Femoral Hernia

Where a femoral hernia occurs

The femoral canal sits just below the inguinal ligament, the band running from the hip bone to the pubic bone along the groin crease. It lies next to the femoral vein and artery. A femoral hernia pushes through this canal and appears as a lump below and to the side of the pubic bone, in the top of the inner thigh.

An inguinal hernia, the much more common type, comes through above the inguinal ligament and may extend into the scrotum or labia.

Femoral vs inguinal hernia

Symptoms

• a small, round groin lump in the upper inner thigh, often the size of a grape or walnut
• the lump may be more visible when standing, coughing or straining and smaller when lying down
• aching or dragging groin pain, sometimes spreading to the hip or thigh
• many cause no symptoms and are found on examination, sometimes only once they become trapped

Femoral hernias are easy to miss in people with more body fat. Some first show up as an emergency with signs of bowel obstruction: cramping belly pain, vomiting, bloating and constipation.

Incarcerated and strangulated hernia

• Incarcerated: the hernia is stuck and cannot be pushed back. It may be tender.
• Strangulated: the blood supply to the trapped tissue is cut off. The lump becomes very painful, red or dark, and the bowel can die within hours. This is a surgical emergency.

Because the femoral canal is narrow and rigid, femoral hernias are much more likely than inguinal hernias to become strangulated, which is why they are repaired promptly.

Causes and risk factors

• Female sex: a wider pelvis creates a wider femoral canal.
• Older age: tissues weaken over time.
• Pregnancy and childbirth.
• Increased abdominal pressure: chronic cough, constipation, straining to urinate, heavy lifting.
• Obesity or rapid weight loss.
• Previous groin hernia repair.

For other hernia types, see hernia.

Diagnosis

A doctor diagnoses most femoral hernias by examination while you stand and cough. Imaging is used if the diagnosis is uncertain or the lump might be something else:

• ultrasound: quick and accurate for groin lumps
• CT scan: especially in emergencies, to see trapped bowel

Other causes of a groin lump include swollen lymph nodes, a groin strain or sports hernia (which causes pain without a lump), a saphenous varix (a dilated vein that disappears when lying down), lipomas and femoral artery aneurysms.

Treatment

Surgery

International groin hernia guidelines recommend repairing femoral hernias soon after diagnosis rather than watching them. Options include:

• Laparoscopic repair (TEP or TAPP): small keyhole incisions with mesh placed behind the abdominal wall. It allows the surgeon to check for other hernias and often means a quicker recovery.
• Open repair: an incision in the groin or lower belly to close the defect, often with mesh.
• Emergency surgery for strangulation, which may include removing a damaged section of bowel.

Most planned repairs are day-case procedures. People usually return to light activity within 1 to 2 weeks and heavy lifting after about 4 to 6 weeks, depending on the surgeon's advice.

Risks of surgery

Infection, bleeding, chronic groin pain, recurrence (uncommon with mesh), and rarely injury to nearby vessels or nerves. Emergency surgery carries much higher risks than planned repair, which is the main reason to repair early.

Frequently asked questions

Where is a femoral hernia located?

A femoral hernia appears just below the groin crease, in the upper inner thigh near where you feel the pulse of the femoral artery. It pushes through the femoral canal beside the main thigh vein. Inguinal hernias appear above the crease.

What are the symptoms of a femoral hernia?

The main symptom is a small lump in the upper inner thigh or groin, which may ache, especially when standing, lifting or coughing. Many cause no symptoms until they become trapped, causing severe pain, vomiting and a tender, hard lump.

Why are femoral hernias more common in women?

Women have a wider pelvis, which makes the femoral canal wider. Pregnancy and childbirth also stretch and weaken the tissues. Even so, inguinal hernias remain the most common groin hernia in women as well as men.

Does a femoral hernia need surgery?

Yes, in almost all cases. Femoral hernias have a high risk of strangulation, where trapped bowel loses its blood supply. Guidelines recommend planned repair soon after diagnosis, because emergency surgery is riskier.

How long is recovery after femoral hernia surgery?

Most people go home the same day and return to normal light activities within 1 to 2 weeks. Strenuous exercise and heavy lifting are usually resumed after about 4 to 6 weeks. Recovery is often quicker after laparoscopic repair.