Femoral hernia (femoral hernia): Symptoms and treatment

At VenaZiel Hernia Center Berlin (in Kreuzberg at Checkpoint Charlie), we specialize in the diagnosis and treatment of hernias. We offer modern, gentle treatment methods to help you recover quickly. Below you will find out how to recognize a femoral fracture, what causes it, how the treatment works and why you are in the best hands with us in Berlin.

What is a femoral hernia?

A femoral hernia is a type of hernia in which tissue bulges outwards through a weak point in the lower groin area. More specifically, the protrusion occurs below the inguinal ligament on the upper thigh, where blood vessels pass from the abdomen into the leg. A hernia sac emerges through this gap (hernial orifice), which often contains parts of the intestine. From the outside, a femoral hernia may appear as a small swelling or bump on the inside of the thigh. Due to the anatomical conditions, femoral hernias are significantly more common in women than in men.

Overall, femoral hernias are relatively rare (around 5% of all hernias) – by comparison, inguinal hernias make up the majority. A femoral hernia is often initially confused with an inguinal hernia, as both hernias occur in the groin region. The crucial difference is that a femoral hernia is located below the groin, whereas an inguinal hernia occurs in the groin.

Why is a femoral fracture dangerous?

On the one hand, the symptoms can increase and impair quality of life. On the other hand, there is a particularly high risk of intestinal loops becoming trapped in femoral hernias (medical term: incarceration). The hernial orifice in a femoral hernia is usually very narrow, which is why trapped organs are quickly squeezed out. In up to 40% of cases, the hernia is already incarcerated when it is diagnosed.

An incarcerated femoral hernia leads to an interruption of the blood supply in the affected part of the intestine – if left untreated, there is a risk of intestinal obstruction and permanent tissue damage. For this reason, a femoral hernia should be operated on as early as possible, ideally before an incarceration occurs.

Symptoms: How do you recognize a femoral fracture?

The symptoms of a femoral hernia are often subtle and can be similar to other problems. Typical signs to look out for are:

• Protrusion on the upper thigh: A soft bump or swelling below the groin, usually on the inside of the thigh. In overweight people, this protrusion may be difficult to feel or not visible at all.
• Pressure or pulling pain: vague pain in the groin region or in the lower abdomen, which can radiate into the thigh. It often occurs during exertion, e.g. when walking, standing for long periods, coughing or lifting heavy objects.
• Complaints without visible findings: Small thigh fractures in particular initially remain without a visible bump, but become noticeable through groin pain. Women often report non-specific abdominal pain.
• Acute pain due to incarceration: If severe pain suddenly occurs in the groin, possibly with nausea or abdominal swelling, an incarceration may be present. In this case, the protrusion is hardened, painful under pressure and can no longer be pushed back – immediate action is required (emergency).

Please note: A femoral hernia can remain asymptomatic for a long time. In older or obese patients in particular, it is often only discovered when complications arise. You should therefore have unexplained groin or thigh pain investigated by a specialist at an early stage. With a simple physical examination (palpation while standing and pressing) and an ultrasound examination, an experienced surgeon can usually diagnose a femoral hernia with certainty. Occasionally, an MRI/CT is required if the diagnosis is unclear.

Causes and risk factors of a femoral fracture

A femoral hernia is caused by a weak point in the connective tissue of the lower abdominal wall. At the exit point of the leg blood vessels (lacuna vasorum), there is a natural gap under the inguinal ligament, which can become a “hernia” under stress. The following factors favor the formation of a femoral hernia:

• Congenital connective tissue weakness: Some people have weaker connective tissue, especially women due to hormonal influences. Tissue strength decreases with age, so older women are more frequently affected.
• Repeated pregnancies: Repeated pregnancy stretches the abdominal wall and can reduce stability.
• Overweight (obesity): High abdominal girth exerts constant pressure on the abdominal wall.
• Heavy lifting and straining: Regularly carrying heavy loads or pushing hard (e.g. chronic constipation) and chronic coughing increase the intra-abdominal pressure . This puts more strain on the weak points.
• Previous inguinal hernia surgery: Men rarely develop a femoral hernia – if they do, it is often after previous open inguinal hernia surgery. The surgery may have changed something anatomically, which favors a femoral hernia.

Several of these factors often work together. Targeted prevention is difficult, as connective tissue predisposition plays a major role. Nevertheless, it is worth minimizing risk factors: Keep your weight in the normal range, refrain from smoking (reduces coughing and promotes tissue health) and avoid lifting extreme loads. This way you can at least reduce the pressure on the abdominal wall.

Treatment: Femoral hernia surgery (hernia surgery)

A femoral hernia does not heal on its own – surgery is always necessary. Even if the symptoms are mild at first, doctors advise prompt surgery, as an incarceration can occur at any time. The aim of femoral hernia surgery is to bring the contents of the hernia (e.g. intestine) back into the abdominal cavity and to close the hernia gap permanently. This eliminates pain and prevents complications. You can rest assured: Nowadays, hernia operations are part of routine surgery and generally go off without a hitch. Thanks to modern procedures, the relapse rate (recurrence) is very low (only around 1-10%).

Surgical methods

At our hernia center in Berlin, we rely on gentle, minimally invasive techniques whenever possible. Depending on the findings, two procedures are available: the keyhole method (laparoscopic surgery) or open surgery. Both methods are usually performed under general anesthesia.

• Minimally invasive hernia surgery: We operate through 2-3 very small incisions in the skin. We insert a mini camera (laparoscope) and fine instruments through these incisions. The hernia sac is carefully pushed back and the hernial orifice is covered from the inside with a special plastic mesh. The mesh serves to reinforce the tissue so that the hernia does not recur. Methods such as TEP (total extraperitoneal) or TAPP (transabdominal preperitoneal) are established minimally invasive procedures that differ mainly in the access route. With the TEP technique, the abdominal cavity remains closed, with TAPP the peritoneum is opened from the inside – both methods allow safe treatment of the femoral hernia.

  Advantage: The incisions are small, there are hardly any scars and patients usually have less pain and a quick recovery time after the operation. Such an operation takes about an hour and can be performed on an outpatient basis – so you can go home the same day.

• Open surgery: In some cases, open surgery is necessary, e.g. for very large fractures or when minimally invasive techniques are not possible. In this case, a slightly larger incision is made in the groin or thigh to directly expose the fracture.
  The surgeon pushes back the hernia contents and closes the hernia site, often also with a mesh inserted from the outside. The open technique can be performed under regional anesthesia (partial anesthesia), which is advantageous for patients who cannot tolerate general anesthesia.

  Disadvantage: The wound is larger and healing tends to take a little longer. Nevertheless, an open femoral fracture can also be operated on as an outpatient procedure in many cases.

At our practice in Berlin, we perform most femoral hernia operations on an outpatient basis – an inpatient stay in hospital is not necessary. You come to the surgery in the morning and can go home again in the afternoon after sufficient rest and a check-up.

Our experienced team ensures that you are well informed and feel safe during the entire procedure. Of course, we use state-of-the-art medical equipment and gentle anesthetic procedures.

Aftercare and recovery after surgery

Aftercare for a femoral fracture is straightforward. Immediately after the operation, you will remain in our facility for a few hours for monitoring. You will be allowed to get up and walk around carefully on the day of the operation . In the first few days, you should take it easy on the wound area and cool it regularly to keep swelling to a minimum. Light everyday activities are usually possible again after 2-3 days. Pain is normal in the days following the operation, but can be managed well with prescribed painkillers. After minimally invasive surgery, the pain is usually less and the recovery time shorter than after open surgery.

In the following 2-4 weeks, avoid heavy lifting (nothing over 5-10 kg, depending on your doctor’s instructions) and intensive sport. However, walks and light exercises without abdominal presses are beneficial to get the circulation going.

We will send you the exact behavioral tips for after the operation in writing. We will also invite you for a check-up: As a rule, we will see you again around 7-10 days after the procedure to check wound healing and remove stitches (if non-self-dissolving material was used).

If you have any questions or problems, you can of course contact us at any time. The aim of aftercare is for you to make an optimal recovery and return to your everyday life as quickly as possible.

Your advantages at the VenaZiel Hernia Center Berlin

Why go to VenaZiel? Our hernia center in Berlin offers you specialized care for all aspects of thigh hernias – from diagnosis to aftercare. Here are some of your advantages at a glance:

• Experienced hernia specialists:
  At VenaZiel, you will be treated by an experienced team of surgeons who specialize in hernia surgery. We have extensive expertise in the treatment of femoral hernias and other types of hernia.

• State-of-the-art technology & minimally invasive procedures:
  Our equipment meets the highest standards. We use high-tech procedures such as laparoscopic surgery (TEP/TAPP). Gentle, minimally invasive surgical methods allow us to operate on you with as little tissue trauma as possible – for a faster recovery and barely visible scars.

• Outpatient operations:
  All procedures are performed in our outpatient surgery center. For you, this means: no long hospital stay and usually a return home on the same day. You recover in your familiar surroundings and only have to be there for the operation itself.

• Short waiting times & flexible appointments:
  We know that you don’t want to wait weeks for help with a fractured femur. Thanks to our efficient organization, we can offer prompt consultation and surgery appointments. An initial consultation or even an operation is often possible within a short time.

• Personal support:
  You, the patient, are the focus of our attention. From the first consultation to the last follow-up check, you will receive individual care. We take the time to answer your questions and provide you with clear information. Especially if you are anxious about an operation, we will help you with sensitive advice so that you feel that you are in good hands.

• Central location in Berlin-Kreuzberg:
  The VenaZiel Hernia Center is located directly at Checkpoint Charlie in Berlin – conveniently located and easy to reach, even from other districts. Thanks to our central location, we are easy to reach by public transport (U-Bahn Kochstraße, Stadtmitte) as well as by car.

Frequently asked questions about the femoral hernia (FAQ)

How do I notice a femoral fracture?

Small femoral fractures often do not cause any clear symptoms at first. Pay attention to unusual pain in the groin or upper thigh, especially if it occurs during exertion. A palpable lump below the groin is an indication of a femoral hernia. If you are unsure, have yourself examined by a doctor – an ultrasound can provide clarity.

Is a femoral fracture dangerous?

If left untreated, a femoral hernia can become dangerous because there is a risk of incarceration. In the event of an incarceration, for example, a piece of intestine becomes trapped in the hernia and the blood supply is interrupted – resulting in an acute emergency with severe pain.

Without timely surgery, this can lead to an intestinal obstruction or even life-threatening complications. You should therefore never take a suspected femoral hernia lightly.

The good news is that with early treatment (planned surgery), the risk of complications is minimal.

What is the difference between a femoral hernia and an inguinal hernia?

Both types of hernia occur in the groin area and are therefore easily confused. The inguinal hernia occurs directly in the groin and is very common in men, but rather rare in women.

A femoral hernia occurs below the groin on the thigh and mainly affects women. An inguinal hernia often feels like a pulling pain with a bulge in the groin, whereas a femoral hernia can lead to deeper pain in the thigh.

The decisive factor is: Both fractures should be operated on, as both have a risk of incarceration. The surgical techniques are similar. Your doctor can determine which hernia is involved during an examination. Sometimes an inguinal and femoral hernia coexist (especially in older patients).

Does every femoral fracture require surgery?

Yes, the only sensible treatment for a femoral hernia is surgery. Unlike some umbilical hernias, for example, which can remain small and asymptomatic, a femoral hernia almost always tends to worsen. Conservative measures (such as hernia bands) are not a permanent solution.

As a femoral fracture does not heal spontaneously and the risk of sudden incarceration is high, doctors advise surgery in practically all cases.

How is a femoral hernia operated on? Does the operation hurt?

The procedure is performed under general anesthesia so that you do not feel any pain during the operation. The surgeon puts the expelled abdominal contents back in place and reinforces the hernia site with a mesh to prevent the hernia from recurring.

Depending on the situation, this is done minimally invasively (keyhole surgery) through a few small incisions or openly through a slightly longer incision. Both methods take around 45-60 minutes. Thanks to modern anesthesia, you will wake up gently.

Wound pain may occur after the operation, but this is treated with painkillers. Many patients are surprised at how tolerable the discomfort after hernia surgery is today.

Is the femoral hernia operation performed on an outpatient basis?

In our hernia center, yes. We usually perform thigh hernia operations on an outpatient basis. This means that you can go home on the same day. Outpatient surgery is possible because the procedure is relatively short and complications are rare. Of course, you will stay with us for a few hours for monitoring.

If an overnight stay is necessary for medical reasons (very rare), we will organize this for you – but this is not usually necessary.

The advantage of outpatient surgery is that you can recover at home afterwards and do not have to stay in a clinic.

How long does it take to heal and when can I go back to work?

The healing time depends on the surgical procedure and your personal constitution. In the case of minimally invasive surgery, many patients are able to return to work after one to two weeks, provided their job does not involve heavy lifting.

Physical rest (no heavy lifting, no straining) is recommended for about 4 weeks. Office work can often be resumed after 7-10 days, heavier physical work after approx. 4-6 weeks – discuss this individually with your doctor.

It is important to listen to your own body: start with light activities and increase slowly. Most everyday activities (walking, climbing stairs, light housework) are possible again after just a few days.

You should only resume sports such as jogging or fitness once you have been cleared by your doctor (usually after 4-6 weeks).

What do I need to consider after a femoral hernia operation?

Avoid anything that puts pressure on the abdominal wall in the first few weeks: heavy lifting, intensive pushing during bowel movements (ensure soft stools, e.g. by eating a high-fiber diet), coughing vigorously (it is therefore advisable to stop smoking).

Care for the wound according to the instructions – keep it clean and dry, change plasters as recommended. Light showers are usually permitted after 2-3 days, bathing only after the wound is completely closed. If necessary, wear a special support bandage or bandage if prescribed by us.

Listen to your body: pain is a warning signal, do not overexert yourself. If redness, swelling or fever occur, contact us immediately.

As a general rule: The best way to recover after a femoral hernia operation is with sufficient rest, a balanced diet and moderate exercise in a pain-free environment – this is the best way to promote healing.

Does the health insurance company cover the costs of the operation?

Yes, hernia operations are generally covered by health insurance as they are medically necessary procedures. If you are covered by statutory health insurance, you will be billed as usual by your health insurance provider (only the statutory co-payment will be charged, if necessary).

Privately insured persons receive an invoice in accordance with the scale of fees for doctors, which is usually reimbursed in full by the private health insurance company. If you are a self-payer, we will provide you with a cost estimate in advance.

The preliminary examinations (consultation, ultrasound, etc.) are also covered by health insurance. Please do not hesitate to contact us if you are unsure about the costs – we will be happy to advise you in detail.

Can a femoral hernia be prevented?

A femoral hernia cannot be prevented with certainty, but you can take some preventative measures. It is important to strengthen the connective tissue and not put unnecessary strain on it: maintain a healthy body weight, eat a diet rich in vitamins and minerals (for good collagen in the tissue) and do moderate exercise to strengthen the abdominal muscles.

Avoid chronic straining – a high-fiber diet or mild laxatives can help with constipation, while the cause of a chronic cough should be treated.

Lift loads with care: preferably from a squatting position with a straight back to reduce the pressure on the groin. These measures can reduce the risk, but are no substitute for any necessary treatment of existing hernias.

If you have risk factors (e.g. weak connective tissue in the family), have yourself examined regularly – this way, a developing hernia can be detected early.

Contact us: Your femoral hernia treatment in Berlin-Kreuzberg

A femoral hernia is not a fate you have to resign yourself to – we will be happy to help you live a pain-free life again. Contact the VenaZiel Hernia Center Berlin to discuss your individual situation.

Whether it’s an initial examination, a second opinion or a planned operation: we will advise you personally and competently. You can reach us by phone during our consultation hours or request an appointment online at any time.

Our practice is centrally located in Berlin-Kreuzberg, at Checkpoint Charlie – so we are easily accessible from all over Berlin. Make an appointment now and let our experienced team look after you. We look forward to helping you and welcoming you to the VenaZiel Hernia Center soon!