Understanding A Femoral Hernia

Femoral Hernia Overview

As mentioned in the inguinal hernia section, femoral hernias are the "other" groin hernia. We see at least 20 to 30 groin hernia patients with direct or indirect inguinal hernias for every one femoral hernia which we treat. However, although they are less common, femoral hernias are more likely to cause problems.

So, What is a Femoral Hernia?

It is the least common groin hernia type that occurs specifically within the femoral canal. The femoral canal is a narrow passageway from the pelvis to the leg which contains the femoral vessels. There are two femoral vessels within the femoral canal, they are the femoral artery and femoral vein which transport blood to the leg and back towards the heart. Because these vessels are quite large, a significant size canal must be present to accommodate them. This femoral canal can sometimes contain abnormal bulging tissue from the pelvis. The abnormal, bulging tissue is the femoral hernia. The pelvic tissue which can push through, or herniate into the femoral canal is most often pelvic fat, but it can also be bowel or even the urinary bladder.

Femoral Hernia Symptoms

Femoral hernias seem to present at an earlier stage with pain. Perhaps it is because of the smaller canal than the inguinal canal, or perhaps it is due to pressure on the femoral nerve that the hernia bulge creates. In this individuals and children, the femoral hernia bulge is easier to see and diagnose. If someone is experiencing pain in the area of the femoral canal, which is located at the high, inner thigh area, and we are unable to see or feel a bulge, we usually obtain imaging such as an ultrasound or CT scan as femoral hernias can be more difficult to diagnose on exam alone.

Warning Signs of a Femoral Hernia

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Again, pain is the most important warning sign. If you have a bulge within the femoral area and no pain, it should still be evaluated by your physician to rule out the possibility of femoral hernias. Because of the smaller, tighter, area of the femoral canal, obstruction and strangulation of a femoral hernia occurs more often than inguinal hernias. If bowel becomes entrapped within the femoral hernia sac and he blood supply to the bowel is interrupted it will cause severe pain to the area and possibly within the lower abdomen as well. There could be red or bruised appearing skin over the area from the created inflammation. If you have these symptoms, seek urgent medical care.

Femoral Hernia Risk Factors

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Similar to other hernias, femoral hernias are more common in patients that smoke cigarettes, those with connective tissue disorders, as well as those with a family history of femoral hernia, children born with a weak spot at the femoral canal, patients who have to strain because of repetitive lifting, straining during urinating, or bowel movements, chronic coughing, childbirth, and obese patients.

Femoral Hernia Treatment and Repair

My preferred repair for femoral hernias is a small, "open" incisional repair. The incision is placed directly or just above the low groin bulge and the defect or hole in the inguinal ligament which allows the bulging tissue down into the femoral canal is repaired with a mesh product as long as there are not other factors present such as infection or contamination which would preclude the use of mesh. The repair itself is very similar to an inguinal hernia repair. The size of the incision depends on the size of the hernia and the size of the patient. Obese patients with more subcutaneous fat overlying the femoral area require a slightly larger incision, but it is still usually a relative small incision. We also perform laparoscopic femoral hernia repairs and we utilize the Da Vinci surgical robot for some of these laparoscopic femoral hernia repairs. Femoral hernia repair usually stops the pain immediately after surgery, but the patient will be sore for a week or two and we recommend limiting strenuous activity for about 6 weeks after surgery.

Femoral Hernia Prevention

There is honestly not much that most patients can do to prevent a femoral hernia. If we look at the risk factors listed above, we can see that some of the conditions listed under excessive straining can be treated or lessened. Chronic cough, straining to urinate, or straining to have bowel movements such as chronic constipation, should be treated accordingly. Cigarette smoking should be avoided not only due to the known cancer risks which smoking causes, but as we have discussed, smoking cases patients to develop hernias in any area more commonly than non smokers. Maintaining a healthy weight and core exercises should also be pursued.

What To Do If You Have A Femoral Hernia

If you feel that you could have a femoral hernia, call our office for an appointment and we will start with a simple physical exam, this is adequate to diagnose most femoral hernias.