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Femoral Hernia

Overview

Femoral hernias are relatively rare, making up only 3% of all hernias and about 6% of groin hernias. Surgical correction is usually required since femoral hernias could result in serious complications.

Hernias develop when tissue, like the piece of bowel, pierces the muscle wall of the groin at the upper inner thigh. It enters the femoral canal by pushing past the weak spot.

Femoral hernia symptoms are a lump in the inner thigh or groin and discomfort in the groin. In severe situations, stomach pain and vomiting may also occur.

By Able Health I Medically reviewed by Dr. Alireza Estedlal

Page last reviewed: February 2024 I Next review due: February 2026

What is a Femoral Hernia?

Normally, the muscles are sturdy enough to hold the intestines in their appropriate position. However, the abdominal tissue can sometimes push past the weak spot in the muscle. When this happens in the femoral canal wall, it is referred to as femoral hernia.

The femoral canal contains femoral artery, nerves, and small veins and is situated in the groin, just under the inguinal ligament. Femoral hernias, also known as femorocele, usually look like a bulge around the thigh or groin.

Femoral hernias are more common among women compared to men. Generally, they are uncommon, and most cases affecting the groin are inguinal hernias, while less than 3% are femoral.

 

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Symptoms of Femoral Hernia

Severe femoral hernia symptoms may indicate an obstruction in the intestines, a serious condition known as strangulation. This causes bowel or intestinal tissue to die, posing a life-threatening risk, which is regarded as a medical emergency.

Femoral hernia severe symptoms are:

  • Intense stomach pain

  • Abrupt groin pain

  • Vomiting

  • Nausea

Hernia that is obstructing the intestines can cut off blood flow, and emergency medical care is required to repair the condition and prevent death.

Physical Signs of Femoral Hernia: What to Look for

A physical exam, which involves checking for signs like swelling around the groin and noticeable bulge, can help detect femoral hernia. Medical practitioners can also feel for masses or lumps within the femoral canal while coughing or stretching. Such physical indicators might help affirm femoral hernia presence.

Sometimes, femoral hernia may be strangulated, which implies that the blood flow to the protruding tissue or organ is impaired. Strangulated femoral hernia signs are extreme pain, reddening or discoloration of the skin surrounding the hernia, and inability to shove hernia back in position. These cases of strangulated hernias need immediate treatment since they can cause tissue damage or additional complications.

Causes

Femoral hernias occur due to intestinal tissues pressing through a weak spot in the muscle wall around the inner thigh or groin. The precise cause is not known but may include being born with a structural weakness in the muscle wall.

In addition, femoral hernias can develop from too much pressure or straining because of the following:

  • Constant strong cough

  • Pushing or lifting heavy objects

  • Difficulty passing stool or urine

  • Obesity

  • Childbirth

  • Ascites (abdominal fluid build-up)

  • Peritoneal dialysis (kidney disease treatment)

Risk factors

These factors are likely to increase the possibility of femoral hernia:

  • Sex: Femoral hernias are about 10 times more common in women compared to men due to the wider female pelvis.
  • Age: Adults are far more likely to develop femoral hernias, unlike children. In minors, it usually occurs due to underlying medical problems.
  • Family history: Having a close blood relative who has had a groin hernia increases a person's risk.

Femoral Hernia Vs Inguinal Hernia

Both femoral hernias and inguinal hernias develop in the groin region but greatly differ from one another. Inguinal hernias are usually common and happen when abdominal contents push through a weakened point in the inguinal canal located over the groin crease. On the other hand, femoral hernias occur through the femoral canal, lower down within the groin region.

Femoral hernias symptoms, such as swelling, pain, and bulge in the groin area, might resemble those of inguinal hernias. Nonetheless, there are certain variations in symptoms as well as the available treatments. If not treated, femoral hernias have increased risks of becoming strangulated or incarcerated, resulting in serious complications.

Surgical repair is usually necessary for both hernias; however, the precise approach might vary based on the person's case.

How is a Femoral Hernia Diagnosed?

Femoral hernia diagnosis involves a physical exam, which is done by touching or gently palpating the region to assess the presence of femoral hernia. Most likely, the bulge is felt if the hernia is big.

If the bulge is not visible during the physical exam but the provider highly suspects femoral hernia, an ultrasound of the groin and abdomen can establish or confirm the diagnosis. Imaging scans can also be used to view the protruding tissue and muscle wall defects.

Treatment for Femoral Hernia

Asymptomatic and tiny femoral hernias might not need any treatment, but the condition can be monitored for the progression of the symptoms. For moderate and big hernias, a surgical repair may be necessary, mainly if there is discomfort.

The surgical repair of the hernia is done under general anaesthesia, meaning that youwon't feel pain during the procedure since you will be asleep. Open or laparoscopic surgery can be used to correct femoral hernia. Open surgical procedure necessitates a bigger incision and prolonged recuperation time. On the other hand, the laparoscopic operation involves 3 to 4 keyhole-sized cuts that reduce blood loss.

The form of surgery performed will depend on these factors:

  • The expertise of the surgeon

  • Hernia size and any potential complications

  • Anticipated healing period

  • Cost

For example, laparoscopic surgery causes less discomfort and scarring with a shorter recovery period compared to open surgery. It is however, more costly than the open surgical procedure.

Both surgeries involve creating incisions around the groin to get to the hernia. The intestines or any tissue that protrudes from the femoral region is put back into place. The hole will then be sewn and may be reinforced using a piece of mesh to help strengthen the canal wall.

There are other minimally invasive treatments known as tension-free repairs that don't need general anaesthesia.

Laparoscopic vs Open Surgery for Femoral Hernia Repair

There are two primary surgical methods for treating femoral hernias; laparoscopic surgery and open surgery. Every approach has pros and cons of its own, and the decision between them is based on a number of factors, such as the particular case of the patient and the surgeon's level of expertise.
Unlike open surgery, laparoscopic surgery has various advantages. Because small incisions are made, there is less pain after surgery, minimal scarring, and a shorter healing period. Furthermore, laparoscopic surgery offers enhanced visualization of the nearby structures and the hernia, facilitating a more accurate repair. Nevertheless, this approach might not be appropriate for all cases, particularly if the hernia is big or complicated.

In contrast, open surgery requires a wider incision in the groin region in order to access the hernia. Although this procedure provides direct visualization and hernia repair, it may also cause more discomfort after surgery and a prolonged recuperation period. Since this method allows for better accessibility to the affected part, it is frequently considered for bigger or more complex hernias.

Recovery and Postoperative Care for Femoral Hernia Surgery

The duration of recovery following femoral hernia surgery varies based on the person and the surgical method performed. After surgery, most people can usually return to their regular activities in a few weeks. It's however, essential to adhere to the postoperative care guidelines given by the medical staff to ensure a speedy and smooth healing.

One may feel some pain, bruising, and swelling in the groin area during the first period of recovery. Painkillers may be recommended to ease discomfort. Also, it's essential to refrain from heavy lifting and intense activity during this period to ensure proper healing of the surgical site. Under the supervision of a medical practitioner, steadily increasing physical activity can aid in recuperation as well as prevent complications.

Prevention of Femoral Hernia

Even if preventing all femoral hernia cases may be impossible, there are measures people can consider to lower the associated risks. It is important to maintain a healthy weight since obesity puts additional stress on the abdominal wall, increasing the possibility of hernias. Also, regularly exercising can minimize the likelihood of developing hernias by strengthening the abdominal muscles.

In addition, refraining from activities like heavy lifting and addressing persistent coughing that exerts too much stress on the abdominal region can prevent femoral hernias. Its also crucial to talk to your provider about the risks and take the necessary precautions if you've had prior abdominal surgery or have a family history of hernias.