inguinal lymph nodes during infectious diseases can have a negative effect on the tendon structures.
- Systemic diseases of connective tissue, collagenosis contribute to dystrophic changes in the fibers of the ligament, and its anatomical integrity is disrupted.
Symptoms of a sprain
If the integrity of the fiber is damaged abruptly, at the moment of stretching the patient feels a crunching sensation and pain in the groin. During pregnancy, tension in the structure occurs gradually, without significant symptoms for a long time. Other signs:
- In the groin area, subcutaneous swelling of the tissues surrounding the ligament may form - a compensatory reaction of the body, which seeks to limit the source of damage.
- Pain in the groin on one or both sides increases, which increases when the torso is tilted or the lower limb is flexed at the hip joint.
- With palpation and pressure on the inguinal ligament, the pain intensifies, and subcutaneous tissue compaction may be detected.
A physiological condition during pregnancy is mild discomfort in the groin in late pregnancy. If symptoms are severe, you should consult a doctor who will conduct a comprehensive examination.
Functions of the Pupart's ligament
The inguinal ligament, which is formed at the junction of the thigh and the peritoneal cavity, has a connecting role. It acts as a bone to which the deep fascia of the thigh and the large abdominal muscles - the external oblique, internal oblique and transversus - are attached.
The inguinal ligament is an anatomical structural component. It participates in the formation of the inguinal space, being one of its sides, demarcating the inguinal and femoral regions. The fibers that make up the tendinous arch form some adjacent bands of connective tissue.
The topography of the inguinal region is a complex structure. The anatomy of the inguinal ligament is complicated by the proximity of the abdominal cavity, thigh, and genitourinary organs. Everything is supplemented by a system of nerve fibers, blood vessels, lymph nodes, thigh muscles, and connecting tendons. The condition of the fallopian ligament and inguinal canal determines the potential for hernias in the perineal area and other diseases.