Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Hernias are commoner in men. That single fact delays a lot of diagnoses in women.
Groin pain in a woman is often put down to the ovaries, to the hip, or to a pulled muscle. A hernia is thought of late, or not at all.
The pattern is well described. It matters, because the hernias women get are the ones most likely to trap bowel.
Femoral hernias are much commoner in women. A femoral hernia comes out below the inguinal ligament. It passes through a narrow, rigid ring. That narrow neck is what makes it dangerous. Bowel gets trapped in it far more readily than in a groin hernia above the ligament. A good number are first seen as an emergency, with the bowel already blocked.
There is often no obvious lump. Groin hernias in women are often small, deep and hard to feel. That is most true in the femoral position. No visible bulge is weak evidence against a hernia here.
Pain may be the only symptom. A dragging or aching groin pain. Worse on standing, or at the end of the day. Nothing to see.
Other diagnoses get there first. An ovarian cyst, endometriosis, a hip problem and an adductor strain all cause groin pain. All are fair first thoughts. The error is stopping at one of them without examining for a hernia.
Swollen round ligament veins in pregnancy can look very like a groin hernia. They are managed quite differently. A scan tells them apart.
Inguinal and femoral hernia side by side
| Inguinal hernia | Femoral hernia | |
|---|---|---|
| Where it comes out | Above the inguinal ligament | Below it, through a narrow, rigid ring |
| Who gets it | Commoner in men | Proportionally far commoner in women |
| What you see | Usually a lump that goes back on lying down | Often nothing to see at all |
| Main symptom | A bulge, with a dragging ache | Groin pain, worse by the end of the day |
| Risk of trapping bowel | Lower, especially with a wide neck | Much higher. The ring will not stretch |
| Usual plan | Repair, or watch a small symptomless one | Repair when it is found |
Groin pain without a lump still deserves an examination for a hernia. Bring any imaging you already have.
The femoral spot is hard to judge from the front. It is often only found during the operation itself. So going in from behind, by keyhole or robotic surgery, has a real advantage in a woman with a groin hernia.
From behind, every opening of the groin is seen in one view. The indirect, the direct, the femoral and the obturator. Hernias in more than one of them are not rare. An approach that only shows the one you expected will miss the one you did not.
This is also why a femoral hernia in a woman is repaired rather than watched. The case for watching rests on a low risk of trapped bowel. That case does not hold here.
Umbilical hernias are common after pregnancy, as the abdominal wall stretches and the umbilical ring widens. Many are small and cause no symptoms.
Separation of the rectus muscles is not the same thing as a hernia, although the two do occur together. A midline bulge on sitting up is usually this rather than a defect, and it is treated differently.
Incisional hernias through a caesarean scar do happen, more often where the wound became infected or opened up.
Where further pregnancies are planned, timing is a real consideration and worth discussing openly. A repair done before a pregnancy is then loaded by that pregnancy.
Less common than in men, but far from rare. The important difference is that a groin hernia in a woman is proportionally more likely to be femoral, which carries a higher risk of obstruction.
Yes. Groin hernias in women are often small and deep. Femoral hernias in particular can produce pain with nothing obvious to see or feel. Imaging is used where the examination is not conclusive.
It passes through a narrow, rigid opening, so the contents get trapped and lose their blood supply more readily. For that reason femoral hernias are generally repaired when diagnosed, rather than watched.
Often it is separation of the rectus muscles rather than a true defect, although the two can occur together. Examination and, where needed, an ultrasound tell them apart. The treatment differs.
It depends on the symptoms, the type of hernia, and how soon a pregnancy is planned. A repair placed before a pregnancy is then loaded by it. So the timing is worth deciding deliberately rather than by default.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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