Inguinal and Femoral Hernias: Understanding the Condition That Many Delay Seeking Treatment For

John is 58 years old, has worked as a laborer for decades, and a few months ago began noticing a small lump in his right groin. At first, he barely noticed it, and the swelling would disappear when he lay down. Over time, the sensation of heaviness and discomfort increased, especially at the end of a long work day. Embarrassed, he kept postponing the appointment, thinking it "wasn't anything serious." When he finally sought care, his doctor confirmed it: it was an inguinal hernia. John was relieved to learn there was a solution. But he also had a reasonable question: why did it take so long to seek help?

John's story is far more common than it appears. And that's exactly what I want to talk with you about today.

What is a hernia?

Imagine the abdominal wall as a sturdy mesh that keeps all internal organs in the right place. When this mesh has a weak spot, whether from genetic inheritance, repetitive strain, or other factors, part of the abdominal contents can "escape" through this opening. That is a hernia.

In the case of inguinal and femoral hernias, this escape occurs in the groin region, which is the fold between the belly and the thigh.

Inguinal hernia

The inguinal hernia is the most common of all hernias. It occurs when part of the intestine or abdominal fat passes through a channel in the groin wall called the inguinal canal. This channel exists naturally in our body, but when the surrounding musculature loses strength, it becomes an unwanted exit.

Femoral hernia

The femoral hernia is less common and appears slightly lower, passing through a space called the femoral canal, near the blood vessels of the leg. It is more frequent in women, especially after pregnancies, and tends to be smaller, which doesn't mean it's less concerning. On the contrary: the risk of complication is greater because the space through which it passes is narrower.

What are the symptoms?

The most classic sign is a visible bulge or lump in the groin region. This lump can appear and disappear depending on body position: it tends to appear when standing, coughing, sneezing, straining, or carrying weight, and may disappear when the person lies down.

In addition, a person may feel:

  • Sensation of heaviness or pressure in the groin
  • Discomfort or pain when rising, squatting, straining, or at the end of the day
  • Sensation of "pulling" in the region
  • In men, discomfort that radiates to the testicle on the affected side

In some cases, especially early on, the hernia doesn't hurt at all. That's why many people delay seeking help, thinking that if it doesn't hurt, it doesn't need attention. This is a mistake that can be costly.

Who is at greater risk of developing one?

Hernias don't pick and choose, but there are factors that significantly increase the chances of developing them:

Male sex
The inguinal canal in men is anatomically wider, making them much more susceptible to inguinal hernia. It is estimated that men have 10 times more chances of developing this type of hernia than women.

Advanced age
With aging, muscle fibers and supporting tissues naturally lose elasticity and strength.

Family history
If a close relative had a hernia, your chances are greater. There is an important genetic component in the quality of the connective tissue that forms the abdominal wall.

Intense and repetitive physical exertion
Those who carry weight frequently, do heavy lifting, or work in positions that increase abdominal pressure are more exposed. It's not that exertion causes the hernia from scratch, but it accelerates the process in those who already have a predisposition.

Chronic constipation
Frequent straining to have a bowel movement increases pressure inside the abdomen repeatedly over the years.

Chronic cough
Lung diseases such as COPD or heavy smoking, which cause persistent cough, also increase this pressure continuously.

Obesity
Excess weight constantly overloads the abdominal wall.

Multiple pregnancies
Pregnancy, especially when it occurs more than once, stretches and weakens the abdominal and pelvic musculature, which explains why women have a higher risk of femoral hernia.

Previous surgery in the region
Any procedure that has already passed through the abdominal wall can create points of weakness.

Is a hernia always a pathological condition?

Yes. Unlike conditions that may be natural and not require treatment, a hernia is always a structural change, a real point of weakness in the abdominal wall. It will not resolve on its own, will not disappear with medication, and will not improve with specific exercise.

This doesn't mean that every hernia represents an immediate emergency. There are cases where the hernia is small, causes no relevant symptoms, and can be monitored clinically for some time, with the doctor evaluating whether the patient's surgical risk at that moment is greater than the risk of waiting.

But the fact is that hernias have a natural tendency to grow over time. And the larger it is, the more difficult the surgery and the greater the risk of complications.

Is surgery always necessary?

This is one of the questions I hear most often in my office, and the honest answer is: in most cases, yes, surgery is the only definitive treatment for a hernia.

There is no medication that closes a hernia. There is no exercise that repairs the torn tissue. Abdominal binders and bands help contain discomfort in the short term, but they don't treat the problem.

The decision to operate or monitor depends on a series of factors that the doctor will evaluate individually:

  • Size of the hernia
  • Symptoms present
  • Patient's clinical conditions
  • Surgical risk
  • Presence or absence of complications

Incarceration and strangulation

And speaking of complications, there is a situation that transforms the hernia into an immediate emergency: incarceration and strangulation.

Incarceration occurs when the content that escaped through the hernia becomes trapped and can no longer return inside the abdomen. Strangulation is the next step: the trapped intestine has its blood supply compromised, which can lead to necrosis (tissue death) within a few hours. This is a surgical emergency.

When to seek urgent care?

There are signs that don't allow waiting. Seek immediate care if you notice:

  • The hernia lump became hard, did not go back in, and doesn't disappear when you lie down
  • Sudden, intense pain in the region
  • Nausea, vomiting, or fever associated with groin discomfort
  • Redness or warmth in the skin over the lump
  • Cessation of bowel movements and gas

These signs may indicate incarceration or strangulation, and every hour counts.

Why caring for it early makes a difference?

Treating a small hernia, electively, with the patient in good clinical condition, is a much simpler and safer surgery than operating on a large, symptomatic, or worse, strangulated hernia.

Elective surgery, performed at the right time, has a high success rate, low risk of complications, and relatively short recovery time. Laparoscopy, a minimally invasive technique, is widely used and allows faster return to activities.

Delaying treatment out of fear or because you think you're "fine as is" is a risk not worth taking.

What can you do now?

If you've noticed something similar to what was described here, or if you have any of the risk factors mentioned, the first step is to see a doctor for a clinical evaluation. The diagnosis is usually made by history and physical examination, and in some cases can be supplemented with ultrasound.

Don't wait for pain to appear to take action. Hernias that don't hurt also need attention.

Important information

This content is informational and educational in nature. It does not replace individualized medical evaluation, clinical diagnosis, or follow-up by a healthcare professional. Each case is unique. If you have questions about your health, see a doctor.

Dr. Rebeca Soares Andrade. CRM-GO 39335