Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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N.A. Al-Enazi and B.P. Jacob
pubalgia pain. We therefore recommend initiating treatment for pubalgia
first and delaying a hernia repair until the pubalgia pain is better controlled
and the patient understands the difference between the hernia
pain and the pubalgia pains.
The main goal of physical rehabilitation is to strengthen and stabilize
the pelvis and pubic symphysis. Physical rehabilitation, usually for 6–8
weeks, has been found in multiple observational studies to be effective
in reducing pain among patients with osteitis pubis [ 14 ]. Conservative
measures have been shown to be effective in treating osteitis pubis, and
the expected duration of treatment before resolution should be around
2–3 months. A majority of the patients with osteitis pubis respond very
well to this modality of treatment. After the osteitis is improved or
resolved, the hernia repair can then be sought.
Conclusion
Osteitis pubis can be easily missed when patients complain of groin
pain and present with a simultaneous inguinal hernia. History and
physical examination should include a high index of suspicion. If the
diagnosis is suspected, the potential to make the diagnosis will increase,
and thus the surgeon and the patient may be able to prevent a case of
chronic groin pain that would otherwise be at risk for being associated
with an inguinal hernia repair. Usually, the treatment of choice for
patients with osteitis pubis is conservative, with rest, painkillers, and
physiotherapy or steroid injection. The healing process for most
patients is 6–8 weeks. In patients who have an obvious inguinal hernia
and osteitis, it is important to educate the patients about the osteitis and
its associated symptoms, treatment options, and outcomes before
repairing the inguinal hernia.
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differential. Phys Sportsmed. 1998;26(4):78–103.
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