Many people think of men when talking about groin hernias, but women can absolutely get them too. While they are more common in men, we diagnose and treat hernias in women daily.
Hernias in women may be misdiagnosed or mistaken for gynecological conditions such as ovarian cysts, endometriosis, or musculoskeletal pain.¹ There are also different types of hernias that can occur and understanding these sometimes subtle differences is crucial for accurate diagnosis and effective treatment.²
Key points:
The difference between inguinal and femoral hernias – Women develop both types of groin hernias, but femoral hernias are more common due to differences in pelvic anatomy.³ Both represent a hole in the abdominal wall at a natural point of weakness or space that is supposed to exist for other structures to pass through. Femoral hernias have a higher chance of trapping bulging hernia contents and therefore can be more dangerous until they are repaired.⁴
Risks of hernias in women – Pregnancy and structural differences in ligaments and connective tissues influence hernia formation in women.⁵
Symptoms & Treatment – Hernias in women (as in men) can have varying severity of symptoms, or they may have no symptoms at all. When symptomatic, groin hernias can cause pain, pressure, and less commonly, changes in urination or bowel movements.⁶ They often require surgical repair, especially femoral hernias, which are best treated with mesh placed behind (or internal to) the layer where the hernia hole is located.7,8
Inguinal Hernias in Women
Inguinal hernias occur when tissue, such as fat or intestine, pushes through a weak spot in the lower abdominal wall (the groin).9 Women have a structure in the groin called the round ligament, which helps support the uterus. The round ligament travels through the inguinal canal. Inguinal hernias occur when the inguinal canal increases in size over time and contents from the abdominal cavity bulge through alongside the round ligament.10
Femoral Hernias in Women
Women are more likely to develop femoral hernias than men due to the wider shape of the female pelvis.11 Femoral hernias occur lower in the groin, where tissue protrudes through the femoral canal, alongside the femoral blood vessels and nerve. Femoral hernias are more likely to become incarcerated (stuck), and therefore surgery is typically recommended to prevent strangulation (loss of blood supply to the bowel).⁴
How Pregnancy Increases Hernia Risk
Pregnancy may increase the risk of developing a hernia due to hormonal changes, increased abdominal pressure, and stretching of tissues in the abdominal wall that can lead to weaknesses and eventual defects.12 Hernias may develop during or after pregnancy. Some women have small, asymptomatic hernias that worsen during or after pregnancy.
Sometimes, there is no identifiable cause for hernias. Genetics, prior abdominal surgeries, other medical conditions, and certain exercise habits may increase the risk.13
Symptoms of Groin Hernias in Women
Recognizing a hernia can be difficult because symptoms often overlap with other conditions like ovarian cysts, hip pain, or core muscle injuries.¹
- Pain or Pressure in the Groin – Aching, burning, or sharp pain in the groin, especially when standing, coughing, or exercising. Discomfort that goes away when lying down flat may be especially characteristic of a hernia.⁶
- Bulging – A bulge or lump in the groin that is present when standing and disappears when laying down. Sometimes, the bulge is present all the time. It is important to have an exam by a hernia specialist as these may be misdiagnosed.²
- Changes in Urinary or Bowel Habits – While these changes are not commonly associated with hernias, if parts of the bladder or colon are contained in the hernia, there may be increased constipation or difficulty fully emptying the bladder.14
Treatment Options for Women with Hernias
Hernia treatment depends on the type, severity, and symptoms. If you suspect you may have a hernia, be sure to seek an evaluation from a qualified specialist right away to determine the safest treatment plan. If you have emergent symptoms—such as severe pain, fever, nausea, and vomiting—seek emergency medical care right away.⁴
- Watchful Waiting – Some small, painless hernias may be monitored after initial evaluation by a specialist, but femoral hernias almost always require surgery. When watchful waiting is appropriate, wearing a support belt and strengthening core muscles may slow hernia progression.⁷
- Surgical Repair – Surgery is most often the safest solution for symptomatic hernias. The open preperitoneal repair is a preferred option due to femoral and inguinal coverage along with very low recurrence rates.15 The Shouldice (non-mesh) repair is a great option for inguinal hernias but not for femoral hernias.16,17
- Post-Surgery Recovery – Most patients return to normal activities within a few weeks after surgery. Physical therapy and personalized strength coaching may help strengthen the core and prevent recurrence.
References:
1. Zendejas B, Ali SM, Heller SF, et al. Femoral hernias in women: diagnostic pitfalls and management. Am Surg. 2011;77(12):1590-1594.
2. Chan G, Chan CK. Surgical anatomy and clinical relevance of the inguinal canal. Anat Res Int. 2015;2015:1-7.
3. Fitzgibbons RJ Jr, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-763.
4. Dahlstrand U, Wollert S, Nordin P, et al. Emergency femoral hernia repair: a study based on a national register. Ann Surg. 2009;249(4):672–676.
5. Humes DJ, Lobo DN. Hernias. BMJ. 2008;336(7638):269–272.
6. Liem MS, van der Graaf Y, van Steensel CJ, et al. Risk factors for inguinal hernia in women: a case-control study. Eur J Surg. 1997;163(4):273-277.
7. Köckerling F, Bittner R, Jacob DA, et al. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015;29(12):3750–3760.
8. Andresen K, Bisgaard T, Kehlet H, Wara P, Rosenberg J. Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. JAMA Surg. 2014 Aug;149(8):853-7. doi: 10.1001/jamasurg.2014.177. PMID: 25007246.
9. Jenkins JT, O’Dwyer PJ. Inguinal hernias. BMJ. 2008;336(7638):269–272.
10. Amato B, Moja L, Panico S, et al. Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2012;(4):CD001543.
11. Burcharth J, Pedersen M, Bisgaard T, et al. Nationwide prevalence of groin hernia repair. PLoS One. 2013;8(1):e54367.
12. Antoniou SA, Pointner R, Granderath FA. Current treatment concepts for groin hernias in women. World J Surg. 2011;35(8):1789–1795.
13. Kulacoglu H. Current options in inguinal hernia repair in adult female patients. Acta Chir Belg. 2010;110(3):281–287.
14. Andrén-Sandberg A. Groin hernias and urinary symptoms: diagnostic challenges. Scand J Urol Nephrol. 2002;36(1):56–60.
15. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1(1):15–21.
16. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.
17. Köckerling F, Koch A, Lorenz R. Groin Hernias in Women-A Review of the Literature. Front Surg. 2019 Feb 11;6:4. doi: 10.3389/fsurg.2019.00004. PMID: 30805345; PMCID: PMC6378890.
About Boston Hernia
Dr. Michael Reinhorn and Dr. Nora Fullington are leading specialists in inguinal hernia and umbilical hernia surgery. Their mission is simple- to provide better outcomes to patients needing hernia surgery. They achieve this by using evidence-based surgical methods and approaching abdominal core health holistically. Together with their skilled physician assistant teams, they provide a one-of-a-kind focused practice designed to provide a superior patient experience. They perform approximately 1,000 hernia surgeries each year, offering a tailored approach to anesthesia, consideration of mesh vs no-mesh repairs, laparoscopic and open surgery, and non-surgical interventions. Boston Hernia contributes to the continuous advancement of hernia care by tracking patient outcomes, participating in mission-driven organizations, lecturing across the U.S., and publishing medical literature. In addition to serving the greater Boston area at our offices in Wellesley, MA and Derry, NH, we accommodate out of state patients with long-distance scheduling.
