Obturator Hernia

What is an obturator hernia?

An obturator (pronounced “uhb-tr-AY-tr”) hernia occurs when there’s a hernia in your obturator canal. This is an open spot in your pelvis. This type of hernia can happen if you have weak pelvic floor muscles. The weak muscles let sections of your intestines or fat in your abdomen push into your obturator canal. Obturator hernias typically involve your small intestine but may involve your large intestine.

Obturator hernias are rare. They typically affect women aged 70-90.

This type of hernia can be a serious medical issue. It can block your intestine (bowel obstruction). This can happen if the hernia gets stuck in pelvic floor muscles or the obturator canal.

A blocked intestine is a medical emergency. You may need surgery right away to fix it or keep it from happening. Emergency surgery can be a scary experience. Your healthcare team will explain why you need surgery and what you can expect.

Symptoms of obturated hernia

Obturator hernias cause symptoms like:

• Abdominal (belly) pain that starts in your lower right belly and spreads to your entire belly
• Constipation
• Distended stomach
• Nausea and vomiting
• Pain that starts in your groin and moves into your inner thigh

Causes of obturator hernia

Obturator hernias happen when you have a weak spot in your pelvic floor muscles. The weak spot lets tissue and a section of your intestine push into your obturator canal. Several things increase the risk that this will happen. Common risk factors for obturator hernia include:

• Age. Your pelvic floor muscles weaken as you age. Age also affects the membrane that covers the opening to your obturator canal. Both issues make it easier for tissue or your small intestine to push into your obturator canal.
• Chronic constipation. Constantly straining to poop can weaken your pelvic muscles.
• Chronic obstructive pulmonary disease (COPD). This condition causes chronic coughing that puts pressure on your abdominal muscles. That pressure can affect your pelvic muscles.
• Having underweight. Weight loss affects the amount of fat in your obturator canal. Losing fat there makes room for a hernia in the canal to get bigger. You have underweight if you have a body mass index of 18.5 or below.

Complications

Obturator hernia complications include:

• Incarcerated obturator hernia. This happens when a hernia gets stuck in your pelvic muscles. An incarcerated obturator hernia may lead to an obstructed bowel (blocked small intestine).
• Strangulated obturator hernia. This is when blood can’t get to the intestine inside a hernia. Without blood, the intestinal tissue starts to die (necrosis).

How doctors diagnose obturated hernia

A healthcare provider will ask about your symptoms. They’ll do a physical examination. They may do the following tests, too:

• Howship-Romberg test. In this test, your provider moves your hip. They’ll ask if moving your hip causes pain in your inner thigh.
• Hannington-Kiff test. In this exam, your provider taps certain places on your tibia or femur. This test checks to see if the tap makes your hip muscles tighten (contract).

They’ll also do a computed tomography (CT) scan to confirm you have an obturator hernia.

How is an obturator hernia treated?

Surgery to repair the hernia is the only treatment for obturator hernia. A surgeon will make an incision (cut) in your lower abdomen or groin to reach the hernia in your obturator canal. They’ll move the hernia contents back into your lower abdomen. Then, they’ll fix the weak spot in your abdominal muscles. You may have open surgery, laparoscopic surgery or robotic hernia repair surgery.

You may have more surgery if you have damage to your intestine. This can happen if you have a strangulated obturator hernia. Your surgeon may do a colectomy to remove the damaged section of your intestine.

Surgery complications

All hernia repair surgery may cause the following complications:

• Bleeding
• Damage to your obturator nerve
• Surgical site infection

Recovery

Your recovery depends on factors like:

• The type of hernia repair surgery. For example, it takes less time to recover from laparoscopic surgery than from open surgery.
• If surgery involved a colectomy. It takes more time to recover from a colectomy than from hernia repair surgery.
• Your health. It will take you longer to recover from surgery if you have conditions like malnutrition or COPD.

But everyone’s situation is different. Your surgeon will explain what to expect and how soon you can return to your daily routine.

What can I expect if I have this condition?

Hernia repair surgery often cures obturator hernia and eases its symptoms. But it’s not treatment for conditions like malnutrition or COPD. These conditions increase your risk of having an obturator hernia. You may need ongoing medical care and support to help you manage these conditions.

When should I seek care?

You should talk to a healthcare provider if you have belly pain or pain in your thigh that doesn’t go away. These symptoms may mean you have an obturator hernia.

When should I go to the ER?

Go to the emergency room right away if you have:

• Severe belly pain that comes on very fast
• Nausea or vomiting

These symptoms may mean you have a strangulated obturator hernia.