Although both femoral hernia and inguinal hernia are types of hernias that occur in the groin area, they are separated by some fundamental differences. The most distinct difference is their anatomical location; inguinal hernias are above the inguinal ligament, while femoral hernias are below it. There are also significant differences in their frequency, gender distribution (inguinal hernia is more common in men, femoral hernia in women), risk of developing complications (femoral hernia is riskier), and the urgency of treatment approaches.
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What Are the Basic Definitions of Femoral Hernia and Inguinal Hernia Types?
Inguinal hernia, medically known as inguinal hernia, is the protrusion of intra-abdominal tissues through the inguinal canal. The inguinal canal is like a natural tunnel in our groin, through which different structures pass in men and women. Inguinal hernias are quite common.
Femoral hernia, or femoral hernia, is the protrusion of intra-abdominal tissues through the femoral canal just below the inguinal ligament. The femoral canal is a narrow passage next to the main blood vessels going to the leg. Femoral hernias are much less common than inguinal hernias.
What Does Hernia Entrapment Mean in Femoral and Inguinal Hernias?
The condition of the hernia is also important. If the protruding tissue can be pushed back inside manually or on its own, it is called a “reducible” hernia. This is usually less dangerous.
However, if the herniated tissue is trapped outside and cannot be pushed back in, this is called an “incarcerated” hernia. If this entrapment also cuts off the blood supply to the tissue, the situation becomes much more serious. This is called a “strangulated” hernia. Strangulation can lead to tissue death and is a life-threatening condition that requires emergency surgery. This risk creates an important difference between the two hernia types.
Where in the Body Do Femoral and Inguinal Hernias Occur?
The clearest distinguishing feature between the two hernias is their location in the body. In our groin area, there is a strong ligament running from the pelvic bone to the pubic bone, called the inguinal ligament. This structure helps us determine the location of the hernias.
Inguinal hernia usually appears above the inguinal ligament. The swelling can extend downwards, into the scrotum in men or the external genitalia in women.
Femoral hernia, however, is located below the inguinal ligament. The swelling is usually felt in the upper inner thigh, close to the groin crease. This difference in location is very important for diagnosis.
What Do the Inguinal Canal and Femoral Canal Mean in Relation to Femoral and Inguinal Hernias?
The inguinal canal is a natural passage between the layers of the abdominal wall. In men, the spermatic cord related to the testicles passes through here, and in women, the round ligament that supports the uterus passes through. Inguinal hernias originate from this canal.
The femoral canal, on the other hand, is a narrow space just below the inguinal ligament, next to the main blood vessels going to the leg (femoral vessels). Normally, lymph vessels pass through here. Femoral hernias develop toward this narrow canal. The narrowness of the canal explains why femoral hernias are more likely to become trapped.
How Common Are Femoral and Inguinal Hernias?
There is a significant difference in the frequency of these two hernias. Inguinal hernias are quite common. About three-quarters of all groin hernias are inguinal hernias. About 25% of men and only 2-3% of women may experience an inguinal hernia in their lifetime.
Femoral hernias are much rarer. Only 3-5% of all groin hernias are femoral hernias. Thus, femoral hernia is much less common than inguinal hernia.
Do Femoral and Inguinal Hernias Differ in Frequency by Gender?
Yes, their gender distribution is completely opposite. Inguinal hernias are much more common in men than women. Nearly 90% of all inguinal hernias occur in men. This is usually due to a potential weakness along the path of testicular descent in men.
Femoral hernias, on the other hand, are significantly more common in women than in men. About 70% of all femoral hernia cases occur in women. The wider pelvic structure in women is thought to create a more prone environment for herniation in the femoral region. However, it should be noted that if a woman has a groin swelling, the most common cause is still inguinal hernia.
Are There Common Risk Factors for Femoral and Inguinal Hernias?
Yes, there are some common conditions that facilitate the formation of both types of hernias. The main one is any kind of straining that increases intra-abdominal pressure. For example, prolonged severe coughing, constant straining due to constipation, or lifting heavy objects increase the risk.
Aging is another common factor. As we age, our tissues naturally weaken, which can lead to hernia formation. Having a family history of hernia can also slightly increase the risk. Smoking is a risk factor for both types of hernias, as it can cause persistent cough and impair tissue healing.
What Are the Specific Risks for Inguinal Hernia?
The most important cause of inguinal hernias, especially the indirect type, is a congenital condition. In male infants, the testicles descend through a canal during development in the womb, which should close after birth. If it does not close, a hernia may develop from this area. Since this is much more common in males, inguinal hernia is also more common in men.
The direct type of inguinal hernia, on the other hand, usually occurs as the abdominal wall muscles weaken with age. Therefore, male gender is a significant risk factor for inguinal hernia.
What Are the Most Common Symptoms of Femoral and Inguinal Hernias?
The most frequent symptom in both types of hernia is a swelling or lump in the groin or thigh area. This swelling usually becomes more noticeable when standing, coughing, or straining, and may disappear when lying down.
Additionally, there may be pain, discomfort, burning, stabbing, or a sense of pressure in the groin area. These complaints generally increase with movement or exertion. However, it should be remembered that some hernias may not cause any symptoms initially, meaning they can be painless. Femoral hernias are somewhat more likely to be painless.
Does the Location of Swelling Differ in Femoral and Inguinal Hernias?
Yes, the exact location of the swelling is the most helpful sign in distinguishing these two types of hernias.
The swelling of an inguinal hernia is usually above the inguinal ligament. It is located on the inner side of the pubic tubercle and may extend downward into the scrotum in men or the labia in women.
The swelling of a femoral hernia, however, is below the inguinal ligament. It is found in the upper inner thigh, near the groin crease, and is usually outside the pubic tubercle. This positional difference is the most important point observed during examination.
What Symptoms in Femoral and Inguinal Hernias Require Emergency Medical Attention?
Symptoms that arise when a hernia becomes trapped or strangulated must be taken very seriously. These are situations that require emergency medical attention. Warning signs include:
- Sudden onset and increasing severe pain.
- Nausea and vomiting.
- Abdominal bloating.
- Inability to pass gas or have a bowel movement.
- Redness, bruising, or darkening in the color of the hernia swelling.
- The swelling becoming very hard, extremely tender, and not reducible.
- Fever.
If any of these symptoms are present, it is vital to seek emergency care immediately. Any delay can be very dangerous.
How Do Doctors Diagnose Femoral and Inguinal Hernias?
Hernia diagnosis is usually made through a physical examination by the doctor. The doctor first listens to your complaints, asks when they started, how they occur, and what makes them better or worse. Then, the groin area is carefully examined.
During this examination, the doctor inspects and palpates the groin both while you are lying down and standing. You may be asked to cough or strain. If there is a hernia, it will become more prominent and the doctor can feel it. Determining whether the swelling is above or below the inguinal ligament provides an important clue about the type of hernia.
When Are Imaging Methods Needed in the Diagnosis of Femoral and Inguinal Hernias?
Most of the time, a doctor’s examination is sufficient for diagnosis. However, in some cases—such as when the diagnosis is unclear, the patient is very overweight making examination difficult, or there is suspicion that the hernia is trapped or strangulated—imaging methods may be needed.
The most commonly used method is ultrasound. This test uses sound waves, is harmless, and easily accessible. It is quite successful in showing the hernia and its type. In more complex cases or when other problems are suspected, more detailed imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary.
Is There a Difference in the Risk of Strangulation Between Femoral and Inguinal Hernias?
Yes, and this is a very important difference. The risk of strangulation in femoral hernias is much higher than in inguinal hernias. According to various studies, 15-20% of femoral hernias—or in some long-term follow-ups, up to 45%—result in strangulation.
In inguinal hernias, this risk is much lower, usually around 1-3%. This significant risk difference fundamentally changes the treatment approach for the two types of hernias. The high risk of strangulation makes femoral hernia a much more dangerous condition.
Why Is Femoral Hernia Considered More Risky Compared to Inguinal Hernia?
The main reason femoral hernia is riskier is anatomical. Femoral hernias emerge through the femoral canal, which is a narrow space surrounded by firm tissues. This narrow passage makes it easy for the hernia contents (such as a segment of intestine) to become trapped and for the blood supply to be cut off, resulting in strangulation.
The inguinal canal, on the other hand, is generally wider and the likelihood of hernia contents becoming trapped is lower. This anatomical difference increases the need for urgent surgery and the general danger associated with femoral hernias.
Are the Treatment Approaches for Femoral and Inguinal Hernias the Same?
No, treatment approaches are distinctly different. The main difference stems from the risk posed by the hernia.
Due to the high risk of strangulation, femoral hernia treatment is almost always surgical, and this surgery needs to be performed as soon as possible. Waiting is risky.
For inguinal hernias, the situation is somewhat different. If the hernia is causing symptoms (pain, discomfort) or growing, surgery is recommended. However, in men with asymptomatic or very mild hernias, a “watchful waiting” approach under doctor supervision can be considered. This option is generally not recommended for women.
How Is Femoral Hernia Treated in the Context of Femoral and Inguinal Hernias?
When a femoral hernia is diagnosed, there is usually no room for delay due to the high risk of complications. The treatment is surgical, and the operation should be scheduled as an emergency or at least very soon.
The aim is to repair the hernia and prevent the dangerous complication of strangulation. Non-surgical methods such as hernia belts are not effective or recommended for femoral hernias. The keyword in treatment is “urgency.”
What Are the Treatment Options for Inguinal Hernia in the Context of Femoral and Inguinal Hernias?
There are two main options in the treatment of inguinal hernia.
- The first is surgical treatment. If the hernia is causing pain, discomfort, affects daily life, or is growing, surgery is recommended. Surgery is the only permanent way to treat a hernia.
- The second option is watchful waiting, which can be considered only in men who have no symptoms or only very mild symptoms. In this approach, the patient is not operated on but is monitored regularly by a doctor. If symptoms appear or the hernia grows, surgery is planned. This option is generally not recommended for women.
What Surgical Techniques Are Used for Femoral and Inguinal Hernias?
Hernia surgeries are generally performed using two main techniques today.
- In the open surgery method, the hernia is repaired through a single incision made in the groin area. A synthetic mesh is usually used to strengthen the weak area in the abdominal wall.
- In the minimally invasive (laparoscopic or robotic) surgery method, the repair is performed through several small holes made in the abdominal wall using a camera and special instruments. Mesh is also usually used in this method. The advantages of minimally invasive surgery include less pain, faster recovery, and smaller scars. Deciding which method is most appropriate should be done in consultation with your doctor.
Can There Be Other Causes of Groin Swelling Besides Femoral and Inguinal Hernias?
Yes, not every swelling or pain in the groin area is a hernia. Swelling of lymph nodes in this region (due to infection or other causes), benign fatty tumors (lipomas), cysts, vascular enlargements (such as varicocele), or fluid accumulation in the scrotum (hydrocele) can cause similar symptoms.
Op. Dr. Ahmet Bekin was born in Istanbul in 1983. He graduated from the Faculty of Medicine at Kocaeli University in 2006 and completed his specialty training in the Department of General Surgery at Istanbul University Çapa Faculty of Medicine in 2011. After his specialization, he worked in the fields of hernia surgery, reflux surgery, obesity surgery, advanced laparoscopic surgery, and robotic surgery. In addition, he received training in endocrine surgery, oncological surgery, and minimally invasive surgery. He is currently accepting patients from Turkey as well as from countries such as Germany and France at his private clinic located in Istanbul.
