A hernia in women is a bulge or protrusion that occurs when tissue, usually part of the intestine or abdominal fat, pushes through a weak spot in the surrounding muscle or connective tissue. While hernias are far more common in men, women develop them too, and the experience can look quite different. The lifetime prevalence of groin hernias in women is 3 to 6 percent, compared to 27 to 43 percent in men. That lower rate is part of the problem: hernias in women are more likely to be missed, misdiagnosed, or mistaken for gynecological conditions like endometriosis or ovarian cysts.
Types of Hernias Women Get
Women can develop any type of hernia, but certain types are more likely or more clinically significant in female patients.
- Inguinal hernia: The most common groin hernia overall. In women, the inguinal canal contains the round ligament, which connects the uterus to the labia. The canal is narrower than in men, which is partly why inguinal hernias are less common in women, but they still occur.
- Femoral hernia: This type develops in the upper thigh, just below the groin crease. Femoral hernias are uncommon overall but occur far more frequently in women than in men. They carry a higher risk of becoming trapped or losing blood supply because the opening they pass through is small and tight.
- Umbilical hernia: A bulge at or near the belly button. Pregnancy is a major trigger, as the growing uterus stretches and weakens the abdominal wall.
- Incisional hernia: Develops at the site of a previous surgical incision, such as after a cesarean section or other abdominal surgery.
- Obturator hernia: A rare type that pushes through an opening in the pelvic bone. It overwhelmingly affects older, thin women, typically between ages 70 and 90.
Why Hernias Are Harder to Detect in Women
Many women with hernias never develop a visible bulge. These are sometimes called “occult” hernias, and they’re a major reason for delayed diagnosis. In one study from a physical therapy practice specializing in endometriosis, 22 out of 35 patients screened positive for occult hernias that were compressing nerves in the groin. None of those hernias had been caught during prior gynecological surgeries.
Without an obvious lump, the symptoms of a hernia in women overlap heavily with conditions like endometriosis, pelvic floor dysfunction, or chronic pelvic pain. Groin pain, pain during sex, discomfort during menstruation, urinary pressure, and inner thigh pain can all stem from a hidden hernia pressing on nearby nerves. Women may go through multiple rounds of treatment for other conditions before a hernia is considered.
When a physical exam is inconclusive, ultrasound is typically the first imaging step. Research published in the American Journal of Roentgenology found that ultrasound was more sensitive than traditional herniography for detecting hernias in patients with unclear clinical findings. CT scans and MRI are sometimes used as well, particularly for deep or unusual hernias like the obturator type.
Symptoms to Recognize
The classic hernia symptom is a bulge you can see or feel, usually in the groin, belly button area, or at a surgical scar. The bulge often becomes more noticeable when you stand, cough, or strain and may flatten when you lie down. But as noted above, many women never see or feel a bulge at all.
Other symptoms include:
- A dull ache or pressure in the groin, lower abdomen, or pelvic area, especially with activity
- Pain during sex or sharp discomfort in the genital area
- Groin or inner thigh pain that worsens with coughing, lifting, or exercise
- Increased lower abdominal pain during menstruation
- A feeling of heaviness or dragging in the pelvis
Obturator hernias have their own pattern. The pain typically starts in the lower right abdomen and spreads, often radiating from the groin into the inner thigh. Nausea, vomiting, constipation, and a distended stomach are common because the hernia frequently traps a loop of bowel.
Risk Factors Specific to Women
Pregnancy is one of the biggest risk factors. The weight of a growing uterus stretches the abdominal wall, and the hormonal changes of pregnancy soften connective tissue. Multiple pregnancies compound the effect. Umbilical and inguinal hernias can both develop during pregnancy or shortly after delivery.
Other risk factors include:
- Obesity: Extra body weight increases pressure on the abdominal wall.
- Smoking: Research published in JAMA Surgery identified smoking as an independent risk factor for incisional hernias. Smoking impairs collagen metabolism, which weakens the tissue that holds surgical repairs together.
- Chronic coughing or constipation: Repeated straining raises abdominal pressure and can push tissue through weak spots over time.
- Previous abdominal surgery: Any incision creates a potential weak point. Cesarean sections, hysterectomies, and laparoscopic procedures all carry some risk of later incisional hernia.
- Low body weight: For obturator hernias specifically, being underweight (BMI of 18.5 or below) is a risk factor because less fat cushions the pelvic canal, leaving more room for tissue to push through.
Hernias During Pregnancy
Discovering a hernia during pregnancy can feel alarming, but the standard approach is watchful waiting. Research supports holding off on surgical repair until after delivery, as long as the hernia isn’t causing severe symptoms or showing signs of becoming trapped. In a study tracking pregnant women with hernias, none experienced incarceration or strangulation before or after delivery, and none required emergency surgery.
Elective repair is typically scheduled in the postpartum period. In one series, women underwent hernia repair anywhere from 4 to 52 weeks after delivery, with an average of about 22 weeks. All repairs were done as outpatient procedures, and there were no complications.
Treatment and Recovery
Small, symptom-free hernias in women can sometimes be monitored without surgery. But hernias don’t heal on their own, and most will eventually need repair, especially femoral hernias, which carry a higher risk of complications.
Surgical repair can be done through an open incision or laparoscopically (through small incisions using a camera). Both approaches typically involve placing a mesh to reinforce the weakened area. Laparoscopic repair generally means less postoperative pain and a faster return to normal activity, though recovery timelines vary by individual.
One important finding for women: a 2025 analysis from the Abdominal Core Health Quality Collaborative found that female patients have a greater risk of hernia recurrence within one year after surgery, particularly after open repair. This is one reason some surgeons recommend laparoscopic or robotic approaches for women when the anatomy allows it.
When a Hernia Becomes an Emergency
A strangulated hernia occurs when the trapped tissue loses its blood supply. This is a surgical emergency. Warning signs include sudden, severe pain in the abdomen or groin that doesn’t let up, nausea and vomiting, and skin color changes around the bulge. The skin may turn reddish at first, then become darker or paler than surrounding tissue. If you notice these symptoms, call emergency services immediately. Strangulated hernias can cause permanent tissue damage within hours.
Femoral hernias are the most dangerous in this regard. Their small, rigid opening makes them more likely to trap and strangulate tissue compared to other hernia types. Because femoral hernias occur more often in women, this risk is disproportionately relevant for female patients.