What are the other Names for this Condition? (Also known as/Synonyms)

• Crural Hernia
• Enteromerocele
• Femorocele

What is Femoral Hernia? (Definition/Background Information)

• When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region
• Medically, there are various types of hernia and the most common ones are:
  • Inguinal hernia
  • Incisional hernia
  • Femoral hernia
  • Umbilical hernia
  • Hiatal hernia            
• A Femoral Hernia is a type of hernia that bulges out of a weak spot in the groin region, just above the line that separates the abdomen from the legs. The abdomen contents (such as the intestine) along with peritoneum (lining of abdomen contents) can push through the weakened spot into the femoral canal
• Femoral Hernias accounts for only 5% of all abdominal hernias. It is most common in elderly women over the age of 50 years. The condition is typically caused by a weak spot (enlarged femoral ring) in the groin region and also due to increased pressure or strain on this weakened spot
• Factors that increase intra-abdominal pressure and put pressure on the weakened area include enlarged prostate (straining to go urine), pregnancy, intense work-outs, frequent cough due to respiratory diseases, chronic constipation, and many other factors. Sometimes, the causative factor is not clearly evident
• The clinical presentation of Femoral Hernia is varied; they may not have any symptoms too. A prominent bulge may be observed in the groin region. In the absence of the bulge, the individual may experience pain in the upper thigh region. in some cases, a severe pain may be suddenly felt
• Surgery is the only definitive treatment for Femoral Hernias; there are no alternatives. The prognosis is generally good with prompt diagnosis and suitable surgery

Who gets Femoral Hernia? (Age and Sex Distribution)

• Femoral Hernias occur more frequently in adults (especially older adults) than children
• Women are more likely to get this condition than men. The shape of a woman’s pelvis makes the femoral canal wider than a man’s
• It can occur worldwide; no racial or ethnic preference is noticed

What are the Risk Factors for Femoral Hernia? (Predisposing Factors)

Having a weakened spot in the groin region (femoral canal) and frequent strain to the weakened area are factors that increase one’s risk for Femoral Hernia. An increase in intra-abdominal pressure is a main trigger factor for a Femoral Hernia. The following factors may increase the pressure or strain:

• Obesity
• Individuals with chronic cough or chronic constipation are more susceptible to the condition
• Enlarged prostate (straining to go urine)
• Improper heavy lifting
• Elderly, low weight women have an increased risk than individuals of any other age group
• Rarely, a congenital anatomical weakening can increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Femoral Hernia? (Etiology)

Having both, a weakened spot in the groin (femoral canal) and repeated or chronic strain (high intra-abdominal pressure) to the weakened area causes Femoral Hernia. The causal factors may include:

• An enlarged prostate can lead to straining during urination, which can ultimately contribute to a Femoral Hernia
• Pregnancy: It is more common in women who get pregnant many times than those who get pregnant fewer times
• Intense physical activity/work-out or improper/frequent heavy lifting
• Chronic constipation
• Chronic cough: It is more common in individuals who smoke than those who do not

Femoral Hernias are sometimes seen in association with a connective tissue disorder, when the condition is observed in infants.

What are the Signs and Symptoms of Femoral Hernia?

Most Femoral Hernias present no symptoms. They are often discovered when a part of the intestine is caught within the hernia, or if the blood supply to the tissues is cut-off due to the hernia being contorted or blocked.

• One of the most common signs of a Femoral Hernia is a bulge - about the size of a cherry, located in the groin region
• If one does have a lump or bulge, he or she may experience pain in the upper part of the thigh
• An unexplained bowel obstruction may lead to the finding of a Femoral Hernia

Immediate medical attention should be sought, if any of the following symptoms occur, which may be due to a Femoral Hernia:

• If the hernia is painful, and if it cannot be pushed back into the abdomen with a gentle pressure
• If the hernia becomes dark, discolored, or starts looking bruised
• If abdominal pain, nausea and/or vomiting occur due to the hernia

Femoral Hernias are sometimes confused with an inguinal lymph node, or an inguinal hernia, etc.

How is Femoral Hernia Diagnosed?

The following exams and procedures may be used to diagnose a Femoral Hernia:

• Thorough evaluation of the individual’s medical history and a complete physical examination including examination of the groin and abdomen. Femoral Hernias are primarily diagnosed through a physical examination of the groin area
• During history taking the physician may want to know the following:
  • When the symptoms began and whether they are becoming worse
  • About one’s personal and family history of hernia, smoking, prostate conditions, pregnancy history, bowel movement, etc. 
• A surgical consultation is often necessary, as surgical consultants are the experts in dealing with hernias
• An ultrasound, CT, or MRI scan may be used for further diagnosis, or if the diagnosis is not clear

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Femoral Hernia?

The complications of Femoral Hernia could include:

• If tissues surrounding the hernia or the intestines becomes obstructed by the hernia, the tissue in the area may die, if the condition is not immediately treated through surgery
• If the intestine gets stuck (incarcerated) and or strangulated (blood supply gets “cut off”), it may lead to the formation of gangrene (death of tissue). If this condition is not addressed promptly, it can cause peritonitis (inflammation and infection of the abdomen lining and its contents) and may even cause death

The complications from surgery could include:

• Difficulty with urination
• Bowel injury
• Temporary limb weakness
• Injury to nerves surrounding the hernia
• The development of a lump under the surgical wound
• Recurrence of the hernia

How is Femoral Hernia Treated?

A surgery is the only available method to completely eliminate a Femoral Hernia, as they typically do not subside, or go away by themselves; frequently such hernias only continue to grow.

An elective (planned) surgery is preferred to an emergency surgery, due to the involvement of lesser complications. The surgical treatment options for Femoral Hernia may include:

• Open surgery, although less commonly done, may be performed by making a large incision in order to push the lump (hernia sac and its contents) back into the abdomen and repair the defect, either by approximating the tissues together or by using a mesh. A plastic mesh can be used during surgery to repair weakness in the abdominal wall
• Currently, laparoscopic surgery that is minimally-invasive is the preferred method depending on the clinical situation. Usually three small incisions are made, and the surgeon uses microscopic instruments and surgical cameras to aid in the repair

How can Femoral Hernia be Prevented?

There are no guaranteed ways to prevent the formation of a Femoral Hernia, or to stop one from worsening. Alleviating pressure on the abdominal wall may help delay, or stop the painful symptoms that a hernia can cause. The following measures may be beneficial, if an immediate surgery is not planned:

• If one is obese or overweight, losing weight is beneficial
• Increasing fluid and fiber intake may help with constipation
• Using proper lifting techniques may prevent a hernia from forming, or an existing condition from worsening
• Treating the symptoms of an enlarged prostrate may be helpful in men

What is the Prognosis of Femoral Hernia? (Outcomes/Resolutions)

• If Femoral Hernia is diagnosed in a timely manner and treated suitably with surgery, then the chances of recurrence is only between 5-10%
• There is about a 1% chance of the incision site becoming infected following a non-emergency hernia repair
• If the hernia reaches a stage where an emergency surgery is necessitated, then the surgical complications can be severe, than when compared to a planned (elective) surgery

Additional and Relevant Useful Information for Femoral Hernia:

• A femoral hernia repair or a femoral herniorrhaphy is a surgical procedure performed to repair the femoral hernia

The following article link will help you understand a femoral hernia repair surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/femoral-hernia-repair/