Hernia, femoral

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.

What is a femoral hernia?

A femoral hernia is an uncommon type of hernia. It's estimated that only about one in every 20 groin hernias are femoral hernias, and the rest are inguinal hernias.

Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or will disappear when you lie down. Coughing or straining may make the lump appear.

What causes a femoral hernia?

A femoral hernia usually occurs when fatty tissue or a part of your bowel, such as the intestine, pokes through into your groin at the top of your inner thigh.

It pushes through a weak spot in the surrounding muscle wall (abdominal wall) into the femoral canal. The femoral canal is a channel through which blood vessels and nerves pass to and from your leg.

Unlike inguinal hernias, femoral hernias occur far more frequently in women, particularly older women. This is because of the wider shape of the female pelvis. Femoral hernias are rare in children.

Femoral hernias can sometimes appear suddenly due to strain on the abdomen, such as straining on the toilet if you have constipation, or carrying and pushing heavy loads. They have also been linked to obesity and having a persistent, heavy cough.

When is surgery needed?

Femoral hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall.

Unlike some other types of hernia, treatment of femoral hernias is almost always recommended straight away because there is a higher risk of complications developing in these cases.

Complications that can develop as a result of a femoral hernia include:

obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply so it does not die

Surgery will get rid of the hernia and prevent any serious complications, although there is a chance of it returning after the operation.

What happens during surgery?

There are two ways that an femoral hernia repair can be performed:

open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen
keyhole (laparoscopic) surgery – a less invasive but more difficult technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

There are advantages and disadvantages to both methods. The type of surgery you have will depend on which method suits you and your surgeon’s experience.

You should be able to go home the same day or the day after surgery. It is important to follow the hospital's instructions on how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound and not straining yourself too soon.

Most people make a full recovery from femoral hernia repair within six weeks, although many people are able to return to driving, work and light activities within two weeks.

Are there any risks from the operation?

Femoral hernia repair is a routine operation with very few risks, although around 1% of hernias will return after the operation.

Other uncommon complications of femoral hernia repair include:

developing a lump under the wound
difficulty passing urine
injury or narrowing of the femoral vein (which passes through the femoral canal)
injury to the bowel
temporary weakness of the leg
injury to the nerves, causing pain or numbness in the groin area

Complications are more likely if you are over 50 or you have another illness, such as heart disease or breathing problems.