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Femoral Hernia – Causes, Symptoms & Treatment

A femoral hernia is a type of hernia in which abdominal tissue protrudes through the femoral canal, below the inguinal ligament. It occurs more often in women.

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Things worth knowing about "Femoral Hernia"

A femoral hernia is a type of hernia in which abdominal tissue protrudes through the femoral canal, below the inguinal ligament. It occurs more often in women.

What Is a Femoral Hernia?

A femoral hernia (also called a crural hernia) is a condition in which a portion of abdominal tissue -- such as a loop of intestine or fatty tissue -- pushes through the femoral canal, a small passage located just below the inguinal (groin) ligament on the inner thigh. Unlike the more common inguinal hernia, a femoral hernia sits below the inguinal ligament. It is more frequently seen in women, likely due to the wider anatomical structure of the female pelvis and femoral canal.

Causes

Femoral hernias develop when increased pressure in the abdomen forces tissue through a weak point in the abdominal wall near the femoral canal. Contributing factors include:

Chronic straining due to persistent cough, constipation, or heavy lifting
Pregnancy, which increases intra-abdominal pressure over time
Connective tissue weakness, which may be inherited or develop with age
Obesity, which places ongoing stress on the abdominal wall
Aging, which is associated with a gradual weakening of supporting tissues

Symptoms

Many femoral hernias are initially asymptomatic and discovered incidentally. When symptoms are present, they may include:

A visible or palpable bulge in the groin or upper inner thigh area
Dull or aching discomfort in the groin, particularly during physical activity
In cases of incarceration (trapped hernia): sudden severe pain, nausea, vomiting, and signs of bowel obstruction -- this constitutes a medical emergency

Diagnosis

Diagnosis is primarily based on a thorough physical examination of the groin and femoral region. Imaging studies may be used to confirm the diagnosis or plan treatment:

Ultrasound: A quick, radiation-free method to visualize the hernia and its contents
MRI or CT scan: Used in unclear cases or for detailed preoperative planning

Distinguishing a femoral hernia from the more common inguinal hernia is important, as their anatomical locations differ and surgical approaches may vary accordingly.

Treatment

Due to the relatively high risk of incarceration associated with femoral hernias, surgical repair is generally recommended even in the absence of significant symptoms.

Surgical Options

Open surgery: A direct incision is made in the groin area to close the hernia defect, often reinforced with a synthetic mesh
Laparoscopic (minimally invasive) surgery: The repair is performed through small incisions using a camera and instruments; associated with faster recovery and less postoperative pain (e.g., TAPP or TEP techniques)

Emergency Treatment

An incarcerated femoral hernia requires immediate surgical intervention to prevent ischemia (loss of blood supply) and potential necrosis of the trapped bowel segment.

References

Simons MP et al. - European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.
Miserez M et al. - Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal and femoral hernia in adult patients. Hernia. 2014;18(2):151-163.
Townsend CM et al. - Sabiston Textbook of Surgery. 21st edition. Elsevier, Philadelphia 2022.

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