Femoral hernias account for only about 3–5% of all groin hernias, making them relatively uncommon, yet they are associated with higher rates of strangulation and morbidity compared to inguinal hernias. 

Although groin hernias in general are more common in males, femoral hernias predominate in females, largely due to anatomical factors such as a wider pelvis. A detailed understanding of femoral hernia, including its causes, symptoms, diagnosis, and treatment, is essential if you are preparing for the NEET PG exam. 

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What is a Femoral Hernia?

Femoral hernia is a rare type of hernia that develops inside the upper inner thigh, just above the inguinal crease. It is much more common in women than in men and is mainly attributed to the difference in anatomical structure of the pelvis.

Femoral hernias are not accompanied by any symptoms in a significant proportion of patients; they can be discovered accidentally in the course of a general medical check-up. But even though they are usually presented subtly, they have a greater risk of having complications like incarceration or strangulation. 

The healthcare professionals tend to recommend surgical intervention to preclude the possible adverse outcomes.

What Causes Femoral Hernia?

The exact cause of femoral hernias is often not identified. In many cases, individuals may either be born with a naturally weak area in the femoral canal or develop this weakness gradually over time.

A significant causative agent includes high abdominal pressure that may overwhelm and weaken the walls of the muscles that surround it. Some of the common activities and conditions that can cause such straining are:

• Childbirth
• Heavy lifting without support
• Chronic coughing
• Obesity
• Chronic constipation
• Trouble passing urine because of an enlarged prostate (in men)

What are the Symptoms of Femoral Hernia?

In many cases, femoral hernias do not produce noticeable symptoms, especially in the early stages. When femoral hernia symptoms are present, they may include:

• Identifiable swelling or enlargement in the groin or upper inner thigh
• Pain or discomfort in the lower abdomen or groin that can be dull or sharp 
• Vomiting and nausea, especially when the hernia gets incarcerated or strangulated
• Thigh or groin pain 

Symptoms often intensify with physical activity such as:

• Prolonged standing
• Heavy lifting
• Straining during bowel movements or urination

The patient should not ignore these symptoms, particularly when they are accompanied by agonising pain or gastrointestinal manifestations, since it may be a surgical emergency.

How to Diagnose Femoral Hernia?

To diagnose a femoral hernia, a healthcare provider will begin with a detailed physical examination. They will typically inquire whether the groin or upper thigh bulge is intermittent, and whether it becomes more noticeable during activities that increase intra-abdominal pressure, such as straining during bowel movements or lifting heavy objects.

To confirm the diagnosis and exclude other conditions that may mimic a femoral hernia, imaging studies are often recommended. These may include:

• Ultrasound
• CT (computed tomography) scan
• MRI (magnetic resonance imaging)

Several medical conditions can present with symptoms or physical findings similar to a femoral hernia. These include:

• Femoral Artery Aneurysm: It can give rise to a pulsatile mass in the groin area.
• Hydrocele: Fluid in the scrotal sac, leading to swelling in men.
• Inguinal Hernia: A more prevalent variation of groin hernia, which is confused with the femoral one.
• Nuck’s Cyst: A rare condition in females causing painful groin swelling.
• Psoas Abscess: A localised collection of pus in the psoas muscle, potentially extending into the groin
• Enlarged Lymph Nodes:  Often due to infections or malignancies.
• Varicocele: Dilated veins in the scrotum that can resemble a hernia-like swelling.

How to Treat Femoral Hernia?

Femoral hernias can be treated by surgical repair. The surgery entails the sealing of the protruding tissue into the abdominal cavity and strengthening of the weakened patch of the abdominal region to avoid recurrence.

In contrast to some other types of hernias, femoral hernias usually require timely surgical correction as the risk of serious complications is much higher.

Types of Surgical Procedures

There are 2 methods of carrying out femoral hernia repair:

• Open Surgery: These would involve a single larger cut made to facilitate the repair of the hernia through direct means.
• Laparoscopic (Keyhole) Surgery: This is surgery where a limited incision is made and special equipment is used through small incisions.

There are advantages and drawbacks to each of the techniques. The procedure is decided by the overall health of the patient, the nature of the hernia, and the skills of the surgeon.

Recovery and Postoperative Care

After the surgery, most patients are discharged within the same day or 24 hours. Aftercare is very important and is composed of:

• Prevention of constipation by eating a fibre-rich diet
• Taking care of the wound in the right way
• Not pushing too hard too soon in the recovery period

Potential Complications of Untreated Femoral Hernia

• Bowel Obstruction: A bit of the intestine can be trapped in the femoral canal, causing nausea, vomiting, abdominal pain, and a groin lump.
• Strangulation: In more severe cases, the incarcerated part of the bowel may have its blood supply obstructed, leading to death of the tissue. It is a surgical emergency, and as such, prompt measures are needed to restore blood flow and avoid serious implications that can be fatal.

Prevention and early surgical treatment not only eliminate the hernia but also these complications, though a slight possibility of a new development of the hernia after treatment with surgery.

FAQs About Femoral Hernia

1. Is a femoral hernia common?

No, femoral hernias are not that common, as they represent only 3-5% of all groin hernias. It is more common to encounter them in women, especially older women, since their pelvic region is different.

2. Can children get a femoral hernia?

Femoral hernias in children are rare. Where they are developed, they are mostly congenital, and they might need surgical correction. Most hernias in children are not in the femoral region but are inguinal.

3. How can a femoral hernia be prevented?

Although it is not always possible to prevent, lowering abdominal pressure through a healthy weight, not lifting a lot of items, avoiding a prolonged cough or constipation in perception, and correct lifting requirements can contribute to the prevention of femoral hernia.

4. What are the risks of femoral hernia surgery?

Bleeding, infection, reoccurrence of the hernia, damage of adjacent structures, e.g., blood vessels or bowel, and difficulties with anaesthesia are the possible risks involved. Nevertheless, more severe issues are uncommon if performed properly.

Conclusion

In case you experience a painful swelling in the groin region, especially when you have nausea, vomiting, or abdominal pain, you might be having a femoral hernia. Early diagnosis and surgery will help in preventing serious complications such as obstruction or strangulation. 

Pay attention to the manifestations of the development of the disease, swelling of the groin that does not improve while lying, chronic pain, acute gastrointestinal manifestations; these symptoms indicate the need to go to the doctor.

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