Femoral Hernia

A hernia arises when a spot in the muscles of the abdominal wall allows a segment of the intestine or abdominal tissue to protrude further. If a segment of tissue pushes through the femoral canal's wall specifically, it is called a femoral hernia or femorocele. 

It is the rarest kind of hernia with higher prevalence in women comparatively, and the bulge is usually observed close to the groin or thigh. 

Femoral hernia can also be classified into 

1. Reducible hernia- These can be forced back in and might shrink when you lie down.
2.  Irreducible hernia- It occurs when a portion of your intestine pulls into the hernia, making it difficult to force the hernia back in. It leads to complications like bowel obstruction and the development of strangulated hernia that requires immediate treatment

 

Internal tissues force a weak area in the muscular wall at the groin or inner thigh, causing a femoral hernia. These are more common in older females due to the wider structure of the female pelvis.  

The exact cause of femoral hernia is unknown; however, it is possible that you might have weak muscles in the femoral canal region since birth and straining your abdomen might contribute to the weakening of muscles too.  

Factors leading to overstraining are: 

1.  Persistent coughing 
2. Persistent constipation 
3.  Obesity 
4. Childbirth 
5.  Heavy lifting 
6.  After peritoneal dialysis 
7.  Difficulty in urination 
8. Ascites or building up of water  

 

Generally, a small-sized femoral hernia is not even noticeable in most cases and does not show any sign or indication. However, the large size femoral hernia might indicate a few signs such as: 

1. Chronic Constipation
2. Chronic Cough
3. Strain while urinating
4. A noticeable bulge  
5. Discomfort 
6.  Abdominal pain 
7. Nausea  
8. Vomiting 
9.  Groin pain while standing, heavy-lifting or any kind of straining  

 

Your healthcare professional will look into your clinical records as well as other parameters. 

1. A physical examination by gently touching or palpating the area will be performed by your doctor. In the case of a large size femoral hernia, the doctor might be able to feel the bulge.  
2. The doctor will look for any symptoms indicating femoral hernia such as vomiting, constipation, abdominal pain, family history, etc. 
3.  Other diagnostic techniques include: 
4.  Blood tests: These are performed to identify any infection led by necrosis or intestinal blockage. 
5.  MRI, CT scan, and Ultrasound: These imaging tests aid in identifying blockage as well as the exact location of the disease. 

 

Treatment 

1. Small-sized, asymptomatic femoral hernia might not be advised for immediate surgery, and your doctor might ask you to wait for the symptoms to progress. 
2. In case of a moderate to a large-sized femoral hernia that is causing you extreme discomfort, immediate surgery will be advised by your doctor.  
3. Surgical hernia repair is performed under general anaesthesia, and therefore, you will not feel any pain during the procedure. 
4. The procedure takes around 60-90 minutes, and you might be discharged on the same day based upon the type of your surgery and complications. 
5. There are a few types of surgeries for femoral hernia, and a doctor might advise you a surgery based on: 
6. The size of the hernia 
7.  Location of the hernia 
8.  Anticipated recovery time 
9.  Cost
10. Your medical history 
11. Surgical hernia repair may be: 

Laparoscopic: 

1. In this procedure, the surgeon utilises a camera inserted via multiple tiny openings to fix the hernia. 
2. Since the size of the cut is small, there are fewer chances of infection. 
3. It is generally an outpatient procedure, i.e., you might get discharged the same day.  

Open surgery: 

1. In this, the surgeon creates an incision next to your hernia, then pulls the tissues firmly into alignment and sews the wound up. 
2.  You might feel pain after the procedure 
3.  You might not get discharged on the same day. 

Mesh placement surgery: 

1. Hernia mesh or surgical mesh is an implant that aids in the healing of injured tissue around hernias.  
2.  Surgeons apply the mesh to the area around the hernia, securing it with sutures, staples, or adhesive. Tissue can grow within the device because of the mesh's pores. 
3. It is a safe, reliable procedure and reduces the risk of recurrence. 

Femoral hernia surgery is generally safe; however, any surgery entails some risk. 

1. Blood clots 
2.  Bleeding near the surgical site 
3. Injury to internal organs 
4.  Side effects to general anaesthesia 
5. Nerve damage around the surgical site 
6.  Scarring 
7.  Wound infection 
8.  Temporary weakness in legs 

How to prepare for consultation 

1. Before going to the doctor, you must pen down a few aspects you should talk about: 
2. What is the severity of the disease? 
3. Do I require any surgery? 
4.  In case of surgery, what will be my recovery period? 
5.  Which kind of surgery will be the most suitable for me? 
6.  What are the dos and don'ts? 
7.  Can the symptoms worsen? 
8. How will my lifestyle be affected? 
9.  What diet should I follow? 
10.  What are the possible side effects? 
11.  Are there any risks and complications associated with my disease or the surgery? 
12. Your doctor will also review your past medical records and family history with hernias and will ask you about any pre-existing medical condition you might have.

 

1.  Overall recurrence rates for groin hernias range between 5% to 10%.
2. Tension-free techniques and mesh-based repairs, if appropriate, lead to approximately 60% reduction in ipsilateral recurrence compared to non-mesh or suture-based repairs.

Risk if not treated

The occurrence of femoral hernia is rare but might lead to severe complications if ignored. As the size of the hernia increases, the symptoms worsen and might lead to a few other complications like: 

1.  Incarcerated hernia: Your intestine remains stuck in a weak abdominal wall and is unable to be pulled back into your abdominal cavity. This could clog your intestine or stop off all its blood circulation. 
2. Obstructed: This occurs when the hernia and a portion of the intestine become intertwined, resulting in an unpleasant intestinal obstruction. 
3. Strangulated: Once the intestine gets clogged and the intestine begins to decay. In such cases, immediate surgery is essential, or else it might even lead to death.