Femoral hernia: “Silent killer” hernia in women?

In Singapore, an inguinal hernia is the most common type of hernia in men and women; though between the two sexes, men experience this condition more. But that’s not to say women are in the clear — in fact, women who have an inguinal hernia are more likely to have a femoral hernia too. Femoral hernias are known as the “silent” hernia because they don’t usually cause symptoms and are more likely to “pinch” a part of the bowel without you knowing. As such, the risk of complications is higher. 

What causes a femoral hernia?

A femoral hernia, also known as a femorocele, occurs when a portion of tissue pushes through a weak spot in the groin or femoral canal. The femoral canal is located around the upper part of the thigh. Femoral hernias are often confused with inguinal hernias due to their similarities in position, but femoral hernias are a lot more painful. 

Like other hernias, the exact cause of a femoral hernia is unknown. You may just be born with a weaker femoral canal, or the area grew weaker as you aged. Many of my patients with hernias are well past their 40s and 50s. 

For the most part, hernias are strongly thought to be contributed by the weakening of the muscle walls. Common activities that strain and weaken the muscle walls include: 

  • Childbirth 
  • Chronic constipation 
  • Heavy lifting 
  • Being obese or overweight 
  • Chronic coughing 
  • Difficulty urinating from an enlarged prostate 

I should add that a hernia can affect even the healthy; in fact I’ve had patients who were athletes in their younger days and developed a hernia over time due to excess strain and pressure during training. 

Why are women more prone to getting a femoral hernia?

Because the female pelvis is wider than the male pelvis, women are 10 times more likely than men to develop a femoral hernia. 

The good news is femoral hernias are pretty uncommon and account for fewer than 3% of all hernias. Most hernias that affect the groin are still likely to be inguinal hernias.

What are the symptoms of a femoral hernia?

Most small and moderate-sized femoral hernias do not present any symptoms. You may not even see a bulge at all!

Larger hernias may be more noticeable and may cause some pain when you stand up, cough or lift heavy objects. Take the case of this 30-year-old lady who presented with a 3cmx2cm swelling. Although the swelling was present for 2 years, pain only started after a trivial blunt trauma on the swelling. Doctors discovered she had a rare form of infected femorocele, which fortunately could be solved with surgery. You may read more about this interesting case from Surgical Case Reports. 

In general, I advise to look out for any discomfort or pain around the hips. Please seek medical attention immediately if you experience sudden groin pain with severe stomach pain and/or nausea and vomiting — these symptoms could signify that you have a strangulated hernia, which can put your life in danger. 

About 35-40% of femoral hernias do not receive a diagnosis till the patient experiences hernia strangulation. 

How is a femoral hernia treated in women? 

Dr Ganesh performing surgeryThere are three main types of surgery to treat a hernia;

Open surgery without mesh 

A large incision is made across the area and the hernia sac is moved back into place. The gap in the abdominal wall is then closed off and reinforced with neighbouring connective tissue. 

Open surgery with mesh 

The same steps as open surgery; except instead of using tissue to strengthen the abdominal wall, synthetic mesh is used instead. 

Keyhole laparoscopic surgery 

This is minimally invasive surgery that involves making several small incisions in the skin. A camera and small surgical instruments are then inserted into the abdomen (or as far as the abdominal walls allow) to move the hernia sac into place. In laparoscopic surgery for hernia, a synthetic mesh is always used. 

Femoral hernias in women are usually treated with laparoscopic surgery including the use of a mesh. I prefer using a mesh instead of connective tissue as the former seems to be more effective in closing the gap. A mesh also allows the patient to return to normal activities sooner. I don’t always recommend open surgery in women, as their risk of developing another hernia after is greater. As it is, women already have a higher risk of developing another hernia — henceforth the mesh to prevent another reoccurrence. 

How long does a strangulated hernia operation take?

Surgery for a strangulated hernia involves gently applying pressure to the hernia and releasing trapped tissue back into place. The entire procedure takes about 30-45 minutes.

Have any questions? Drop me an enquiry and I’ll be happy to help!