A femoral hernia occurs when tissue pushes through a weak spot in the muscle wall of the groin or inner thigh. Common causes include being overweight and overstraining while coughing, exercising, or passing stool.
Symptoms of a femoral hernia include a lump in the groin or inner thigh and groin discomfort. It may cause stomach pain and vomiting in severe cases.
Femoral hernias are uncommon, accounting for fewer than 5 percent of all groin hernias. Typically, surgical repair is necessary because femoral hernias can lead to severe complications.
In this article, we discuss the causes and symptoms of a femoral hernia, how to get a diagnosis, when to see a doctor, and potential treatment options.
A femoral hernia results from internal tissues pushing through a weak point in the muscle wall, near the groin or inner thigh.
The exact cause may be unknown. Sometimes, people may be born with a structurally weak muscle wall in the area.
Femoral hernias can also result from straining or excess pressure in the area due to:
- passing urine or stool
- being obese
- lifting or pushing heavy objects
- having a persistent, strong cough
- giving birth
- having ascites or an abnormal buildup of abdominal fluid
- receiving dialysis, or treatment for kidney disease
Though the direct cause may be unknown, some people are at higher risk than others.
Risk factors include:
- Sex: Both sexes can develop a femoral hernia, but they occur approximately 10 times more often in females. This is because the female pelvis is wider than the male pelvis.
- Age: Femoral hernias are far more common in adults than in children. If a child does develop one, it typically results from a medical condition, such as a connective tissue disorder.
- Family history: People with a close family member who has a groin hernia have up to 8 times the risk of developing one themselves.
The most apparent symptom is a lump on the upper inner thigh or groin. The lump may be tender or painful. It sometimes may seem to disappear when a person is lying down and may worsen when they are straining.
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Aside from a small bulge, most femoral hernias do not cause symptoms. However, severe cases may cause:
- stomach pain
People who suspect they have a femoral hernia should see their doctor promptly. This is because there is a high risk of complications that can be serious.
Between 35 and 40 percent of femoral hernias do not receive a diagnosis until the person experiences hernia strangulation or bowel obstruction.
A doctor will need to examine the bulge and confirm that it is a hernia before recommending repair. They will gently press on the area and may order imaging tests to see the internal tissues.
Small hernias that do not cause symptoms may not require surgery. Doctors may monitor them regularly instead to check for progression of symptoms and the potential for complications.
If a femoral hernia becomes trapped, obstructed, or strangulated, it can cause additional symptoms and complications. A strangulated hernia is a life-threatening situation that requires immediate medical attention.
Incarcerated femoral hernia
This occurs when a hernia becomes trapped in the femoral canal, and it cannot move back into the abdomen.
Obstructed femoral hernia
When a hernia and a section of the intestine become entangled, doctors call it an obstructed hernia. It can lead to a painful intestinal obstruction.
Strangulated femoral hernia
This complication arises when a hernia prevents blood from reaching the bowel. It is a medical emergency that can be fatal without treatment.
Symptoms of this complication include:
- sudden, worsening pain and extreme tenderness around a hernia
- rapid heart rate
- skin redness around the bulge
Without immediate surgery, a strangulated femoral hernia can cause the intestinal tissue to die and decay. This can result in life-threatening infection, and so immediate treatment is necessary.
Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. This intervention stops internal tissues from pushing through and causing a bulge. Moderate and severe hernias typically require surgery.
There are 2 types of surgery for femoral hernia repair. The type of surgery necessary depends on the size of the hernia, the person's age, their general health, and other factors.
Surgical hernia repair may be:
People having open surgery typically receive general anesthesia, meaning they are fully asleep for the operation. They may sometimes receive a local anesthetic so that the area is numb, but they are awake for the procedure.
The surgeon will begin by making a small incision in the groin to access the hernia. They will move the bulging tissue back into the abdomen before repairing the femoral canal wall with strong stitches or a piece of mesh.
Doctors perform this minimally invasive surgery under general anesthesia. It involves making several small incisions in the lower abdomen.
The surgeon will then place a thin tube with a tiny camera, a laparoscope, into the incisions. They will also insert surgical tools into the other incisions to move the tissue back into the abdomen and repair the damaged muscle with mesh.
Laparoscopic surgery is not suitable for all patients, for example, those with a very large hernia.
Recovery time is, however, usually quicker than open surgery. There is also less scarring than with an open repair.
People recovering from a femoral hernia repair can usually go home the same day or the day after.
During recovery people will typically need to:
- take pain medication to alleviate discomfort
- restrict their activities and movements for several weeks
- eat a healthful diet to prevent constipation and straining
- take care of the wound
Recovery can take 6 weeks or more, but most people return to light activities after 2 weeks of rest.
Surgical complications and risks
Surgery for a femoral hernia is typically safe, although all surgery carries some level of risk.
Complications, while uncommon, include:
- bleeding or bruising at the incision site
- blood clots
- difficulty passing urine
- injury to internal organs
- nerve damage around the incisions
- side effects of general anesthesia
- temporary leg weakness
- wound infection
Older adults are more likely to experience complications than younger people.
People who suspect they have a femoral hernia should see their doctor for a diagnosis. The doctor will decide if treatment is necessary.
Anyone with symptoms of a strangulated hernia should call the emergency service immediately. Emergency medical attention is essential and may be life-saving.
After a femoral hernia repair, individuals should contact their doctor if they develop any of the following:
- abdominal swelling
- difficult or painful urination
- high fever, 103° Fahrenheit or higher
- intense pain that does not go away with medications
- persistent or heavy bleeding
- redness around the incision site that worsens with time
- severe nausea or vomiting
- shortness of breath
A femoral hernia is relatively uncommon. The risk of complications, however, means people should see their doctor if they notice a lump on their upper inner thigh or groin, especially if it worsens when they strain.
Femoral hernia repair is a relatively straightforward procedure with little risk, and most people make a quick recovery.