Inguinal Hernia in Children: What You Need to Know

 

What is an inguinal hernia?

An inguinal hernia occurs when part of the intestine bulges through a gap in the abdominal tissue wall near the groin. Normally, the abdominal wall is strong and sturdy enough to keep the intestines contained inside the abdominal cavity. When there is a hole or weak area in the abdominal wall, the intestines can fall through and create a bulge under the skin called a hernia. Inguinal hernias in children are often caused by a congenital (present at birth) abnormality in their abdominal wall.

Inguinal hernias are the most common type of hernia and are more common in boys.  In boys and girls, the hernia first appears as a bulge in the groin area. The bulge will vary in size and may not be present all the time. Usually, the bulge will increase in size when the child cries or strains their muscles, and shrink when the child is relaxed. An inguinal hernia can affect people at any age, but it most commonly occurs during infancy and early childhood.  However, in many cases the hernia is not detected for years because of its small size, and may not be diagnosed until older childhood or adolescence.

An inguinal hernia is not always dangerous, but it will not go away on its own. Without treatment, the hernia can cause serious complications like incarceration and strangulation. Incarceration occurs with the intestines become trapped inside the abdominal wall, which can cause painful bowel obstruction. Strangulation occurs when the incarcerated intestines become and cut off from their normal blood flow. Without blood, the intestinal tissue begins to die, and this can be life-threatening.

What causes an inguinal hernia in children?

Inguinal hernias occur when the baby’s inguinal canal fails to close before birth. During development in the womb, all babies form an inguinal canal (a short tunnel that connects the abdominal cavity to the scrotum in boys and the labia in girls). Before birth, the inguinal canal is supposed to close, and failure to do so results in a hernia.  

Factors that increase your child’s risk of developing an inguinal hernia include:

• Prematurity
• Undescended testicles in boys
• Family history of hernias

What are the symptoms of an inguinal hernia in children?

The primary symptom of an inguinal hernia is a bulge in the groin that becomes more obvious when your child cries, coughs, passes a bowel movement or otherwise strains themselves.  Usually, this bulge is not painful. Other symptoms include:

• Irritability
• Decreased appetite
• Pain or discomfort in the bulging area of the groin

Other, more serious symptoms of an inguinal hernia include

• Intense pain in the area around the hernia bulge
• Difficulty passing gas or bowel movements
• Vomiting
• Fever
• A bulge in the groin that turns red or purple

The above symptoms could be a result of an incarcerated or strangulated hernia, which can be very dangerous. Seek immediate care if your child has any of these more serious symptoms, particularly if you notice red or purple discoloration in the area of the bulge. 

How is an inguinal hernia diagnosed in children?

Inguinal hernias are diagnosed through physical examinations. During the exam, the doctor will determine whether the hernia is reducible or irreducible.

• A reducible hernia can be pushed back through the hole in the abdominal wall into the abdominal cavity, causing the bulge in the groin area to disappear.
• An irreducible hernia cannot be pushed back into the abdominal cavity. This means that the hernia is trapped, or incarcerated, in the abdominal wall and will need to be treated promptly to stop any dangerous complications from occurring.

Other imaging tests like abdominal x-rays and ultrasounds may be used to help the doctor visualize your child’s abdominal cavity.

How is an inguinal hernia treated in children?

Inguinal hernia surgery

Inguinal hernias are treated with surgery to repair the abdominal wall and place the intestines back in the abdominal cavity. The type of surgical operation depends on the child’s age, health, and whether their hernia is reducible or irreducible. 

Surgical repair of inguinal hernias is performed under general anesthesia, so your child will be asleep and feel no pain during the operation. It is typically a simple procedure, and in many cases the child can go home the same day as their surgery.  Some children may need to stay a night in the hospital for observation.  

Children younger than one year old with an inguinal hernia are at high risk of developing another hernia on the other side of their groin. Therefore, it is recommended that both inguinal areas be repaired. 

Inguinal hernia surgery risks and recovery

After surgery, there may be some swelling around the incision or groin area, but this will go away after a few weeks.  Medical attention is required if the child is experiencing any of the following symptoms:  fever, signs of infection including redness or swelling, bleeding, or increasing pain.