A hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen. They will often occur in children whose inguinal canals do not close after testicles have come into the scrotum or in males whose testicles are undescended. Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias in this area as well.
Hernias are most common in boys, but can also occur in girls.
Inguinal hernias occur:
- In 1 to 3 percent of full term infants
- Three times more often in premature infants
- In children who have a family history of inguinal hernias
- More often in infants and children with other urogenital anomalies.
Hernias occur more often in children who have one or more of the following risk factors:
- A parent or sibling who had a hernia as an infant
- Cystic fibrosis
- Developmental dysplasia of the hip
- Undescended testes
- Abnormalities of the urethra
Hernias usually occur in newborns, but may not be noticeable for several weeks or months after birth. Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.
Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If the bulge is pushed on gently when the child is calm it should get smaller or go back into the abdomen, known as reducing the hernia.
Occasionally, body parts that protrude through a hernia, such as the loop of intestine or an ovary, may become stuck, and the hernia is no longer “reducible.” This means that the hernia cannot be gently pushed back into the abdominal cavity as it can be at all other times. When this happens, these body parts inside the hernia may lose their blood supply. A good blood supply is necessary for these body parts to be healthy and function properly. This is called an incarcerated hernia and requires immediate medical attention. If a hernia is no longer reducible, is hard, very painful, red or swollen, if the abdomen is distended, or if the child is vomiting, seek medical attention immediately.
If your child is not in discomfort and the bulge is incidentally discovered, you can try to reduce it. Your child should be in a warm, comfortable position and lying down. Sometimes simple relaxation will cause it to reduce spontaneously. Otherwise, you may try to push the bulge back into the abdomen with gentle pressure upward along the groin. There will be no harm from trying to push it into the abdomen. Do not worry if it is easily reduced and happens to slide back out. Seek medical attention if there are symptoms and pain associated with the hernia and it is difficult to push inward or cannot be reduced.
If the hernia is reducible, it can be repaired electively. If it is stuck, an attempt should be made by a physician to reduce the hernia. If it is reduced, it should be repaired semi-electively, meaning within a few days. If it cannot be reduced by a physician, it should be emergently repaired because of the problems previously mentioned. We recommend repair of all groin hernias regardless of age.
How do you repair an inguinal hernia?
An inguinal hernia is repaired with surgery. Your child should not eat or drink prior to the surgery. Your child will have general anesthesia and will not feel any pain during surgery. The surgery usually takes one hour. An incision is made in the lower abdomen along a skin crease. The hernia sac is separated from the blood vessels and spermatic cord (in boys) and traced to the inner abdomen where it originated. A stitch is placed there to close that opening. Sometimes, in boys, the portion of the sac going down toward the scrotum is dissected to fix a hydrocele which is filled with fluid. Once this is repaired, the wound is closed with absorbable stitches and has a sterile dressing. A local anesthetic is injected into the wound to east post-operative pain.
Do you repair both sides?
Children under one year of age often have both sides repaired. There is a high incidence of having a hernia on the other side, especially in girls. Normally the opposite side can be assessed laparoscopically. If a hernia is seen, it will be repaired at the same time.
When will my child go home?
The surgery is performed as an outpatient procedure for children older than three months of age. After surgery, your child will go to the recovery room. Most children go home on the same day. If your child is less than 52 weeks post conceptual age, and is a prematurely born infant, they will be watched overnight in the hospital on an apnea monitor for safety.
Can an inguinal hernia come back?
The recurrence rate of a pediatric hernia is very low. If this area has a bulge in later life, it may be an adult type of hernia. This type usually involves a weak muscle floor and not an opening that has been there since birth. Infants and children do not have a weak muscle floor.