Female Hernia: Misdiagnosis and Common Issues

In females, hernia symptoms are often smaller and deeper without a noticeable lump and can mimic gynecological issues, with misdiagnoses being common. Can knowing the risk factors and how female hernias are treated help women get relief?

Female Hernia

A hernia occurs when an internal structure pushes through a weak spot in the abdominal wall, the muscles, and the tissue covering the front of the torso. The more common include:

• Groin hernia, known as an inguinal hernia.
• Upper thigh or femoral hernia.

However, a hernia can develop anywhere from the ribcage to the upper thigh. Hernias are less common in women, have different symptoms than in men, and are often misdiagnosed. Lower abdominal and pelvic hernias present differently in women than men, who typically have a visible bulge. Instead, female hernias tend to be smaller, deeper, and less noticeable. They can also cause chronic pelvic pressure or pain that can be mistaken for gynecological problems.

Hernia Symptoms For a Woman

Hernias in women tend to be smaller and deeper than male hernias, with no lump showing. Instead, female hernias can cause chronic, deep pelvic pain and occasional sharp, stabbing pain that comes on fast and lingers. (Köckerling F., Koch A., & Lorenz R. 2019) Hernia pain worsens with exercise, laughing, coughing, or straining to evacuate the bowels. The pain is often described as:

• Dull
• Aching
• Pinching
• Sharp
• Shooting
• Burning

Inguinal hernia pain is usually felt at or above the groin and may radiate to the hip, lower back, vulva, or thigh. Many women find the pain increases during their menstrual cycle. The pain can also be exacerbated by any activity that generates extra pressure on the pelvic floor, including:

• Prolonged sitting or standing.
• Bending
• Getting in or out of bed.
• Getting in or out of a car.
• Sexual intercourse

Emergency

Hernias in the pelvic area are at risk of becoming incarcerated hernias. An incarcerated hernia occurs when a portion of the intestine or other abdominal tissue becomes trapped in the hernial sac, making it impossible to push it back into place. If this gets trapped or strangulated, it can cause tissue death. Strangulated hernias are a medical emergency. Symptoms include:

• Deep red or purple tissues.
• The hernia bulge does not shrink when you lie down.

Other  symptoms that warrant immediate medical attention include: (Johns Hopkins Medicine, 2025)

• Worsening pain
• Bloating
• Difficulty with bowel movements
• Nausea
• Fever
• A fast, racing heartbeat.

Contact a healthcare provider or the emergency room if experiencing any of the above symptoms.

Types

Hernias can occur anywhere on the abdominal wall. They may be caused by:

• Internal pressure, such as during pregnancy.
• A sports injury
• Tissue weakness

Hernias in the lower abdomen or groin are typically indirect inguinal hernias. The inguinal canal comprises multiple layers of muscles and fascia that the thin round ligament threads through. Other groin and pelvic hernias include:

• A direct inguinal hernia
• A femoral hernia at the top of the inner thigh.
• An obturator hernia in the front upper thigh, although this type is rare.

Other common hernias in women are:

• Incisional hernia – at the site of a surgical incision
• Umbilical hernia – around the belly button
• Ventral hernia – abdominal midline

Less common hernias include:

• Hiatal hernia – diaphragm
• Perineal hernia – pelvic floor

Risk Factors

Risk factors for developing a hernia include: (Johns Hopkins Medicine, 2025)

• Obesity
• Frequent constipation
• Abdominal or pelvic surgery.
• Allergies with chronic sneezing.
• A chronic cough.
• Collagen defects or connective tissue disorders.

Pregnancy and repeated pregnancies are linked to an increased risk of hernia. Types that are more common in pregnancy include:

• Umbilical hernia
• Ventral hernia
• Inguinal hernia

Umbilical hernias are the most common. However, only a small percentage of pregnant individuals get them. (Kulacoglu H. 2018)

Diagnosis

A hernia diagnosis is made with a physical examination and, if needed, imaging studies. Patients are asked to describe their symptoms precisely, where the pain is located, and any activities that exacerbate it. To check for a hernia, the healthcare provider will palpate for a hernia while the patient sits, stands, or coughs. Imaging tests can include:

• Ultrasound
• CT scan
• Endoscopy – a camera is used to see inside the esophagus and stomach.

Misdiagnoses

Female hernia symptoms can be vague, which often points healthcare providers in the wrong direction. Female hernias are commonly misdiagnosed as: (Köckerling F., Koch A., & Lorenz R. 2019)

• Cysts in the reproductive organs
• Endometriosis
• Fibroid tumors

Treatment

A small hernia that does not cause problems or pain may be treated with a wait-and-evaluate protocol. A hernia often worsens over time and could eventually require surgery. (University of Michigan Health, 2024) Self-care treatments include:

• Rest (American Academy of Orthopaedic Surgeons, 2022)
• Compression wraps (American Academy of Orthopaedic Surgeons, 2022)
• Ice (Northeast Georgia Health System, 2022)
• Over-the-counter pain medication (Northeast Georgia Health System, 2022)

Medical treatments usually start with conservative measures, including physical therapy, stretching, exercise, and rest. Physical therapists often use myofascial release techniques to relieve muscle spasms. Surgery may be needed to repair the weak area of the abdominal wall to relieve symptoms. (University of Michigan Health, 2024) Hernia repair surgery is typically performed as a laparoscopic surgery. (Köckerling F., Koch A., & Lorenz R. 2019) Most patients heal quickly from the surgery and can return to regular activities in a week or two.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

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References

Köckerling, F., Koch, A., & Lorenz, R. (2019). Groin Hernias in Women-A Review of the Literature. Frontiers in surgery, 6, 4. doi.org/10.3389/fsurg.2019.00004

Johns Hopkins Medicine. (2025). How to tell if you have a hernia. www.hopkinsmedicine.org/health/conditions-and-diseases/how-to-tell-if-you-have-a-hernia

Kulacoglu H. (2018). Umbilical Hernia Repair and Pregnancy: Before, during, after…. Frontiers in surgery, 5, 1. doi.org/10.3389/fsurg.2018.00001

University of Michigan Health. (2024). Inguinal hernia: Should I have surgery now, or should I wait? www.uofmhealth.org/health-library/za1162

American Academy of Orthopaedic Surgeons. (2022). Sports hernia. orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

Northeast Georgia Health System. (2022). Living with a hernia. Northeast Georgia Health System Improving the health of our community in all we do. www.nghs.com/2022/02/15/living-with-a-hernia