While the reducible right inguinal hernia in this patient was obvious, the patient’s history and physical examination gave high suspicion for the clinical diagnosis of osteitis pubis as well. The symptoms of osteitis pubis can be presented as any complaint in the groin or lower abdomen [1]. Pain generally is localized over the symphysis and may radiate to the groin, scrotum, perineum, medial thigh, hip, or abdomen [2].

Physical findings for osteitis pubis can vary. It is important always to consider any sport involved, as well as the chronicity of the conditions [3]. Gradual onset of pelvic pain, with pubic symphysis tenderness, is one of the features of osteitis pubis [4]. One great modality for the diagnostic investigation in detecting the osteitis pubalgia is MRI. The differential diagnoses of chronic groin pain that can present similarly to osteitis pubis include musculotendinous strain, osteomyelitis, inguinal hernia, referred low back pain, intra-articular hip disease and genitourinary disease, and adductor tendinopathy. Osteomyelitis of the pubic symphysis is one of the diseases most commonly confused with osteitis pubis [5], so clinical evaluation requires a careful synthesis of history taking, physical examination, and appropriately directed investigation.

Nonoperativemanagement of osteitis pubis is similar to that of other causes of chronic groin pain and consists mainly of rest, ice or heat, and nonsteroidal anti-inflammatory drugs (NSAIDs) or other oral medication if patient can not take an anti-inflammatory medication. If these initial modalities are not helpful after a defined trial period (3 weeks for example), then the next intervention to consider would be glucocorticoid injections directly into the pubic symphysis or oral glucocorticoids [12, 13]. Additional nonoperative interventions can then also include physiotherapy focusing on core stability, muscle balance, and rotational hip range of movement; and activity modification. The most important lesson here is that if a patient has osteitis pubalgia and an inguinal hernia, just repairing the hernia alone will not alleviate the 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.