Femoral Hernia

Overview

What is it? Similar to an “inguinal hernia”, the term “femoral hernia” is used to describe a bulge in the area of the groin. The bulge of a femoral hernia is closer to the thigh compared to that of an inguinal hernia and is typically found medially and just below the groin crease.
Why it happens: Like inguinal hernias, femoral hernias develop because of increased pressure in the abdomen. The increased pressure can be the result of a wide range of activities such as heavy manual handling, exercise or weight lifting but also coughing, laughing, sneezing of being chronically constipated. Obesity also plays a role in developing a femoral hernia.
Frequency: A femoral hernia can develop in either side of the body. It is much more common in women than in men, particularly elderly women. This is because of the wider female pelvis and also because the same type of pressure in men would typically produce an “inguinal” rather than a femoral hernia.

Symptoms

• Acute presentation – Frequently, a femoral hernia presents as an emergency with acute abdominal pain, abdominal distention, nausea and vomiting. It is also common for a femoral hernia to cause bowel obstruction with bowels not opening and no wind. In such scenario, a femoral hernia needs to be operated as soon as possible.
• Subacute/chronic presentation – less frequently, a femoral hernia will present as a bulge in the area of the groin, just below the crease of the groin. The bulge may or may not be painful on palpation and it may or may not be reduced when lying flat. Even when presenting without acute pain it is still recommended that a femoral hernia is repaired surgically. This is because femoral hernias are likely to strangulate.

Diagnosis

In most cases a careful medical history and a physical examination will diagnose the hernia. Sometimes it may be required to have some radiology imaging, either an ultrasound or an MRI scan.

Treatment

Once diagnosed, femoral hernias ideally should be repaired on all patients who are fit to undergo surgery.
Open repair of femoral hernias – This is the preferable approach when dealing with an emergency as it offers some technical advantages over key hole surgery. There are different ways to reach the area of the femoral canal where the hernia typically develops and therefore it can be performed with different types of incisions. The two most frequently used is either a horizontal incision lateral and just below the umbilicus or an elliptic incision just above the bulge in the groin. Both approaches offer good exposure and therefore the final choice depends on the surgeon’s preference and individual patient characteristics. Irrespective of the incision, an open femoral hernia repair can be achieved with or without the use of a mesh.
Laparoscopic repair of femoral hernias – This type of surgery uses small incisions and a scope/camera. The surgeon repairs the hernia while working through the scope and a synthetic mesh is used to strengthen the repair. It is not recommended when in an emergency however, it is ideal when dealing with an elective femoral hernia repair or when it remains unclear from the clinical examination and the radiological investigations if the hernia is inguinal or femoral.
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Follow Up

If you had surgery for femoral surgery

  • It is important to follow all your doctor’s instructions, take any medication prescribed regularly and keep your follow-up appointments.

  • Getting out of bed and walking is an important part of recovery and helps prevent complications.
  • Take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
  • Try avoiding heavy lifting and other strenuous activity. Ask your doctor what types of activities are safe and for a timed plan on when to resume your normal lifestyle. You should also ask when you can return to work which will depend on the type of your job.
  • Do not drive before you feel safe to emergency break – check with your insurance company for any small prints in your policy
If you have a hernia recently diagnosed
  • Consider having surgery sooner rather than later and make sure you are reviewed by a specialist.
  • take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
  • Try avoiding heavy lifting and other strenuous activity whenever possible.
Seek immediate medical attention if
  • You have a painful bulge that can’t be pushed back inside
  • If you have increasing pain, swelling, or redness
  • If you have nausea, fever, or vomiting along with hernia pain