Groin Hernias

There are 2 types of groin hernias:

Inguinal Hernias

These are common and affect men more than women by a factor of 9:1. They exist in a naturally weak area of the abdominal wall called the inguinal canal. The canal is a space created between the external oblique aponeurosis (anterior wall) and the fused internal oblique and transversalis aponeurosis called the conjoint tendon (posterior wall). There are 2 holes here. The deep inguinal ring in the posterior wall and the superficial ring in the anterior wall. The testicle passed through this canal in men around 38 weeks of gestation. In women the round ligament passes through the canal. This is a suspensory ligament for the ovary/uterus but has no real structural strength.

In an inguinal hernia the peritoneum either pokes through the deep ring or creates a new hole medial to this ring.

Femoral hernias

These exist in the groin and are closely related to inguinal hernias in position. A groin hernia can be inguinal or femoral in origin, but inguinal hernias are much more common than femoral hernias in both men and women. They can be hard to differentiate, particularly in women. Femoral hernias are more common in women than men, but occur at a ratio of 9 inguinal hernias to 1 femoral hernia in women.

The natural weakness with these hernias is in the femoral canal. Where the femoral vein enters the pelvis from the thigh a space exists that allows the femoral vein to expand as blood return increases with exercise/walking/changing hydration etc. This allowance for expansion can be countered by gravity that allows the abdominal content to press down into the femoral canal from above and peritoneum to poke through. This kind of hernia has the highest incidence of bowel strangulation and should always be repaired. It is more common in some women as they have a shallower wider pelvis to allow easier childbirth. This pelvic shape makes larger allowance for the femoral vein to expand so that the weight of abdominal contents above can push down through the femoral canal more easily.

At Hernia Clinic Hampshire we see many women and men with femoral hernias and can repair them under local anaesthetic with sedation with a quick recovery and return to straightforward activity. Usually, these are simpler to repair than inguinal hernias. See our web page about women and hernias for more information.