Femoral hernias occur when pelvic or abdominal tissue protrudes through a weakness in the wall of the groin or upper, inner thigh — the femoral canal. In rare cases, these hernias can also appear in other locations. The symptoms vary depending on the hernia’s location and development.
Causes
Most femoral hernias develop because the muscles of the abdominal wall are weak. This weakness may stem from inherent genetic traits or age and strain on the abdominal and groin regions. Common causes of muscle strain leading to hernias include physical exertion, pregnancy, obesity, frequent coughing, or overworking the muscles during bowel movements.
Signs and Symptoms
A femoral hernia usually presents as a lump or bulge in the groin that may differ in size throughout the day. These lumps are typically shaped like a drooping teardrop (medically, “retort-shaped”) and may disappear entirely when the person lies on their back. Some femoral hernias are painful, especially when lifting heavy objects. They are often the cause of small bowel obstructions.
Diagnosis
A doctor can identify most hernias with a physical exam. Either the hernia is a visible bulge or the doctor can feel it just beneath the skin. Soft-tissue imaging, such as a CT scan or ultrasound, allows for an accurate diagnosis of the condition. If a doctor is having difficulty differentiating between an inguinal and a femoral hernia, they may see if the hernia is pressing on the femoral vein.
Inguinal vs. Femoral
Femoral and inguinal hernias share many symptoms and are often difficult to differentiate. Femoral hernias develop when a part of the intestine enters the femoral canal, while inguinal hernias develop when the intestines enter the inguinal canal. Femoral hernias develop below the crease of the groin. Additionally, femoral hernias more commonly affect females, while inguinal hernias appear more often in males.
Classifications
Experts refer to hernias with a few different descriptors to more quickly express how they are presenting. These include:
- Reducible femoral hernia: most common form, usually painless, can pull back into the abdominal cavity spontaneously or be manipulated into place
- Irreducible, incarcerated, or obstructed femoral hernia: portion of the intestine becomes twisted or constricted due to the hernia and causes intestinal obstruction
- Strangulated femoral hernia: constriction of the hernia limits blood flow to part of the bowel, causes nausea and pain; this is a life-threatening medical emergency
Specific Forms
Experts have identified a few atypical or otherwise noteworthy variations of femoral hernias:
- Narath’s hernia: hernia emerges from the abdomen, lies behind the femoral vein, only visible if the hip is congenitally dislocated
- Velpeau hernia: hernia sits in front of the groin’s femoral blood vessels
- Serafini’s hernia: hernia sits behind the groin’s femoral blood vessels
- Laugier’s hernia: hernia develops through the lacunar ligament
- Béclard’s hernia: hernia emerges through the saphenous vein
- Cloquet’s hernia: hernia emerges from the pectineal fascia, lying behind femoral vessels
- De Garengeot’s hernia: hernia contains the appendix
Complications
Hernias do not disappear on their own and will often grow larger without treatment. As they grow, they become more painful, and certain complications can emerge. Obstruction, resulting from an incarcerated hernia, can cause vomiting, nausea, and extreme stomach pain. Strangulated femoral hernias can lead to life-threatening tissue death (necrosis) and require immediate medical attention.
Management
Femoral hernias usually require surgical intervention. Open hernia repair involves making a small incision in the groin and manually moving the hernia to its proper location. Comparatively, laparoscopic surgery uses minimally invasive incisions and a small camera to repair the hernia with synthetic mesh. Laparoscopic surgeries usually have shorter recovery times, but they are not ideal for larger people or those with a history of pelvic surgery.
Prevention
A few lifestyle changes can help prevent femoral hernias. Maintaining a healthy weight can help slow down the weakening of the abdominal wall. Avoid constipation and similar bowel issues by eating a diet rich in fiber, fruits, and vegetables. Use correct form when lifting heavy items or weights. Frequent coughing can contribute to muscle weakness, so avoid smoking and visit a doctor to treat any chronic issue.
Prognosis
After surgery, patients must follow specific instructions concerning their diet, caring for the incision site, and avoiding physical strain. Hernias may recur after the surgery, especially in people who smoke or those with obesity. People who receive treatment early typically recover well, while emergency surgeries have higher mortality rates.
