Femoral Hernia

A femoral hernia is a rare type of hernia that develops in the upper thigh near the groin, occurring when tissue or part of the intestine pushes through a weak spot in the abdominal wall into an area called the femoral canal.

Table of contents

• What is a Femoral Hernia?
• Who is Most Affected?
• Symptoms
• Causes and Risk Factors
• Complications
• Diagnosis
• Treatment
• Recovery After Surgery
• Outlook

What is a Femoral Hernia?

A femoral hernia happens when tissue or part of the intestine pokes through a weak spot in the muscle wall of the lower abdomen and pushes into an area called the femoral canal (a passage that contains the femoral artery)^[1]. This creates a bulge in the inner upper part of the thigh or groin, just below the area where your groin meets your thigh^[5].

Femoral hernias are uncommon, accounting for only 3% of all hernias^[4]. The hernia occurs in an area bordered by the inguinal ligament above, Cooper’s ligament below, the femoral vein on the side, and the junction of the iliopubic tract and Cooper’s ligament in the middle^[2].

Who is Most Affected?

Females are much more likely to develop femoral hernias than males. In fact, femoral hernias are 4 times more likely to occur in females^[2]. This is because of the wider shape of the female pelvis^[5]. Femoral hernias are particularly common in older women^[8].

While femoral hernias are rare in children, when they do occur in young people, they are more likely to be associated with conditions that increase pressure in the abdomen or with connective tissue disorders. Seventy percent of femoral hernias in children occur in infants under the age of one^[4].

The lifetime occurrence of a groin hernia is 27% to 43% in men and 3% to 6% in women^[2].

Symptoms

Many people with a femoral hernia may not have any symptoms at all. You might only learn you have a femoral hernia during a routine physical examination^[1].

When symptoms do occur, they may include:

• A bulge or lump in your groin or inner upper thigh
• Lower abdominal pain
• Pain in your groin or upper thigh that may feel like an ache or be sudden and sharp
• Nausea and vomiting

You may notice your symptoms get worse when you stand for a long time, lift heavy objects, cough, or strain to use the bathroom^[1]. The lump may seem to disappear when you lie down^[5].

Causes and Risk Factors

Most femoral hernias happen when something puts pressure on your lower abdominal muscles, causing tissue or intestine to push through a weak spot^[1]. Generally, hernias result from activities that cause increased pressure inside the abdomen^[2].

You may be born with a femoral hernia that formed during development before birth. However, most femoral hernias develop later in life^[1].

Risk factors that increase the likelihood of developing a femoral hernia include:

• Advanced age
• Obesity
• Smoking
• Pregnancy and giving birth
• Chronic coughing
• Straining to have a bowel movement (constipation)
• Lifting or pushing heavy objects
• Receiving peritoneal dialysis for kidney disease or kidney failure
• Connective tissue disorders

^[1][2]

Complications

Femoral hernias can lead to serious complications and have the highest rate of strangulation (when blood supply is cut off) among all types of hernias, occurring in 15% to 20% of cases^[2].

A femoral hernia may get stuck in the femoral canal, which is called an incarcerated hernia. When this happens, pressure on the hernia can affect blood flow to the tissue inside, leading to a strangulated hernia^[1]. A strangulated hernia is a medical emergency^[1].

If a section of the bowel becomes trapped and does not get enough blood, the tissue can die (called necrosis), followed by tissue decay (called gangrene). This is a life-threatening condition requiring immediate surgery^[4].

Signs that you may have a strangulated hernia include:

• Sudden, severe groin pain that gets worse
• Nausea and vomiting
• Severe stomach pain
• Fever and rapid heart rate
• The lump turning red, purple, dark, or discolored
• Not being able to go to the bathroom

If you experience these symptoms, you need to get emergency care immediately^[8].

Diagnosis

A healthcare provider will do a physical exam to diagnose a femoral hernia. They will ask if the bulge in your groin or upper thigh comes and goes, and whether it appears when you do things like straining or lifting heavy objects^[1].

Your provider may order imaging tests to confirm the diagnosis and rule out other conditions. These tests may include:

• MRI (Magnetic Resonance Imaging)
• CT scan (Computed Tomography scan)
• Ultrasound

^[1]

Several conditions can be mistaken for a femoral hernia, including:

• Femoral artery aneurysm (may cause a lump in your groin)
• Hydrocele (males may have swollen scrotums from fluid)
• Inguinal hernia
• Nuk cyst (a rare condition affecting females causing painful swelling in the groin)
• Psoas abscess (an abscess in the psoas muscle)
• Swollen lymph nodes in the groin
• Varicocele (swollen veins in the scrotum)

^[1]

Treatment

A femoral hernia should be repaired even if it does not cause symptoms^[5]. The only way to effectively repair a femoral hernia is through surgery^[1]. Surgery is recommended because femoral hernias are more likely than other hernias to develop serious complications^[5].

If the hernia is not repaired, the intestine can become trapped inside the hernia, which can cut off blood supply to the intestines. This can be life-threatening and would require emergency surgery^[5].

Types of Surgery

There are two main ways to repair a femoral hernia:

Open surgery: The surgeon makes a cut near the hernia site. The bulging tissue is pushed back into place, and the weakened area is sewn closed or strengthened with stitches. Often, a piece of mesh is sewn into place to strengthen the abdominal wall^[1][5].

Laparoscopy (keyhole) surgery: This is a less invasive technique where the surgeon makes several smaller cuts. A medical device called a laparoscope (a thin, lighted tube with a camera) is inserted through one of the cuts to see inside the body. Other tools are inserted through the other cuts to repair the hernia^[5].

Some centers also offer robotic surgery, which uses three small incisions in the upper abdomen and provides finer control of instruments and better visualization^[12].

The type of surgery depends on which method suits you and your surgeon’s experience. You should be able to go home the same day or the day after surgery^[5].

Risks of Surgery

Femoral hernia repair is a routine operation with very few risks, although in a small number of cases the hernia returns after the operation^[5].

Other uncommon complications may include:

• Developing a lump under the wound
• Difficulty passing urine
• Injury or narrowing of the femoral vein
• Injury to the bowel
• Temporary weakness of the leg
• Injury to nerves, causing pain or numbness in the groin area
• Infection
• Long-term pain

Complications are more likely in older people or those with existing medical conditions^[5].

Recovery After Surgery

After the operation, your groin will feel sore and uncomfortable. You will be given painkillers to help relieve this discomfort^[15]. An adult must stay with you for the first 24 hours after your operation^[15].

It is important to follow the hospital’s instructions on how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound, and not straining yourself too soon^[5]. Drinking lots of fluids and eating plenty of vegetables, fruit, and high-fiber foods can help prevent constipation^[15].

Most people are able to do light activities, such as shopping, after 1 or 2 weeks. You should also be able to return to work after 2 or 3 weeks, although you may need more time off if your job involves manual labor^[15].

Gentle exercise, such as walking, can help the healing process. However, you should avoid heavy lifting and strenuous activities for about 6 weeks. You should also not participate in sports like football and rugby for at least 8 weeks and 12 weeks respectively^[15].

Most people make a full recovery from femoral hernia repair within 6 weeks, although many people can return to driving, work, and light activities within 2 weeks^[5].

When to Call a Doctor

Call your surgeon if you develop any of the following symptoms after surgery:

• A persistent high temperature
• Persistent or heavy bleeding
• Increased swelling or pain in your tummy
• Pain that is not relieved by painkillers
• Persistent nausea or vomiting
• Chills
• Persistent coughing or shortness of breath
• Increasing redness around your incisions
• Difficulty peeing

^[15]

Outlook

Hernia repair surgery cures a femoral hernia. However, you can develop another one^[1]. Surgery gets rid of the hernia and prevents serious complications, although there is a chance of it returning after the operation^[5].

Your surgeon may recommend routine follow-up exams to make sure you don’t have another femoral hernia and need more treatment^[1].