What Is a Femoral Hernia and How Is It Treated? My Diagnosis
When you discover a painful lump in your lower abdomen or groin area (right around the hip crease), well, all sorts of bad thoughts can go through your mind. Painful lumps in the groin can never be a good thing, so I was worried when I got one. I was diagnosed with a femoral hernia. The good news is that it wasn't something worse and can be easily fixed!
What you'll learn from this article:
- What is a femoral hernia, exactly, and where does it occur?
- What are the causes?
- What are the risks and is it preventable?
- What happens next?
- How do I keep a hernia from getting worse while waiting for treatment?
- How long does it take to recover?
- What are the chances of it coming back?
- Where can I find pictures of femoral hernias?
A lot of the "medical information" you find online can be misleading, so I set out to gather useful, reliable information on femoral hernias to complement the stories of my own experience. I hope that you'll find this article to be helpful.
What Is a Hernia?
According to MedicineNet.com, a hernia is any protrusion of a tissue through the wall of the cavity in which it is normally contained.
Hernias are generally categorized according to body region—most commonly the abdomen or groin—and can be further specified depending on the specific location. For example, in the groin area, a hernia may be either inguinal (closer to the scrotum) or a femoral (closer to the thigh).
What Can Cause a Hernia?
It all comes down to pressure on a weak spot, usually as a result of excess strain from:
- Heavy lifting
- Bladder obstruction
- Chronic coughs
Obesity and pregnancy can increase your risk of getting a hernia. In my case, heavy lifting—or as I now call it, "doing something stupid"—caused the protrusion in my femoral wall.
What Type of Hernia Do You Have?
Depending on the location and severity of the protrusion, there are few different types of hernias:
According to The Doctor's Guide to Gastrointestinal Health, an inguinal hernia occurs in "the groin, the area between the abdomen and the thigh. Intestines push through a weak spot in the inguinal canal. This is a triangle-shaped opening (Hesselbach's triangle) between layers of abdominal muscles near the groin."
A femoral hernia is also located in the groin area, but lower down—"at or very near the leg crease." In this case, the gap through which the intestines protrude is a triangular area that's bordered by the inguinal canal, the femoral vein, and the pelvic bone. They are one of the less common types of hernias—accounting for only 3% to 5%—and are more likely to develop in adults than in children, and in women rather than in men.
It is possible to have both hernias at the same time, but it can be difficult to clinically distinguish between the two kinds. However, "finding a painful lump or bulge on the hip crease adjacent to the pubic area suggests a femoral hernia." In layman's terms: if your hernia is well below the bikini line, it's most likely femoral.
If the protrusion can recede through the wall, either through pushing or passively when lying down, it is considered reducible. This is the most common type and usually less painful.
If the protrusion can't recede, it is considered irreducible. You may also hear that a hernia is incarcerated, meaning "trapped" or "imprisoned." An irreducible hernia usually comes with some pain and/or a feeling of illness.
If an irreducible hernia's blood supply is cut off, it is considered strangulated. Femoral hernias are the most likely to become strangulated because of the narrow canal the protrusion passes through. These are generally very painful and tender and are considered a medical emergency. The protruding tissue can die off and interfere with normal digestive function. Symptoms may include pain, nausea, vomiting, and a fever.
All hernias should have prompt medical attention, as they will not heal by themselves. While a reducible hernia is not generally considered an emergency situation, there is a chance that it may become irreducible. It is always best to see a doctor if you suspect you have a hernia.
Not All Lumps Are Hernias
It is normal to feel small lumps at the top of your inner thigh. They are likely lymph nodes that are slightly enlarged. Lymph nodes aren't generally painful unless you press excessively hard on them. If it is painful with even the slightest touch, it can be a hernia.
Signs You May Have a Hernia
According to The Doctor's Guide to Gastrointestinal Health, "People don't always know when they have a hernia. They may get a painful or painless lump that may change with position."
Harvard Health also notes that "some hernias can cause twinges of pain or a pulling sensation, but most do not cause pain. Hernias are usually easier to see with coughing or straining. They also tend to be more prominent with standing and often disappear with lying down. Most people discover their own hernias by noticing a bulge."
How I Discovered My Hernia
It started with a sharp pain in my groin when I was lifting my elderly dog to her feet. A few more weeks of this and I could feel a nagging discomfort in my hip crease. I also had what my doctor kindly called "bladder awareness." I was never sure if I had to go to the bathroom, or if I had emptied my bladder completely, and I had a general ache in my lower abdomen.
I didn't think anything of my symptoms until I found a lump in my hip crease, close to the groin area. Whenever I pushed on it, it would recede, and I would feel a sharp pain and a burning sensation. There was also a twinge everytime I coughed. This was when I decided to go see my doctor.
What to Expect When You See Your Doctor
Examination and Diagnosis of a Femoral Hernia
Your doctor and/or nurse will start by asking questions about your condition. It helps if you can think about your experiences ahead of time so you can clearly explain your condition. It's always a good idea to take notes of things to tell your medical team so you don't leave out anything that might be important or find yourself struggling to remember dates and details.
If this your first visit to this particular doctor, the nurse will likely get a general medical history to start. This will involve a series of questions about your family health history and your personal health, any pre-existing conditions or diseases, any surgeries that you've had, what medications you're taking, allergy information, and so on. Again, it will help if you're prepared to answer these questions. Carrying your prescription medications along with you is often recommended so there's no confusion about what you're taking, at what dose, how often.
Questions Your Doctor May Ask
These are the questions my doctor asked me to help diagnose my hernia. Your doctor may ask slightly different questions.
- Where is the lump?
- How long has it been there?
- How did you discover it?
- Has the lump changed in size or shape since you first noticed it?
- Are you experiencing any pain, and if so, how would you describe it?
- Did you have a bowel movement today?
- Are there any changes in your bathroom habits? For example, are you getting up in the middle of the night to empty your bladder?
- Any other health concerns?
This should give you a sense of what you should be prepared to answer. If you can write down this information and carry it with you to refresh your memory, that will help the doctor make the correct diagnosis more quickly and accurately.
You will likely first be asked to lie down so the doctor can palpate your abdomen. They'll press firmly to check for tenderness any masses in your abdomen that shouldn't be there. Once they locate the lump, they may press on it quite hard to see if it can be pushed back into place. This may feel quite uncomfortable, but it can be an important diagnostic procedure. If it becomes too painful, let your doctor know.
If the lump goes away when you lie down or when the doctor presses on it, you may be asked to turn your head and cough. This is to check whether the lump will reappear.
It is also possible that you will be asked to stand up while the doctor keeps his hand pressed against the lump. This is to help the doctor determine the size and shape of the lump and confirm the diagnosis.
Tip: If you wear loose trousers or shorts, your doctor may be able to examine you properly without you needing to strip down altogether. This can be important if you're the shy type or if the doctor's examining room is too chilly!
Is It Necessary to Have Surgery on a Hernia?
Surgery to repair a hernia is a non-elective but non-emergency procedure. In other words, it has to happen, but it is not life-threatening. It may become an emergency if the hernia is strangulated.
For most of us, however, there will likely be a considerable waiting period before the repair surgery is scheduled. How long will you have to wait for surgery? That depends on your current health situation, where you live, and what surgical resources are available to serve your community.
Here in Canada, I had an appointment for a consultation with a surgeon within two months of the initial diagnosis. The surgery was scheduled within four weeks of that appointment. The total time, from diagnosis to surgery, was just over three months.
"If I Had a Hernia" - A Doctor's Viewpoint
"A hernia is simply a hole and the way we fix it surgically is we want to either close it shut with stitches (the problem with that is they often come back), or we put a plastic mesh on top or underneath."
–Dr. Daniel B. Jones, MD, FACS, of Beth Israel Deaconess Medical Center and Harvard Medical School
This quote is from an InsiderMedicine interview with Dr. Daniel B. Jones. I love how matter-of-fact he was about the condition—it was very comforting to hear those words before going into surgery! In this interview, Dr. Jones goes on to explain what a laparoscopic surgery is and why he prefers that method for hernia repairs.
Recovery From a Femoral Hernia Surgery
Within a few weeks, you'll probably feel a lot better and may forget to take it easy and avoid strenuous activities.
Don't rush it. There's still a risk of reinjuring yourself.
As my doctor explained to me when I took my concerns to him, the repair surgery for a femoral hernia takes place in an area with a lot of tiny nerves, and it will take a longer time for those nerves to heal. I found I was still getting some numbness, tingling, and a dull ache in the incision area for as long as a year after the operation.
Follow all post-surgery instructions very carefully. If you are given a prescription for pain-killers, don't try to act tough. Take the prescription. Pain can actually interfere with the body's ability to heal, so it makes sense to reduce the pain you'll feel in those first few days.
Ask for help with moving around and lifting things. After a short time, you will be given permission to lift smaller items (up to 10 pounds).
It helps not to worry too much. There will be bruising in the area of the surgery, but like with other bruises, an ice pack can help the healing. Don't panic if you feel a lump under the site of incision either. This is scar tissue, and it will gradually go away over the course of a few months to a couple of years.
Most importantly, don't rush to get back to normal before your body is ready!
Can a Hernia Belt Help With a Femoral Hernia?
A number of readers have asked about medical devices or garments, such as a truss or support garment, to hold a femoral hernia in place and reduce the pain or risk of further injury until you're able to schedule a surgery. I had to look into this, and it seems that the jury is still out on wearing a support garment.
Depending on your personal situation (i.e. your weight and size and the precise location of your hernia) and the design of the support garment, your doctor may suggest that you wear a truss or support brief on a short-term basis to help you manage the discomfort. However, some physicians and other medical professionals are firmly against the use of a truss.
There are a few obvious reasons why your doctor may not advise a truss, including the concern that:
- A poorly fitting support garment may put pressure in the wrong area, doing no good and possibly making the hernia pain worse.
- A patient may rely on a truss instead of getting their hernia repaired by surgery, particularly if they don't have health insurance or access to a public health care system.
- Wearing a truss might encourage some patients to be less careful, leading to more strain, more damage to the abdominal wall, and possibly very serious complications such as strangulation.
Risk of strangulation is the most common concern:
"Trusses and surgical belts or bindings may be helpful in holding back the protrusion of selected hernias when surgery is not possible or must be delayed. However, they should never be used in the case of femoral hernias."
Patient UK says:
"In view of the high risk of strangulation, all femoral herniae should be repaired as an elective procedure, but as soon as possible. There is no place for a truss for a femoral hernia."
As always, follow the advice of your own doctor, who is familiar with the details of your particular medical situation.
Do you want to see femoral hernia photographs?
Where to Find Pictures
Photos of hernias, and especially inguinal or femoral hernias, are generally not too family-friendly and may be unpleasant for the general public to view, although most people are undoubtedly curious. Images of femoral hernias will inevitably show more of the body than most want to see on top of the alarming hernia.
I was careful not to include graphic images in this article to avoid repelling readers who are just here to get the information. Instead, I've included links to sources where you can find the photos if your curiosity takes you there. If you're a visual person like me, you want to see what the painful lump actually looks like.
A few not-too-horrible femoral hernia pictures can be seen on SciencePhoto.com—they're a lot safer than what you'll find from a general Google search. There is a benefit in seeing a more realistic image of a physical condition you believe you may be suffering from and not just a drawing or diagram, although a medical illustration better illustrates what body parts are involved.
Remember, we're talking about the groin area, so it is difficult for pictures to avoid showing the patient's private parts. Most photographs also tend to show the extreme cases—very advanced or large hernias. If you're looking for surgical photos, you'll also see the inside of the body—there will be blood, scars, and bruises. With all of this in mind, I don't recommend doing a broad Google image search unless you have a strong stomach!
The National Library of Medicine website, MedlinePlus, has an excellent diagram of a femoral hernia you can look at if you have trouble getting a clear picture of exactly where a femoral hernia is located and what's involved.
The diagram is one of the A.D.A.M. Medical Image Library illustrations, protected by copyright and licensed to Medline by A.D.A.M. Inc. It is similar to the same kind of medical illustrations you may have seen in a high school health or biology class. That means it will be less disturbing to look at than a photograph of a real person with a hernia.
My experiences and the information given here are not intended as a substitute for professional medical advice. I am not a doctor. If you think you may have a hernia, please make an appointment to see your family physician.