Femoral (Lower Groin) Hernia

A femoral hernia occurs when fatty tissue or part of the bowel pushes through a weak spot in the lower groin, into the narrow channel (the femoral canal) through which the main blood vessels pass from the abdomen into the leg. It appears as a lump below the groin crease, towards the inner thigh, which distinguishes it from an inguinal hernia, which sits higher.

Femoral hernias are much less common than inguinal hernias and are seen more often in women, particularly older women, because of the shape of the female pelvis. Symptoms include a small lump in the upper thigh or lower groin that may be more noticeable when standing, and aching or discomfort in the groin. Because the lump can be small and deep, it is sometimes only found when it becomes painful.

Repair is recommended for almost all femoral hernias, usually promptly after diagnosis, even when symptoms are mild. The opening through which a femoral hernia passes is small and has firm edges, so there is a considerably higher risk than with other hernias that the contents will become trapped (incarcerated) or lose their blood supply (strangulated). When this happens, the bowel can be damaged and emergency surgery is needed.

Because of this risk, a policy of simply watching a femoral hernia is generally not advised. Planned repair is a shorter and safer operation, with a quicker recovery, than surgery performed as an emergency. Your surgeon will confirm the diagnosis, sometimes with an ultrasound scan, and discuss with you the timing of surgery and the approach best suited to your circumstances.

Femoral hernia repair is performed under general anaesthesia and usually takes less than an hour. The hernia contents are returned to the abdomen and the opening is closed and reinforced, usually with a synthetic mesh.

• Open repair - a small incision is made in the groin, either directly over the lump or slightly above it, and the hernia is repaired from the front
• Laparoscopic (keyhole) repair - three small incisions are made in the abdomen and a mesh is placed on the inside of the abdominal wall, covering the femoral canal and the adjacent inguinal area at the same time

The keyhole approach can be useful when there is uncertainty about whether the hernia is femoral or inguinal, or when there are hernias on both sides. Your surgeon will discuss which technique is most appropriate.

Most planned femoral hernia repairs are day surgery or involve a single overnight stay. Some pain, swelling and bruising in the groin are expected for the first one to two weeks and are controlled with simple pain relief. Walking is encouraged from the day of surgery.

People with desk-based jobs usually return to work within one to two weeks, while those in physically demanding roles may need four to six weeks before resuming heavy lifting. Driving can usually resume once you can perform an emergency stop comfortably and are no longer taking strong pain medication. Recovery after emergency surgery, particularly if a section of bowel has needed to be removed, is longer and involves several days in hospital. You will be reviewed in the clinic after surgery to check the wound and your progress.

Femoral hernias carry a higher risk of strangulation than most other hernias, so it is important to know the warning signs while you are waiting for surgery.

Seek emergency care immediately, by going to your nearest emergency department or calling 000, if:

• The lump becomes suddenly painful, hard or tender or cannot be pushed back in
• The skin over the lump becomes red or discoloured
• You develop nausea, vomiting, bloating or severe abdominal pain
• You are unable to pass wind or open your bowels

A strangulated femoral hernia can occur even when the lump itself seems small. If in doubt, seek medical attention rather than waiting to see whether the symptoms settle.