Femoral Hernia: Symptoms, Causes, and Treatment

Femoral hernias are a rare type of hernia that occur in the upper thigh, just below the groin, accounting for about 3% of all hernias1 . They are more common in women, especially those aged 60 to 70 years, due to the wider female pelvis2 3. Although often asymptomatic, femoral hernias carry a high risk of complications such as incarceration and strangulation, which require prompt surgical treatment to prevent serious outcomes4 5.

Types of Femoral Hernias

Femoral hernias occur when abdominal contents push through a natural weakness in the abdominal wall called the femoral canal, located below the inguinal ligament6 1. They are clinically classified based on their reducibility and severity into three main types:

• Reducible femoral hernia: The hernia contents can be gently pushed back into the abdomen4 1.
• Incarcerated (irreducible) femoral hernia: The hernia cannot be manually reduced and may cause bowel obstruction4 1.
• Strangulated femoral hernia: Blood supply to the hernia contents is cut off, leading to ischemia and potential tissue necrosis. This is a surgical emergency4 1.

These types reflect the increasing severity of the condition, with strangulation posing the highest risk of complications such as bowel necrosis and infection4 5.

“Femoral hernias are a relatively uncommon type, accounting for about 3% of all hernias. While femoral hernias can occur in both males and females, they are much more common in women due to the wider female pelvis.”

— Esther Csapo Rastegari, Advameg, Inc1

Femoral Hernia Symptoms

Symptoms of femoral hernias vary depending on the size of the hernia and whether complications have developed4 . Many small femoral hernias cause no symptoms and may be found incidentally during a physical exam or imaging7 5. When symptoms occur, they often include:

• A bulge or lump in the groin or upper thigh, which may be tender or painful4 5.
• Groin discomfort or pain that worsens with standing, lifting, or straining4 5.
• Abdominal pain, nausea, or vomiting in cases of bowel obstruction or strangulation4 5.
• Sudden, severe groin or thigh pain indicating incarceration or strangulation4 5.

Signs of incarceration include acute groin pain, abdominal distension, constipation, and inability to pass gas, which require emergency evaluation4 5. Strangulated hernias may cause redness or discoloration of the skin over the hernia, fever, and rapid heart rate, signaling a medical emergency4 5.

Femoral hernias may initially be asymptomatic but can suddenly become painful and dangerous if the intestine becomes trapped or its blood supply is cut off. Immediate medical attention is critical in such cases. 58

Femoral Hernia Causes

A femoral hernia forms when abdominal tissue pushes through a weak spot in the femoral canal wall, below the inguinal ligament6 9. The exact cause is multifactorial and not fully understood, but several factors contribute to its development:

• Congenital variations in femoral canal anatomy may predispose individuals to hernias6 .
• Increased intra-abdominal pressure from chronic constipation, heavy lifting, or coughing can promote hernia formation4 10.
• Conditions causing straining during urination or defecation, such as enlarged prostate or chronic constipation, increase risk4 1110.
• Obesity and prior hernia repair are known risk factors4 10.
• Femoral hernias occur more frequently in women due to the wider pelvis and are most common in older adults, especially those over 60 years4 31.

Risk Factors

• Female sex: Femoral hernias occur approximately 10 times more often in women than men12 .
• Age: Most cases are diagnosed in elderly women, typically in their seventh decade of life3 1.
• Multiparity: Multiple childbirths increase intra-abdominal pressure, stretching the femoral ring1 .
• Chronic respiratory diseases causing persistent coughing4 10.
• Activities involving heavy lifting or straining4 10.
• Obesity and ascites (fluid buildup in the abdomen) 49.

“Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.”

— Esther Csapo Rastegari, Advameg, Inc1

Diagnosing a Femoral Hernia

Diagnosis of femoral hernia is primarily clinical, based on physical examination of the groin area6 4. The hernia presents as a lump or bulge below the inguinal ligament, which may be tender or non-tender and may or may not be reducible4 5. In obese patients or when the diagnosis is uncertain, imaging is essential.

• Ultrasound: First-line imaging for clinically occult femoral hernias; it helps differentiate femoral hernias from other groin masses7 10.
• Computed Tomography (CT): Preferred in emergency settings to assess complications such as incarceration or strangulation7 12.
• Magnetic Resonance Imaging (MRI): Used for detailed soft tissue imaging but less common than ultrasound or CT7 .

Differential diagnoses include inguinal hernia, femoral artery aneurysm, swollen lymph nodes, hydrocele, and other groin masses8 10.

Imaging tests such as ultrasound and CT scans are important for confirming the diagnosis of femoral hernias, especially in emergency situations or when physical examination findings are unclear. 127

Femoral Hernia Treatment

Surgical repair is the only effective treatment for femoral hernias due to their high risk of complications4 13. Elective surgery is recommended at diagnosis to prevent emergency situations like incarceration or strangulation4 13. Treatment options include open and laparoscopic surgery, with the choice depending on patient factors and surgeon expertise4 .

Open Surgery

Open repair involves making an incision over the groin to access the hernia sac4 12. The surgeon reduces the hernia contents back into the abdomen, closes the defect in the femoral canal, and reinforces the area with mesh to prevent recurrence4 12. If necrotic bowel or tissue is present due to strangulation, resection is performed4 .

• Advantages: Direct access, suitable for complicated or emergency cases4 .
• Mesh reinforcement reduces recurrence rates2 4.
• May require general or regional anesthesia4 .

Laparoscopic Surgery

Laparoscopic repair uses small incisions and a camera to visualize and repair the hernia from inside the abdomen4 12. Techniques such as transabdominal preperitoneal (TAPP) repair allow for better visualization and faster recovery14 15.

• Advantages: Less postoperative pain, quicker recovery, better cosmetic results4 12.
• Useful in bilateral or recurrent hernias4 .
• Requires general anesthesia and specialized surgical expertise4 .

“Femoral hernias are a type of groin hernia that occur lower than inguinal hernias. Due to a high risk of complications such as incarceration and strangulation, femoral hernias often require emergency surgery.”

— UCSF Department of Surgery, University of California, San Francisco12

Preventing Femoral Hernias

While it is difficult to completely prevent femoral hernias, lifestyle modifications can reduce risk by minimizing strain on the abdominal wall4 10:

• Avoid heavy lifting or use proper body mechanics to reduce intra-abdominal pressure4 10.
• Manage chronic cough and respiratory conditions to prevent repetitive straining4 .
• Maintain healthy bowel habits to avoid constipation and straining during defecation4 10.
• Maintain a healthy weight to reduce pressure on the abdominal muscles4 10.
• Strengthen core muscles to support the lower abdominal wall8 .

Preventive measures focus on reducing abdominal pressure through lifestyle changes, which may help lower the risk of developing femoral hernias4 10.

Femoral Hernia Complications

If left untreated, femoral hernias can lead to serious complications4 5:

• Incarceration: The hernia becomes trapped and cannot be reduced, potentially causing bowel obstruction4 5.
• Strangulation: Blood supply to the herniated tissue is cut off, leading to ischemia, necrosis, and possible gangrene4 5.
• Bowel obstruction: Symptoms include abdominal pain, vomiting, constipation, and inability to pass gas4 5.
• Tissue necrosis: May require bowel resection during surgery, increasing morbidity and mortality4 .

Emergency surgery is required to manage these complications and prevent life-threatening outcomes4 5.

Key Points Summary

• Femoral hernias are rare, accounting for about 3% of all hernias, and occur predominantly in older women due to pelvic anatomy2 31.
• They are classified as reducible, incarcerated, or strangulated, with strangulation being a surgical emergency4 1.
• Symptoms range from asymptomatic lumps to painful groin masses, with acute pain and systemic signs indicating complications4 5.
• Diagnosis relies on physical exam and imaging, primarily ultrasound and CT scans7 10.
• Surgical repair, either open or laparoscopic, is the only effective treatment and is recommended promptly to avoid complications4 1312.
• Lifestyle changes can help reduce risk but cannot fully prevent femoral hernias4 10.
• Untreated femoral hernias risk incarceration, strangulation, bowel obstruction, and necrosis4 5.

Femoral Hernia FAQs

What is a femoral hernia?
A femoral hernia occurs when tissue or intestine pushes through a weak spot in the muscle wall of the groin or upper thigh, specifically through the femoral canal below the inguinal ligament6 10.

Who is most at risk for femoral hernias?
Femoral hernias are more common in women, especially those over 60 years old, due to the wider female pelvis and factors that increase abdominal pressure like childbirth, chronic cough, and heavy lifting4 310.

Can a femoral hernia go away on its own?
No, femoral hernias do not resolve spontaneously and require surgical repair to prevent serious complications4 13.

What are the signs of a strangulated femoral hernia?
Signs include sudden severe groin pain, nausea, vomiting, redness or discoloration over the hernia, fever, and inability to pass gas or stool. This is a medical emergency4 5.

What types of surgery are available for femoral hernia repair?
Surgical options include open repair, which involves direct access to the hernia, and laparoscopic repair, which uses small incisions and a camera for minimally invasive surgery4 12.