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Femoral hernia

A femoral hernia occurs when tissue (often consisting of fatty tissue or part of the bowel) pushes into the femoral canal.

Femoral hernias account for around six in every 100 hernias in the abdominal wall. They are four times more likely to affect women than men.

  • About femoral hernias
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Further information
  • Sources
  • Related topics

About femoral hernias

The abdominal wall is a sheet of tough muscle and tendon that runs between your ribs and your groin (upper part of your leg). Your abdominal wall acts like a natural corset holding all the abdominal contents of your body in place. There are natural weaknesses in the abdominal wall, such as where the blood vessels and nerves pass through. One of these weak areas is along the femoral canal which is in the groin.

Sometimes this weakness in your muscle or body tissue opens up so whatever is on the inside can push through the area of weakness. This causes a bulge or swelling called a hernia.

Symptoms

If you have a femoral hernia it may appear as a grape-sized lump in your groin in the inner upper part of your thigh.

Complications

Sometimes the femoral hernia can be pushed back into your abdomen - this is called a reducible femoral hernia. Sometimes the hernia can get stuck in the canal and is called an irreducible or incarcerated femoral hernia. This can cause pain and you may feel sick. Most types of femoral hernia are irreducible and are usually painless.

A femoral hernia can become "strangulated" when a part of the intestine is caught with the hernia and is twisted, causing reduced blood supply or an obstruction. The bulge may increase in size, become increasingly painful and you may vomit.

A femoral hernia is at particular risk of becoming incarcerated and strangulated. If you think you have a femoral hernia it is important that you seek medical advice.

Causes

A femoral hernia can simply occur of its own accord, but anything which increases pressure on this part of your body can also cause a hernia. This can include:

  • coughing
  • straining to pass faeces or to pass urine
  • pregnancy
  • straining to lift heavy objects
  • stresses and straining of muscles due to physical exercise

Diagnosis

Your GP will examine your groin. This may be while you are standing up, lying down or coughing. He or she will try to see if the lump in your groin can be pushed back in. This is called reducing the hernia. Your GP may then refer you to a general surgeon if he or she thinks you may need to have an operation.

Treatment

Hernias generally get larger with time and they don't go away themselves. You may have an open operation or keyhole surgery to repair your femoral hernia.

Surgery

Open operation

Usually during an open operation a cut is made in the groin, the hernia is removed or is pushed back into the abdomen and the weakness, through which the hernia came, is repaired. The weakness will be stitched and a piece of mesh may also be stitched in place to strengthen the area. Open mesh repair is associated with a lower recurrence rate than non-mesh repair.

Keyhole (or laparoscopic) surgery

Keyhole surgery is carried out in exactly the same way as an open operation, but it is performed through several small cuts. If you have keyhole surgery, you may have less pain after your operation. People often return to work sooner after keyhole surgery than if they have undergone an open operation because the wounds are smaller. However, there is a higher risk of more serious complications during keyhole surgery compared to open surgery.

Depending on your particular condition, you and your surgeon can decide on which is the most appropriate treatment for you.

Local anaesthetic

If your hernia is small your doctor may use a local anaesthetic. You will be awake throughout the operation but the skin and nerves around the hernia will be completely numb, though you may feel some pulling and pushing. There will be a screen above your groin so you won't be able to see the operation on your body.

One of the reasons a local anaesthetic is used for operations is that patients tend to recover more quickly afterwards. Also, for most patients it may be safer than a general anaesthetic. Sometimes a sedative is given to help you relax during the operation. This is not the same as a general anaesthetic.

If you have had a sedative the effects may last longer than you expect. Don't drive, drink alcohol, operate machinery or sign legal documents until your doctor tells you that it is safe. This will be at least 24 hours after your operation.

General anaesthetic

Some hernia operations mean that you will need a general anaesthetic, where you are put to sleep completely for the whole operation. General anaesthetic is used in some circumstances, for example, if the hernia is large or for keyhole repairs.

General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure. There may be bruising to the area or swelling. You may feel tension in the area but it is important that you try to walk normally. You can take the painkiller you normally take for a headache to relieve any pain. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Complications

This is when problems occur during or after the operation. Most people are not affected. The main possible complications of any surgery include an unexpected reaction to the anaesthesia, excessive bleeding or clotting under the skin during or soon after surgery, or infection. A blood transfusion may be required to replace the lost blood, or antibiotics to treat an infection. Nerve damage can occur, leaving an area of numb or sensitive skin. A build up of lymph fluid may need to be drained. Some people may experience long-term pain, for which painkillers are provided and, in some circumstances, a further operation may be performed. A hernia may recur in one to two of every 100 people.

How long will I be in hospital?

The length of time you spend in hospital depends on your operation and your general state of health. Most people are treated as day patients and are allowed to go home later the same day. You will need to arrange suitable transport and for someone to look after you for at least 24 hours.

If you have a larger hernia you may need to stay in hospital overnight or for a couple of days but this is rare. Ask your doctor about how long you may stay in hospital.

Recovering from a femoral hernia operation

When you are discharged from hospital, you should expect to see some swelling or bruising around the site of your wound. You are likely to feel some discomfort and tenderness where the incision has been made. After the operation, surgeons generally recommend returning to your normal level of activity quite quickly.

When you feel well enough you can return to work. Office workers can generally return to work after a few days or weeks, whereas those whose job involves a lot of physical activity or heavy lifting may need up to three months off work. Ask you doctor for advice.

Further information

Core Charity

Sources

  • Morris PJ, Malt RA. Oxford Textbook of Surgery. Volume 1 Sections 1-29 and Index. Oxford: Oxford University Press, 1994:1405-1408
  • Hernia. Core Charity. www.corecharity.org.uk, accessed 5 March 2007
  • McLatchie GR, Leaper DJ. Oxford Handbook of Clinical Surgery. 2nd ed. Oxford: Oxford University Press, 2003:390
  • Open Mesh Versus Non-Mesh for Groin Repair. The Cochrane Collaboration. 22 May 2001. www.cochrane.org
  • Laparoscopic Techniques Versus Open Techniques for Inguinal Hernia Repair. The Cochrane Collaboration, 05 November 2002. www.cochrane.org

Related topics

  • General anaesthesia
  • Hiatus hernia
  • Inguinal hernia
  • Local anaesthesia