Inguinal Hernias in Children

Understanding Inguinal Hernias in Children

Inguinal hernias in children happen when part of the intestine or abdominal tissue pushes through a weak spot in the abdominal wall near the groin, known as an inguinal groin hernia. This condition affects both girls and boys, though it is more common in boys. Inguinal hernias are typically present from birth and become more apparent as the child grows. Without treatment, serious complications like incarceration or strangulation of the tissue can develop, requiring urgent medical attention.

What are inguinal hernias?

Inguinal hernias happen in about 2% of all kids, though more frequently in boys. While they may appear on either side or both sides in the groin and scrotal region, they are most frequently seen on the right side.

There are 2 types of inguinal hernias in children, direct and indirect. 

• An indirect inguinal hernia is caused by a congenital defect (a small opening) in the lower abdominal wall at the groin region that is present from birth. This small opening allows for fluid and/or bowel to pass through which results in swelling in that region. The swelling may extend all the way into the scrotum. This type of hernia is common in infants and young children, particularly in those with history of prematurity. More than 90% of the inguinal hernias in children are the indirect type.
• A direct inguinal hernia develops over time from recurrent straining, typically with heavy lifting. This straining results in a weakening of the abdominal wall muscles. Direct inguinal hernias are more commonly seen in adults and are very rare in infants and young children.

An inguinal hernia is seen with swelling in the groin region when tissue, such as fluid, intestine or ovary, projects through a weak spot in the abdominal muscles. The resulting bulge often presents without any discomfort or pain. Increased pressure of a bowel movement, coughing, bending over or lifting heavier objects may cause some discomfort and may make the swelling more pronounced.

Unlike an umbilical hernia, inguinal hernias do not resolve on their own. Because inguinal hernias are not expected to close on their own, and also due to the fact that they possess the potential to cause emergent complications (known as incarceration or strangulation), elective surgical repair is almost always recommended.

What are the symptoms of inguinal hernias?

Inguinal hernias in newborns and children are often noted as soft protrusions that may or may not be seen on one or both sides of the groin. This intermittent swelling may extend all the way into the scrotum. It is not unusual for an inguinal hernia to only be seen with crying or when the child is pushing to pass stool. Older children may also notice a bulge with standing and straining, especially for longer periods of time. You may also notice that your baby or child may be more irritable when the swelling is pronounced. Very commonly, the swelling may disappear on its own or with gentle pressure over it.  

When should I take my child to the doctor for inguinal hernias?

Symptoms that require emergent attention and evaluation by a medical professional include:

• Firmness of the protrusion with or without redness/discoloration
• Sudden, severe pain
• Nausea and vomiting
• Fever
• Inability to pass stool or gas

How do surgeons treat inguinal hernias?

Inguinal hernias, direct or indirect, are not expected to resolve on their own. Given the seriousness of possible complications that can result if a hernia becomes incarcerated, elective surgical correction is recommended in the great majority of patients. Each patient is evaluated individually, so some young infants may be advised to wait until they are older before performing surgery, while others may be taken to the operating room soon after diagnosis. Our surgical team will evaluate the characteristics of the hernia and unique needs of your child to make the best and safest decision related to surgical care.

What are potential complications caused by inguinal hernias?

An inguinal hernia becomes a medical emergency when the protruding tissue becomes stuck and cannot reduce back into the abdomen. The loop of intestine, ovary, etc. can be trapped or incarcerated and the blood supply to this area may be cut off. There is then potential for this tissue to become injured, stop functioning or start to die off. That is also referred to as an incarcerated or strangulated inguinal hernia and urgent evaluation by a physician is important. If this develops suddenly, your child should be seen in the emergency room as soon as possible and without delay.

Expected outcomes of inguinal hernia surgery:

Surgery is performed at Golisano Children’s Hospital and your child typically will be able to go home that same day. He/She will likely have minimal discomfort for just a few days and pain relief should be managed with over the counter pain medications. We will advise you on activity restrictions and specific post op instructions based on your child’s age. Following surgery, there is a less than 2% chance of hernia recurrence with the greatest recurrence happening in children less than one year of age at the time of repair.