Your muscles are usually strong enough to keep your intestines and organs in their proper place. Sometimes, however, your intra-abdominal tissues can be pushed through a weakened spot in your muscle when you overstrain. If a portion of tissue pushes through the wall of the femoral canal, it’s called a femoral hernia. A femoral hernia will appear as a bulge near the groin or thigh. The femoral canal houses the femoral artery, smaller veins, and nerves. It’s located just below the inguinal ligament in the groin. A femoral hernia can also be called a femorocele.
Women are more likely than men to suffer from a femoral hernia. Overall, femoral hernias are not common. Most hernias that affect the groin are inguinal hernias, and fewer than 3 percent of all hernias are femoral. Most femoral hernias do not cause symptoms. However, they can occasionally lead to severe problems if the hernia obstructs and blocks blood flow to your intestines. This is called a strangulated hernia — it’s a medical emergency and requires immediate surgery.
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Before Femoral Hernia Treatment
A femoral hernia results from internal tissues pushing through a weak point in the muscle wall, near the groin or inner thigh.
The exact cause may be unknown. Sometimes, people may be born with a structurally weak muscle wall in the area.
Femoral hernias can also result from straining or excess pressure in the area due to:
. Passing urine or stool
. Being obese
. Lifting or pushing heavy objects
. Having a persistent, strong cough
. Giving birth
. Having ascites or an abnormal buildup of abdominal fluid
. Receiving dialysis, or treatment for kidney disease
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Though the direct cause may be unknown, some people are at higher risk than others.
Risk factors include:
. S-e-x: Both s-e-x-e-s can develop a femoral hernia, but they occur approximately 10 times more often in females. This is because the female pelvis is wider than the male pelvis.
. Age: Femoral hernias are far more common in adults than in children. If a child does develop one, it typically results from a medical condition, such as a connective tissue disorder.
. Family history: People with a close family member who has a groin hernia have up to 8 times the risk of developing one themselves.
Signs and symptoms of a femoral hernia
You may not even realize you have a femoral hernia in some cases. Small and moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.
Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Femoral hernias are often located very close to the hip bone and as a result may cause hip pain.
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Severe symptoms of a femoral hernia
Severe symptoms can signify that a femoral hernia is obstructing your intestines. This is a very serious condition called strangulation. Strangulation causes intestinal or bowel tissue to die, which can put your life in danger. This is considered a medical emergency. Severe symptoms of a femoral hernia include:
. Severe stomach pain
. Sudden groin pain
Call your doctor and seek immediate medical attention if you suffer from these symptoms. If the hernia obstructs the intestines, blood flow to the intestines can be cut off. Emergency treatment can fix the hernia and save your life.
Diagnosing a femoral hernia
Your doctor will perform a physical examination by gently palpating, or touching, the area to determine if you have a femoral hernia. If the hernia is large, the bulging will most likely be felt.
Ultrasound of the abdominal and groin area can confirm the diagnosis or establish a diagnosis if suspicion of a femoral hernia is high but no bulge is evident on physical examination. Imaging technology can show the defect in the muscle wall, as well as the protruding tissue.
If a femoral hernia becomes trapped, obstructed, or strangulated, it can cause additional symptoms and complications. A strangulated hernia is a life-threatening situation that requires immediate medical attention.
. Incarcerated femoral hernia
This occurs when a hernia becomes trapped in the femoral canal, and it cannot move back into the abdomen.
. Obstructed femoral hernia
When a hernia and a section of the intestine become entangled, doctors call it an obstructed hernia. It can lead to a painful intestinal obstruction.
. Strangulated femoral hernia
This complication arises when a hernia prevents blood from reaching the bowel. It is a medical emergency that can be fatal without treatment.
Without immediate surgery, a strangulated femoral hernia can cause the intestinal tissue to die and decay. This can result in life-threatening infection, and so immediate treatment is necessary.
Surgical complications and risks
What are the risks and complications of femoral hernia surgery?
Surgery for a femoral hernia is typically safe, although all surgery carries some level of risk.
Complications, while uncommon, include:
. Bleeding or bruising at the incision site
. Blood clots
. Difficulty passing urine
. Injury to internal organs
. Nerve damage around the incisions
. Side effects of general anesthesia
. Temporary leg weakness
. Wound infection
Older adults are more likely to experience complications than younger people.
During Femoral Hernia Treatment
Treatment for femoral hernias
Femoral hernias that are small and asymptomatic may not require specific treatment. Your doctor might monitor your condition to see if symptoms progress. Moderate to large femoral hernias require surgical repair, especially if they’re causing any level of discomfort.
Surgical hernia repair
Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. This intervention stops internal tissues from pushing through and causing a bulge. Moderate and severe hernias typically require surgery.
There are 2 types of surgery for femoral hernia repair. The type of surgery necessary depends on the size of the hernia, the person’s age, their general health, and other factors.
Surgical hernia repair may be:
People having open surgery typically receive general anesthesia, meaning they are fully asleep for the operation. They may sometimes receive a local anesthetic so that the area is numb, but they are awake for the procedure.
The surgeon will begin by making a small incision in the groin to access the hernia. They will move the bulging tissue back into the abdomen before repairing the femoral canal wall with strong stitches or a piece of mesh.
Doctors perform this minimally invasive surgery under general anesthesia. It involves making several small incisions in the lower abdomen.
The surgeon will then place a thin tube with a tiny camera, a laparoscope, into the incisions. They will also insert surgical tools into the other incisions to move the tissue back into the abdomen and repair the damaged muscle with mesh.
Laparoscopic surgery is not suitable for all patients, for example, those with a very large hernia.
Recovery time is, however, usually quicker than open surgery. There is also less scarring than with an open repair.
After Femoral Hernia Treatment
People recovering from a femoral hernia repair can usually go home the same day or the day after.
After the operation, your groin will feel sore and uncomfortable. You'll be given painkillers to help relieve this discomfort.
During recovery people will typically need to:
. Restrict their activities and movements for several weeks
. Eat a healthful diet to prevent constipation and straining
. Take care of the wound
Recovery can take 6 weeks or more, but most people return to light activities after 2 weeks of rest.
Looking after yourself
An adult must stay with you for the first 24 hours after your operation, in case you experience any problems.
If you're still in pain after going home, continue taking painkillers as advised by the hospital. Applying gentle pressure to your wound using your hand or a small pillow can make coughing, sneezing and moving between sitting and standing more comfortable.
Make sure you follow the instructions your nurse gave you about caring for your wound, hygiene and bathing.
Straining on the toilet because of constipation can cause pain around your wound. You can reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods, such as brown rice, wholemeal bread and pasta. A mild, over-the-counter laxative may also help.
If the operation was carried out under a general anaesthetic (which puts you to sleep during your operation), your co-ordination and reasoning may be affected for a short time. Avoid drinking alcohol, operating machinery or signing legal documents for 24 to 48 hours after any operation involving general anaesthetic.
Over time, you can gradually return to your normal activities as soon as you're able to do them without feeling any pain.
Most people are able to do light activities, such as shopping, after 1 or 2 weeks. You should also be able to return to work after 2 or 3 weeks, although you may need more time off if your job involves manual labour.
Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about 4 to 6 weeks.
You may find sex painful or uncomfortable at first, but it's usually fine to have sex when you feel like it.
Speak to the medical professional in charge of your care for advice about when you can drive. It's usually advisable to avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car).
It will usually be 1 or 2 weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery.
It's usually recommended that you contact your car insurance company before starting driving again.
When to see a doctor
People who suspect they have a femoral hernia should see their doctor for a diagnosis. The doctor will decide if treatment is necessary.
Anyone with symptoms of a strangulated hernia should call the emergency service immediately. Emergency medical attention is essential and may be life-saving.
After a femoral hernia repair, individuals should contact their doctor if they develop any of the following:
. Abdominal swelling
. Difficult or painful urination
. High fever, 103° Fahrenheit or higher
. Intense pain that does not go away with medications
. Persistent or heavy bleeding
. Redness around the incision site that worsens with time
. Severe nausea or vomiting
. Shortness of breath