Inguinal hernia in women – What are the symptoms?

Inguinal hernias affecting women are usually operated on as soon as possible. Although they occur much less frequently, emergency operations are four times more common among women. Why does an inguinal hernia occur? The inguinal canal connects the inner abdominal cavity with the groin area. Its task is to guide blood and lymph vessels, nerves and the ligament to the genitals. It is a natural weak point in the abdominal wall and is therefore more susceptible to hernias. In the event of a hernia, the peritoneum, fatty tissue or intestines bulge through this gap in the abdominal wall. Weak connective tissue or weak abdominal muscles, as well as obesity or smoking, can further promote inguinal hernias.

A typical symptom of an inguinal hernia is swelling in the groin area. However, this can also occur in the genital area or on the labia. If the hernial sac is turned outwards, this is called a direct inguinal hernia. It is also possible for the hernia sac to protrude towards the inside of the body, which is called an indirect inguinal hernia. As with a femoral hernia, no protrusion is then visible, but pain or a pulling sensation in the groin area can still be felt. It usually feels more like an unpleasant pressure or foreign body sensation. If a protrusion is visible, it can often be pushed back for a short time. The pain is less noticeable when lying down or at rest. If you lift something heavy, stand for a long time, cough or sneeze or push during a bowel movement, the pain increases.

Even if the patient has no symptoms, surgery is usually advised. Complications are more common in women and it often becomes apparent during the operation that it is a femoral hernia (fermoral hernia) and not an inguinal hernia at all. Femoral hernias are not always easy to diagnose, but can cause serious complications. In a femoral hernia, the hernial sac underneath the inguinal ligament protrudes towards the thigh. This is not always immediately visible. In around 30% of cases, the so-called fermoral hernia becomes trapped, making immediate surgery necessary. Statistically, women are affected by fermoral hernias much more frequently than men, which is why doctors do not recommend waiting for surgical treatment in women.

An exception is a prolapse during pregnancy. This is rare. The probability of an inguinal hernia occurring during pregnancy is only 0.12%. In this case, however, the doctor may recommend waiting until after the birth to operate. A quick operation is only necessary if an incarceration occurs and complications are imminent. During pregnancy, the round ligament of the uterus (ligamentum rotundum), which passes through the inguinal canal, may also show enlarged vessels, similar to a varicose vein. This can initially lead to the suspicion of an inguinal hernia.

In general, there is a greater risk of a hernia recurring in women (recurrence). If a minimally invasive technique (TEP or TAPP) with mesh insertion is used to treat the hernia in women, the risk of recurrence is lower than with open treatment using the Lichtenstein procedure. Regardless of whether it is an inguinal hernia or a femoral hernia - both can be treated in a laparoscopic procedure. For very small femoral hernias in women, biodegradable meshes can be used, which dissolve over time. The mesh insertion also allows the patient to take weight more quickly after the operation than if the treatment is carried out purely by suturing the adjacent connective tissue. With TAPP (transabdominal preperitoneal plasty), the abdominal wall must be cut through for the operation, whereas with TEP (total extraperitoneal plasty), the operation is performed within the abdominal wall. The surgeon therefore goes less deeply into the body with the instruments for TEP than for TAPP. Nevertheless, the recovery times after the operation, recurrences, side effects and pain are somewhat the same for both procedures.