Information on Femoral Hernias

  • Did you know?

    Femoral hernias are particularly prone to developing obstruction

  • Day Case Surgery is possible for most cases

  • As many as 3 in 10 patients who get a hernia on one side will subsequently get a hernia on the opposite side

  • Femoral hernias are more common in women

  • Most patients are fully active within days

So, what is a femoral hernia?

A femoral hernia is a lump that appears just below the groin crease (also called the inguinal ligament) and lies alongside the pubic bone.

It occurs when part of the bowel or other abdominal structure herniates or pushes out through the femoral canal which is an area of weakness in the wall of the abdomen.

The femoral canal is a natural opening next to the femoral blood vessels and nerve which pass from the abdomen into the leg. It is a potential weak spot in the abdominal wall. Femoral hernias are usually small and may only be the size of a grape.  They are more common in women and account for around 1 in 10 abdominal hernias. Despite their small size, they are at increased risk of strangulation, so repair is recommended for patients who are fit enough for surgery.

Femoral hernia

Much more common in women, especially

women who have had several pregnancies

Femoral hernias are often so small they are not seen or noticed

What are the symptoms of a femoral hernia?

A femoral hernia causes a grape-sized lump in the groin, although this is not always easily noticeable. If the hernia can be pushed back into the abdomen it is “reducible”. Frequently with femoral hernias, this is not possible and the hernia is effectively stuck in the canal. This is called an “irreducible” hernia and is a potentially dangerous condition.

The blood supply to the herniated tissue can become crushed within the canal, cutting off its source of oxygen and nutrients. If this develops, the hernia has become “strangulated” and emergency surgery must be performed to release the trapped tissue and restore its blood supply. A strangulated hernia is very painful and tender to the touch.

What causes a femoral hernia?

Intestine (bowel) or other abdominal structures are more likely to be forced out through the femoral canal if the pressure in the abdomen is increased. Factors that may predispose to the development of a femoral hernia therefore include being very overweight (obese), having smoker’s cough and carrying or pushing heavy loads.

Femoral hernias also tend to occur in older people and the supporting tissues in the abdominal wall become a little thinner. It also appears that pregnancy may weaken the abdominal tissues, making femoral hernias more common in women who have had one or more pregnancies. They are therefore much more common in women compared to men.

Once a hernia has developed, activities such as standing up, coughing or straining may cause the hernia to come out, whereas lying down frequently causes the contents of the hernia to return into the abdomen.

How are femoral hernias treated?

Once a hernia has formed it is important to seek a doctor’s advice. This type of hernia can cause serious medical problems if left untreated, even if there are no troublesome symptoms to begin with. Treatment is by an operation to return the herniated intestine to its proper place and repair the weakness in the abdominal wall.

A truss (a type of corset designed to hold in a hernia) should not be used for a femoral hernia as it can encourage the hernia to become strangulated. All femoral hernias should be treated surgically as they have a high risk of becoming strangulated.

Emergency hernia surgery

Can a femoral hernia cause a serious problem?

Most abdominal hernias appear suddenly when the abdominal muscles are strained or if you have been standing for some time. You may feel tenderness, a slight burning sensation, or a feeling of heaviness in the bulge. It may be possible to push the hernia back into place with gentle pressure, or the hernia may disappear by itself when you lie down. Being able to push the hernia back is called reducing it. On the other hand, some hernias cannot be pushed back into place, and are termed incarcerated or irreducible.

Most hernias do not cause too much pain and many cause no pain at all. Persistent, severe or increasing discomfort is a worrying feature and might indicate that the hernia has become “stuck” or incarcerated. This situation can progress to the development of tissue damage or even gangrene within the hernia which becomes a surgical emergency. If a hernia becomes increasingly painful which is not relieved by lying down, you should seek immediate medical advice as this might be an indicator that it has become incarcerated.  

What are the surgery options for a femoral hernia?

Femoral hernia surgery is usually performed as a day case, without the need for an overnight stay in hospital. The type of anaesthesia will depend on the exact operation and the preferences of the surgeon and patient.

Surgery is generally performed through a 3-5 cm incision which is usually placed over the hernia or on the lower abdomen.  The procedure involves opening up the femoral canal, returning the contents of the hernia (usually a loop of intestine) back to the abdomen. The weakness within the femoral canal is then repaired. This repair is usually reinforced with by a mesh made of a synthetic material that does not irritate the body. Laparoscopic surgery, which is also known as “keyhole” or “minimally invasive” surgery, may also be used.

Want to see a specialist about your hernia?

Contact the Scottish Hernia Centre

What can I expect after femoral hernia surgery?

Most operations are done as a day case. These patients go home once they have recovered from the anaesthetic. Anyone who has a general anaesthetic will need to arrange for a friend or relative to drive them home and stay with them for the next 24 hours.

A general anaesthetic can temporarily affect co-ordination and reasoning skills, so we advise patients  to avoid driving, drinking alcohol or signing legal documents for 24 hours. Before discharge, we will provide detailed advise about caring for the wound. We usually use invisible wound stitches so there will be no need for stitches to be removed. An appointment for clinic review will also be made (usually around six weeks later).

Whether recovering from open or laparoscopic surgery, it will be necessary to take it easy for the first two or three days. We will give you specific advice about resuming normal activities. In general you should be able to move around freely but should avoid strenuous exercise and lifting for at least the first few weeks. Most people continue to experience some discomfort for a few weeks after surgery, but this will gradually settle.

In experienced hands, the long-term success rate for surgery is high with a less than 5% risk of the hernia coming back again.

Hernia surgery

What are the side-effects or complications of surgery?

Side-effects of surgery:

Side-effects are the unwanted but usually temporary effects of a successful procedure. Examples include feeling sick as a result of the general anaesthetic or painkillers.

Complications of femoral hernia surgery:

Complications are unexpected problems that can occur during or after the operation. However, most people undergo femoral hernia without difficulty. As with any surgery, there is a very small risk of developing an unexpected reaction to the anaesthetic. Other rarely encountered problems include excessive bleeding, infection or developing a blood clot within the leg veins (deep vein thrombosis). To help prevent this, most people are given compression stockings to wear during the operation. They may also be given a drug to thin the blood and reduce the risk of clots.

Specific complications of a femoral hernia repair are uncommon but can include accidental damage to internal organs, which could require a larger incision to repair. There is also a risk of abdominal bruising, although this usually settles without treatment. The chance of complications depends on the exact type of operation you are having and other factors such as your general health.

What can I do to avoid a femoral hernia?

In most instances, there is no specific reason why somebody (usually a women) develops a femoral hernia. For some, pregnancy and advancing age may be a factor. Lifestyle measures may help to prevent a femoral hernia from developing. The most important advice is to use lifting equipment for heavy loads. Use safe lifting and carrying techniques and avoid excessive or repeated straining.

Other factors that may help include the following

  • Maintaining muscle strength by taking regular daily exercise
  • Avoiding constipation by eating a healthy high-fibre diet that contains plenty of fruit, vegetables and whole grain cereals, such as wholemeal bread and brown rice
  • Stop smoking
  • Losing weight (if overweight)

Can I undergo femoral hernia surgery at the Scottish Hernia Centre?

Yes. Richard Molloy undertakes  femoral hernia surgery on a regular basis at the Scottish Hernia Centre, based at Ross Hall hospital GlasgowAt the initial consultation, your hernia and any other medical problems will be assessed before discussing the surgical options for repair.

The Scottish Hernia Centre in Glasgow is Scotland’s premier private specialist hernia centre, where highly trained nursing and medical staff work within a state of the art hospital enabling our surgeons to safely treat even the most complex hernia within a safe and comfortable high tech environment.