Brief overview
- Symptoms: Often asymptomatic; swelling in the groin area, unspecific pain in the groin area radiating into the thigh, possibly urinary retention or bloody urine, intestinal obstruction with corresponding symptoms possible – then there is a danger to life
- Treatment: Open or minimally invasive closed surgery depending on the severity
- Causes and risk factors: Weak connective tissue, previous inguinal hernia surgery, risk factors: multiple pregnancies, obesity, connective tissue metabolic disorder; acute trigger: severe coughing, straining or heavy lifting
- Diagnosis: Medical history, palpation, possibly ultrasound examination
- Prognosis: Well treatable with surgery, recurrence is rare; untreated, a life-threatening situation due to bowel obstruction is possible
- Prevention: No specific prevention; certain carrying techniques when lifting heavy loads avoid hernias in general
What is a femoral hernia?
Around five percent of all hernias are femoral hernias. Femoral hernias occur three times more frequently in women than in men and particularly affect older women. In around 40 percent of femoral hernias, the hernial sac is already incarcerated at the time of diagnosis. Nine percent of women and 50 percent of men suffer from an inguinal hernia at the same time.
What are the symptoms?
Femoral hernias usually do not cause any symptoms at the beginning. If pain occurs, it is often uncharacteristic and located in the groin region. The pain radiates into the thigh, particularly during physical exertion, and swelling develops in the groin.
Sometimes the swelling is mistaken for a lymph node located there. If the hernia sac is trapped, the pain often radiates to the groin, abdomen and inner thigh.
If parts of the bladder are trapped in the hernia sac, urinary retention or bloody urine may occur in some cases. If parts of the intestine are trapped, there is redness and swelling in the area of the hernia sac and symptoms of intestinal obstruction (ileus) occur.
In women, it is possible that parts of the ovaries are trapped in a femoral hernia, which manifests itself as non-specific pain.
How can a femoral hernia be treated?
Doctors always operate on a femoral hernia as it does not disappear on its own. Due to the small hernial orifice, sections of intestine can easily become trapped. Surgery may then be necessary as an emergency.
Depending on whether a femoral hernia occurs alone or together with an inguinal hernia, different surgical techniques are used. In addition to traditional open surgery, doctors also operate using the keyhole technique (minimally invasive). The surgeon only makes very small abdominal incisions through which he inserts his instruments.
Open surgery
In open femoral hernia surgery, the surgeon opens the hernia sac either from the groin area or from the thigh area. The doctor then removes the hernia sac, pushes back the contents and closes the hernia.
Isolated femoral hernia
In the case of an isolated femoral hernia, the surgeon operates without opening the inguinal canal. The incision is made diagonally below the inguinal ligament. Once the hernia has been pushed back, he sutures the hernial orifice.
Closed operation
Complications
As with any operation, wound infections or bleeding are possible. In rare cases, embolisms (vascular occlusion) can occur.
Causes and risk factors
A femoral hernia is caused by a weak point in the tissue of the abdominal wall. This consists of abdominal muscle and connective tissue structures such as aponeuroses and fasciae, which ensure optimum stability. However, there are “gaps” in the groin region that are not supported by aponeurosis or muscle and therefore represent a natural weak point.
In a femoral hernia, this “predetermined breaking point” is located behind the so-called inguinal ligament, where the vessels of the thigh run. Excessive pressure in the abdomen and weak connective tissue can lead to a femoral hernia.
It is not yet clear why some people develop a femoral hernia. However, there are several causes that favor a femoral hernia.
These include, in particular, repeated pregnancies, obesity and collagen weakness that increases with age. In certain clinical pictures, such as Marfan syndrome or Ehlers-Danlos syndrome, there is a congenital collagen metabolism disorder.
Among other things, the influence of the female sex hormone on connective tissue leads to a higher proportion of women affected by femoral hernia, usually at an older age.
Coughing, straining or heavy lifting increases the pressure in the abdomen, which can cause tissue to leak out at weak points.
Examinations and diagnosis
If a femoral hernia occurs, you should consult a specialist in surgery and visceral surgery. The doctor will first take your medical history and then examine you closely. Possible questions the doctor may ask are
- How long have you had the symptoms?
- Have you already had an operation?
- Does the pain radiate?
- Do you have a concomitant disease that is associated with a collagen metabolism disorder?
The doctor will examine the femoral hernia while you are lying down and standing up. He will ask you to press hard once. If a hernia sac can be felt below the inguinal ligament, the diagnosis is easy to make – in overweight patients, palpation is often difficult.
The doctor uses an ultrasound examination (sonography) to differentiate a femoral hernia from an inguinal hernia in the case of larger hernias. Any swollen lymph nodes can also be ruled out in this way.
Course of the disease and prognosis
A femoral hernia can usually be treated well. Recurrence of the hernia is not very common and is between one and ten percent.
In the event of an acute intestinal obstruction, emergency surgery is necessary as there is a risk to life.
