About 1 in 10 patients with an inguinal hernia in our practice are women. This ratio is consistent with the fact that 27% of men and 3% of women will get an inguinal hernia in their lifetime. There are slight differences between men and women in terms of symptoms, groin anatomy, hernia types, and hernia surgery.
Hernia symptoms in women
In our experience, men and women present with almost the same symptoms from an inguinal hernia. A visible bulge is the most common complaint, often times associated with pain or discomfort. Some women have a bulge without much discomfort. In these patients, an evaluation by a hernia surgeon is most helpful in making a diagnosis and coming up with a treatment plan. Some women have groin pain without an associated bulge. In our experience, these symptoms are often due to musculoskeletal injuries. A consult with a hernia specialist can help to distinguish between these two diagnoses.
Types of groin hernias in women
There are three types of groin hernias in men and women: indirect inguinal hernia, direct inguinal hernia, and femoral hernia. Indirect inguinal hernias are the most common hernia types in both men and women. Femoral hernias, however, are much more common in women than men. While only 2-3% of men have femoral hernias, in our experience, women have femoral hernias more than 10% of the time. Femoral hernias are much more likely to cause an emergency situation. This is because the defect that allows abdominal contents to pop out of the abdominal cavity is very small. Therefore, femoral hernias are more likely to become incarcerated or even strangulated. An incarcerated hernia occurs when the contents are stuck out of the abdominal cavity. This can turn into an emergency if the hernia loses blood supply, or becomes strangulated. In our practice, we find that more women than men present with femoral hernias that are chronically incarcerated. In this situation, patients typically present with a lump or swelling that does not fully go away when lying flat. Often this lump is just below the groin crease and just on the inside of the big blood vessels that travel through the leg. High volume hernia surgeons can typically distinguish between a femoral hernia and an inguinal hernia by physical exam.
Types of groin hernia in women
Recently published international guidelines suggest that posterior mesh placement for groin hernias is best for both men and women. Mesh can be placed posteriorly either laparoscopically under general anesthesia, or under local anesthesia as we do in our fast recovery procedure. These approaches are especially effective in femoral hernia where the traditional mesh approach neglects a femoral hernia completely.
Recent media attention, and patient experience suggest that a small subset of patients will have chronic groin pain after mesh hernia surgery, and in our experience women are slightly more likely to “feel” their mesh, or experience discomfort that can last for weeks or months.
While chronic groin pain is very uncommon after our fast recovery, posterior mesh repair, we feel that the decision to implant mesh is a personal one. Many women prefer to try a non-mesh repair as their first choice as a way of avoiding mesh initially. For this reason, we feel that a Shouldice repair, which addresses indirect, direct and femoral hernia is the ideal no mesh repair. While hernia literature suggests that the recurrence rate for non-mesh repairs is significantly higher than with mesh repairs, we feel this is not the case in high volume groin hernia clinics like ours. We try to tailor our recommendations to each women’s needs and concerns when it comes to inguinal hernia surgery.
Women sometime experience a slight increase in discomfort after inguinal hernia surgery because a small tube (round ligament) is often cut in order to place the mesh properly. This does not lead to any long term issues, but may lead to slight increase in short term pain, and temporary numbness along the groin, inner thigh and upper part of the labia.
Umbilical hernia in Women
Women are often more likely to develop belly button (umbilical hernia) then men, mostly due to pregnancy. Since pregnancy contributes to umbilical hernias more than most other conditions, repairing umbilical hernias in women can be looked at slightly differently than in men. For this reason, we offer no mesh surgery to women who have small umbilical hernias and are not overweight.
Diagnosing inguinal hernias in men is not that different, read more about our thought process.