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Can IBS Cause Hip and Groin Pain?

By 16th December 2022May 16th, 2023IBS
IBS and Hip Pain

Introduction

IBS is often a chronic condition that has an impact on a wide number of the general population. This can be in the range of 14% to 21% of the general population, with women 2-3 times more likely to experience symptoms than men. [Source: Pubmed]  

The diagnosis of IBS is not made on the results of specific tests but based on a set of symptoms. These symptoms are outlined in the ROME criteria, which state that for someone to be diagnosed with IBS, they must be experiencing abdominal pain and at least 2 of the following:

  • altered frequency, consistency, and/or passage of stools
  • and/or associated feelings of abdominal distension or bloating.

These symptoms must also have been present for at least 3 months. 

The feature of abdominal pain can improve once passing a stool. However, when it’s present in the abdominal region and doesn’t resolve after a bowel movement, this pain’s precise location and/or origin can be hard to locate.

It can be tempting to link the problem to a specific area or cause when we suffer from health issues. However, this is not usually the case. 

The human body is a series of closely connected parts constantly interacting with one another. As such, what happens in one area can lead to symptoms in another. This may make it hard to distinguish the location of the discomfort and contribute to referred pain.

Referred Pain

Referred pain is when the pain originates in one part of the body and can be felt in another.  This is true for IBS, where pain can be felt in multiple locations. It’s also clearer to see where a heart attack leads to pain in the jaw.

This movement of pain can be due to 2 reasons:

From a digestive perspective, the increase in abdominal girth seen in bloating can place additional pressure on the organs in the abdomen. This can be seen in those where bladder symptoms are also present. These changes in the abdominal cavity may then place pressure on nerves, triggering sensations in other areas of the body.

It’s also possible for the pain to be ‘created’ in the brain. This can be due to the neurons responsible for locating the pain processing this information in a manner that leads to the incorrect location of the pain.

An example of this is the referred pain that is experienced during a heart attack. This is where pain can be felt in the teeth or jaw without there being an issue in this region.

Similar issues can be seen in other chronic pain conditions such as fibromyalgia, and chronic low back pain.

A test that can be carried out for dental or jaw pain is administering a local anaesthetic. If the pain is originating from this region, the pain will subside. If the issue is due to referred pain then the pain will continue. [Source: Pubmed]

This test is not suitable for gut issues, especially when there is hip and groin pain. However, it does illustrate the way referred pain can appear.

It’s also possible that digestive issues can lead to pain in the back. For example, gallstones can lead to pain in the back between the shoulder blades. [Source: Pubmed]

Chronic Pelvic Pain

There is a clear crossover in symptoms in those with IBS and those experiencing chronic pelvic pain.

Research into procedures to address chronic pelvic pain founds a link between this and IBS. The procedures in question were laparoscopies and hysterectomies specifically for chronic pelvic pain.

The results indicated that 50% of women undergoing laparoscopy and 40% undergoing hysterectomy (due to chronic pelvic pain) also had additional symptoms that were compatible with IBS. [Source: Pubmed]

As well as gut issues such as IBS and SIBO, other factors and conditions can contribute to chronic pelvic pain. These are:

  • chronic cystitis
  • endometriosis
  • adhesions
  • painful bladder syndrome
  • musculoskeletal injury [Source: Pubmed]

99% of those with chronic pelvic pain are female. Additionally, those with a history of pelvic trauma or surgery are at a significantly higher risk of chronic pelvic pain.

It has also been reported that almost 50% of women with chronic pelvic pain have a history of physical or sexual abuse. [Source: Pubmed].

These are both factors that can increase the risk of developing IBS. [Source: Pubmed]

As in IBS, one study indicated that individuals with chronic pelvic pain have higher rates of:

  • affective disorder (such as depression or bipolar)
  • anxiety
  • sexual abuse in early childhood
  • history of hysterectomy [Source: Pubmed]

Food Poisoning & Joint Pain

Food-borne illnesses (such as Campylobacter, Salmonella, Escherichia coli) are also highly associated with both gastrointestinal symptoms (abdominal pain and bloating) but also joint pain.

Post-infectious symptoms may not manifest for weeks or months following exposure, but a clear link has been linked with reactive arthritis. [Source: Pubmed]

This is believed to take place due to the potentially harmful organisms reaching the general circulation, which activates specific immune cells called T-cells.

It is then possible for these T-cells to mistakenly attack the tissue in the joint by mistake leading to an inflammatory response and pain. [Source: Pubmed]

Can constipation and IBS cause groin pain?

IBS with constipation is one of the subtypes of IBS. This means that along with the other symptoms of IBS (such as bloating and pain) it may be difficult to pass a stool. This can lead to straining and increase the risk of heammoaroids. [Source: Pubmed]

Constipation can also lead to or contribute to strains or muscular issues in the groin areas. This can be in the form on the following groin issues:

  • hernia or muscle strain
  • tendonitis
  • avulsion fracture (where a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone) [Source: Pubmed]

Other factors can be taken into consideration when assessing groin pain. These include urinary, joint related conditions. One of the most common joint issues that lead to groin pain is an issue with the hips.

Also Read: How To Reduce Inflammation In The Gut

Ehlers–Danlos Syndrome

Hypermobility

Ehlers-Danlos syndrome refers to a group of disorders that impact the connective tissue. 

These are characterised by:

  • skin hyperextensibility
  • tissue fragility
  • joint hypermobility and instability

Due to the impact suboptimal connective tissue health plays in the body, this syndrome can lead to a wide range of symptoms. These include:

  • Gastrointestinal symptoms, such as IBS
  • Fibromyalgia
  • Chronic pain syndrome
  • Chronic fatigue syndrome
  • Multiple allergies
  • Pelvic floor disorders
  • Psychological disorders
  • Musculoskeletal complaints such as joint pain. [Source: Wiley]

One study found that out of 228 patients diagnosed with IBS, 42% also had a diagnosis of EDS, with the highest prevalence being the constipation subtype of IBS. [Source: Wiley]

There is a crossover of risk factors before these 2 conditions also, which include: 

  • altered psychopathology
  • abnormal pain processing
  • autonomic dysfunction
  • motility disorders

Due to the changes in bowel motility (the result of suboptimal connective tissue functioning), SIBO is highly associated with EDS. [Source: The American Journey of Gastroenterology

Ehlers–Danlos Syndrome is a complex syndrome that we will be covering in a future article in more depth.

Joint Issues

While there are clear links between what’s happening inside the digestive system, both on a bacterial level and through referred pain, there can also be structural issues in the joints themselves.  

These include:

Labral tear

The hip is a form of a ball-and-socket joint. The rounded tip of the femur slots into the socket of the hip, hence the name. Surrounding this socket is a seal of hardy cartilage, which acts as a shock absorber and allows us to move about without issues. 

The labrum can be damaged through excessive use or considerable trauma, resulting in a labral tear. This can cause an intense, sharp pain that is amplified by the movement and strain of the affected area, flexing your leg as an example. If you are suffering from a labral tear, your hip will feel stiff and locked up, with audible pops accompanying movement. Scans are the most common method of identifying a labral tear. [Source: Pubmed]

Hip tendonitis

The hip and groin area house a great many bodily structures. Tendons, for example, are present to hold bone and muscle together, allowing for movement. These tendons can become damaged through considerable use or trauma and suffer from inflammation. When this happens around the hip, it is known as hip tendonitis.

Hip tendonitis often results in radiating pain. This means that although it starts in the hip, the pain doesn’t just stay there. Usually, the pain radiates to the groin, given the close proximity. If you have pain there, hip tendonitis could be the answer. [Source: Pubmed]

Strained groin

One of the most common causes of hip and groin pain is a strained groin. It is a reasonably easy injury to sustain, with athletic people being most susceptible. A strained groin can be suffered by over-exerting your body, most often when running, stretching, or putting excessive strain on the hip or groin by making unnatural movements.

A strained groin will involve various levels of pain and inflammation, depending on the severity of the strain. It will make it difficult to move, sapping a great deal of strength and flexibility from the affected area. Continuous movement and stretching will cause more pain. [Source: Pubmed]

Gut Health Nutritionists

As outlined, there are several physical issues that are isolated to the gut joints, particularly in the groin and hip area.

However, when these pains are also happening at the same time as the symptoms of IBS, there may be a direct link between what is happening inside the digestive system and elsewhere in the body.