“When you talk to people about hernias, they tend to focus on groin hernias, which are the most common — and they are primarily a male problem,” says Stephen Ganshirt, MD, vice chief of surgery at Northwestern Lake Forest Hospital in Illinois. But other types of hernias are actually more common in women, while still others occur at similar rates in men and women. Hernias occur when an organ or tissue bulges through a weak spot in the wall of muscle that’s holding it in. Inguinal hernias (aka, groin hernias) occur when contents of the abdomen — usually fat or part of the small intestine — bulge through a weak area in the lower abdominal wall into the inguinal canal in the groin region. While inguinal hernias can happen to men and women, they’re much more common in men because men naturally have a small hole in the groin muscles so that blood vessels and the spermatic cord can pass to the testicles, Dr. Ganshirt notes. By contrast, a femoral hernia occurs when a portion of the intestine pokes through a weakened area in the upper thigh muscle, just under the groin. Femoral hernias are more common in women than in men, Ganshirt says, adding that it probably has to do with the shape of the pelvis, which is shaped differently to accommodate childbearing. An umbilical hernia occurs when tissue lining the abdomen protrudes into the belly button area. “Women get more umbilical hernias because of pregnancy — it’s that stretching of the abdominal wall — so we see more of those during childbearing years in women,” Ganshirt says. As people get older, however, umbilical hernias tend to be equally common among women and men. When it comes to hiatal hernias, which occur when the stomach bulges up into the chest cavity through an opening in the diaphragm, women are at slightly higher risk as they get older, especially if they’re obese.
Symptoms and Diagnosis of Hernias in Men and Women
Often a hernia presents with similar symptoms for men and women — a bulge or swelling in the groin or pelvis that’s accompanied by discomfort. The telltale sign for most inguinal hernias is an achiness or dull pain, especially while lifting something, gardening, or getting in and out of a car. By contrast, people with femoral hernias usually have lower and more medial (toward the inside of the leg) groin pain, often radiating down the front of the leg. “Hernias present the same way — it is the index of suspicion on the part of the practitioner that changes with the sex of the patient,” says David Renton, MD, an associate professor of surgery at The Ohio State University Wexner Medical Center in Columbus. “Hernias are less common in women, so we tend to think of other things that may cause problems for them rather than hernias.” In fact, a study in a 2016 issue of the Journal of Ultrasound found that hernias (both the inguinal and femoral variety) are a common cause of pelvic pain in women who are sent for pelvic ultrasounds. Why is the possibility of a hernia sometimes overlooked as a cause of chronic pelvic pain in women? For one thing, “most pelvic pain experts are highly trained gynecologists, who may be more centered upon ovaries and uterine causes for pain,” says study leader Michael Crade, MD, a clinical associate professor in the department of obstetrics and gynecology at the University of California in Irvine. For another, “the right historical questions are not asked,” he adds. “In my experience, femoral hernia patients often answer yes to questions such as: Does the pain go down the front of the leg? Is the pain better if you lie down? Is the pain nagging in the lower abdomen? Do you have pain getting in and out of the car? Or sitting at a computer for a long time? If the patient tells us such things, we are on the hunt for probable hernia.” If your doctor doesn’t follow that line of thinking, it may be a good idea to ask whether your symptoms could point to a hernia, rather than a gynecological problem, Dr. Crade says. If so, a high-quality ultrasound study may be able to make the correct call.
Gender Differences in Treatment
Since hernias don’t usually improve on their own, surgery is often required to repair them. With open surgery, a surgeon cuts into the body at the hernia’s location, puts the protruding tissue back where it belongs, then stitches the weakened muscle wall back together (often implanting mesh for extra support). “Women are less likely to get mesh — because you can completely close off the hernia opening with sutures in a woman without having to worry about keeping some of the opening there to allow blood flow to the testicles,” Ganshirt says. This is why the rate of hernia recurrence is lower in women, he adds. With laparoscopic surgery, a surgeon guides the hernia repair using a telescope-like device that’s inserted through small incisions at the belly button. A study in a July 2017 issue of the American Journal of Surgery found that laparoscopic repair of groin hernias dramatically reduced the risk of a recurrence in women (though the opposite was true for men). Even so, “the two biggest risk factors for recurrence are obesity and smoking,” Dr. Renton says. “Unfortunately, these are shared equally between both sexes.”
