Definition

A hernia is a medical condition characterized by the protrusion of an organ through a weakened area of the adjacent muscle or tissue. This organ will shift and result in the manifestation of nodules.

The abdominal muscles serve the purpose of maintaining the position of the intestines and abdominal organs. However, the abdominal organs may occasionally protrude through weakened abdominal muscles due to severe muscle contraction. A femoral hernia occurs when the abdominal organs protrude through the wall of the femoral canal. The femoral canal is an anatomical cavity located in the thigh region that contains blood vessels, nerves, adipose tissue, and lymph nodes.

A femoral hernia manifests as a protrusion around the groin or thigh. A femoral hernia is alternatively referred to as a femorocele.

Femoral hernias are more common in women than in men. Hernias in the groin region, known as inguinal hernias, tend to be more common than femoral hernias. Only about 3% of all hernias are femoral hernias.

The majority of femoral hernias are asymptomatic. But if the hernia prevents blood from entering the intestines, it may lead to major complications. A strangulated hernia is a life-threatening medical condition that requires emergency surgical intervention.

Causes

The specific etiology of a femoral hernia or any other hernia remains uncertain. An individual might have an inherent vulnerability in the femoral canal, or this region could weaken over time. Straining may lead to damage to the muscle walls. Possible causes of excessive pressure on the abdominal muscles include:

• Delivery
• Chronic constipation
• Weightlifting
• Obesity
• Urinary retention caused by benign prostatic hyperplasia
• Persistent cough

Risk Factor

Several potential risk factors for femoral hernias include:

• Female
  Due to the larger pelvis in women, femoral hernias affect women at a rate ten times higher than men.

• Adult
  Adults are considerably more susceptible to femoral hernias than adolescents. Femoral hernia in children is frequently an indication of an underlying medical condition.

• Familial history
  Having a family member with a femoral hernia may increase the risk.

Symptoms

Femoral hernias are commonly undetected in specific cases. Hernias of small and medium size typically result in no symptoms. Furthermore, there is no visible hernia protrusion in the groin area.

Hernias of considerable size will be prominent and induce pain. Typically, the protrusion is found in the groin region adjacent to the upper thigh. A painful enlargement of the bulge may result from standing or lifting hefty weights. Femoral hernias are situated close to the hip bone and frequently result in hip pain.

Severe symptoms are indicative of a constricted hernia that is impeding the circulation of blood to the intestines. The medical term for this critical condition is strangulated hernia. Obstruction of blood flow results in the death of intestinal tissue and is potentially life-threatening. This is a critical medical emergency.

• Severe abdominal pain
• Sudden pain in the groin area
• Nausea and vomiting

Diagnosis

The doctor will conduct a physical examination to determine the femoral hernia by gently palpating the region surrounding the groin. In a large hernia, the protuberance will be detectable with a touch.

Abdominal and groin ultrasonography (USG) confirms a femoral hernia diagnosis in cases where no visible bulge is seen during a physical examination. Imaging technologies may detect abnormalities in the muscle walls and identify protruding organs.

Management

Minor, asymptomatic femoral hernias may not necessitate specific intervention. The doctor will closely observe your condition to detect potential symptoms. Surgical intervention is necessary for femoral hernias of moderate to large size, particularly if they result in pain.

Hernia surgery is conducted with general anesthesia. Anesthesia will be administered during the operation to induce sleep and ensure you do not experience any kind of discomfort. There are two types of surgery: open surgery and laparoscopic surgery. Open surgery necessitates a larger incision and a prolonged recovery period. On the other hand, laparoscopy necessitates only three to four small incisions, like keyholes, effectively reducing the risk of hemorrhage. The selection of the operation is dependent upon multiple factors, specifically:

• Surgeon's proficiency
• The hernia's size and potential complications
• Recovery period
• Cost

Laparoscopic surgery, for instance, induces reduced pain and scarring compared to conventional surgery. Additionally, the recovery period is shortened. The cost is higher than with open surgery.

During both types of surgical procedures, the surgeon will create an opening in the groin region to allow access to the hernia. The process involves repositioning the intestine or any other tissue protruding from the femoral area to its initial location. The surgeon will suture the opening and strengthen it with a mesh graft. The mesh can improve the structural integrity of the walls of the femoral canal.

Complications

An obstructed, incarcerated, or strangulated femoral hernia can induce further manifestations of symptoms and complications. A compressed hernia necessitates urgent treatment as it is a possibly life-threatening condition.

• Incarcerated femoral hernia
  Femoral hernia incarceration refers to the situation where the hernia becomes stuck in the femoral canal and is unable to return to its original position in the abdomen.

• Obstructive femoral hernia
  The condition occurs once a segment of the intestine within the hernia becomes trapped, leading to a severe obstruction of the intestines.

• Strangulated femoral hernia
  It is the result of a hernia obstructing the circulation of blood to the intestines. This situation is a life-threatening medical emergency that requires immediate treatment to prevent mortality.
  Strangulation is the most common severe consequence, affecting approximately 15-20% of patients. This complication is more commonly observed in cases where the femoral canal is constricted and rigid.

These are some indications of a strangulated hernia:

• Sudden and severe pain
• Severe pain in the area of the hernia protrusion
• Fever
• Nausea and vomiting
• Tachycardia
• Discoloration of the skin surrounding the hernia

If not promptly treated with surgery, a strangulated femoral hernia may lead to necrosis and decomposition of the intestinal tissue. This will result in potentially life-threatening infections.

Prevention

Several preventative treatments for hernias include:

• Maintain a healthy weight through exercise and a nutritious diet
• Adequate intake of whole cereals, fruits, and vegetables may prevent constipation
• Keep the correct posture while lifting weights or other weighty objects. Never lift objects that are beyond your capability.
• See the doctor if you have a persistent cough or sneeze
• Quit smoking to prevent wheezing, which may precipitate a hernia

When to See a Doctor?

If you suspect a femoral hernia, see a doctor for treatment. To prevent life-threatening situations, those with strangulated hernia symptoms should call 911 or seek immediate medical help. Immediate medical intervention may repair a constricted hernia and potentially preserve the patient's life.

Visit your doctor immediately following femoral hernia repair surgery if you develop any of the following symptoms:

• Abdominal distension
• Shivering
• Dysuria
• Fever, particularly ≥39°C
• Intractable pain unresponsive to medication
• Persistent or excessive hemorrhaging
• Progressive exacerbation of erythema surrounding the surgical wound
• Intense nausea or vomiting
• Dyspnea

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Healthline editorial team. (2018). Retrieved December 28, 2021, from https://www.healthline.com/health/femoral-hernia

Leonard J. (2021). How to tell if you have a femoral hernia. Retrieved December 28, 2021, from https://www.medicalnewstoday.com/articles/324118

Femoral hernia repair. (2018). Retrieved December 28, 2021, from https://www.nhs.uk/conditions/femoral-hernia-repair/

Hernia. (2018). Retrieved December 28, 2021, from https://my.clevelandclinic.org/health/diseases/15757-hernia#prevention