Many people are surprised to learn that hernias are fairly
common in kids. Babies (especially preemies) can even be born with
them.
Hernias in kids can be treated (hernia repair is the one of the
most common surgeries performed on children), but it's
important to recognize their symptoms so that you can get your
child the appropriate medical care.
About Hernias
When part of an organ or tissue in the body (such as a loop of
intestine) pushes through an opening or weak spot in a muscle wall,
it can protrude into a space where it does not belong. This
protrusion is a hernia, which may look like a bulge or lump.
Some babies are born with various small openings inside the body
that will close at some point. Nearby tissues can squeeze into such
openings and become hernias. Unlike hernias seen in adults, these
areas are not always considered a weakness in the muscle wall, but
a normal area that has not yet closed.
Sometimes tissues can squeeze through muscle wall openings that
are only meant for arteries or other tissues. In other cases,
strains or injuries create a weak spot in the muscle wall, and part
of a nearby organ can be pushed into the weak spot so that it
bulges and becomes a hernia.
Types of Hernias
There are different types of hernias, and each requires
different levels of medical care.
In many infant and childhood hernias, the herniated tissues may
protrude only during moments of physical pressure or strain. You
may only notice a prominent bulge when your child is crying,
coughing, or straining, and it may seem to retract or go away at
other times. Hernias in this state are called reducible and are not
immediately harmful.
Sometimes tissue can become trapped in an opening or pouch and
do not retract. These are incarcerated hernias, and are a
serious problem requiring immediate medical attention. For example,
a loop of intestine that is caught and squeezed in the groin area
may block the passage of food though the digestive tract. The
symptoms of an incarcerated hernia can include pain, vomiting, and
irritability. If you touch the bulge it has created, it may feel
hard.
A doctor can usually free the trapped tissues by gently
squeezing the lump and trying to force it back into the body
opening. Because incarcerated hernias can be painful, the doctor
usually provides pain medication during this procedure. Surgery is
usually required within a few days to prevent development of
another incarcerated hernia.
The most serious type of hernia is a strangulated hernia, in
which the normal blood supply is cut off from the trapped tissue.
Without that blood supply, the strangulated tissue cannot get
oxygen and will die. Surgery is required immediately to dislodge
that tissue so that oxygen can get to it again.
The two most common hernias in kids are inguinal hernias in the
groin area and umbilical hernias in the belly-button area.
Inguinal Hernias
In infants, an inguinal hernia is most often caused by a
protrusion of a loop or portion of intestine or a fold of membrane
from the abdomen - or in girls, from an ovary or fallopian
tube - through an opening into the groin (the area where the
abdomen meets the top of the thigh). The opening is caused by the
presence of a fold of the peritoneal membrane, which produces a
sac. Within this sac, the loop of bowel can protrude.
The hernia is apparent as a bulge in the groin area, especially
when the child cries, coughs, or stands.
Sometimes, in boys, the inguinal hernia extends beyond the groin
into the scrotum (the sac that holds the testicles). In girls, it
can extend to one of the outer labia (the larger lips of tissue
around the vaginal opening). In these cases, an enlargement or
swelling can be seen that extends from the groin into the scrotum
or labium.
More common on the right side, inguinal hernias occur far more
often in boys than girls and are most common in preemies, baby boys
with undescended testicles, and kids with cystic fibrosis. Kids
with a family history of hernias are also at risk.
Other conditions that may look like inguinal hernias, but are
not:
- A communicating hydrocele is similar to a hernia, except that
fluid causes the bulge rather than protruding tissue. Depending
on its location, the hydrocele may be left to disappear in a year
or two or it may be treated as a hernia - with surgery. In
infants, the hydrocele may not require surgery, as many go away
by the second birthday. Some can change size depending on how
much fluid goes in and out, and some may appear bluish because
the membrane that causes the hydrocele is blue.
- Occasionally, a retractile testicle (a testicle that retracts
from the scrotum from time to time) causes a bulge in the groin
area. It may not need treatment but should be evaluated by a
pediatric specialist.
- A femoral hernia is rare in kids and can be confused with an
inguinal hernia. It consists of tissues that have pushed in
alongside an artery into the top of the thigh. It appears as a
bulge at the top of the thigh, just below the groin.
Umbilical Hernias
Some babies are born with a weakness or opening in the abdominal
muscles around the belly button (under the skin) through which some
abdominal membrane or small intestine protrudes.
The soft bulge this creates is an umbilical hernia. It is most
obvious when the baby cries, coughs, or strains. Umbilical hernias
are more common in females, those of African heritage, and low
birth weight babies. These hernias range in size from less than 1/2
inch (2 centimeters) to more than 2 inches (6 centimeters).
In most instances an umbilical hernia causes no discomfort.
Usually, a doctor can easily push it back in. An infant's
umbilical hernia (unlike an adult's) rarely obstructs or
strangulates. In fact, most umbilical hernias, even the larger
ones, tend to close up on their own by age 2. That's why the
doctor usually advises waiting and watching this kind of hernia in
an infant rather than operating.
Surgery is necessary only if the hernia is very large, grows in
size after age 1 or 2, fails to heal by age 4 or 5, or the child
develops symptoms of obstruction or strangulation, like swelling,
bulging, vomiting, fever, and pain. If such symptoms develop, call
the doctor immediately.
Signs and Symptoms
If you think that your child may have a hernia, call your doctor
immediately. And ask yourself:
- Is the bulge present when your child is straining, crying,
coughing, or standing, but absent when your child is sleeping or
resting? This could indicate a reducible hernia.
- Is the bulge present all the time, but with no other
symptoms? This could be a hydrocele or something else.
- Has the groin area suddenly begun to swell? Do you notice any
discoloration of the bulging area or a "swollen"
abdomen? Is your child irritable, complaining of pain,
constipated, or vomiting? These are signs of an incarcerated
hernia, which calls for immediate attention. See a doctor
immediately or take your child to the emergency department.
- Is the area swollen, red, inflamed, and extremely painful?
Has your child developed a fever? These might be symptoms of a
strangulated hernia. Call your doctor and then go directly
to the hospital emergency department.
Treatment
Once an inguinal hernia is diagnosed, surgery will be done to
prevent it from becoming incarcerated. During surgery, the
herniated tissue is put back into its proper space, and the opening
or weakness that permitted it to form is closed or repaired.
Surgery to correct inguinal hernias is performed on kids of all
ages, sometimes even on premature babies.
Inguinal hernia surgery in kids is usually performed on an
outpatient basis with no overnight stay in the hospital, but some
kids, particularly young infants, may be kept in the hospital
overnight for observation.
The period of recuperation for kids is fairly short. Most can
resume normal activities about 7 days after surgery, with the
doctor's approval. Until that time, kids should avoid
strenuous activity such as bicycle riding and tree climbing. Of
course, if you notice any signs of problems after the surgery, such
as bleeding, swelling, or fever, call your doctor.
Reviewed by:
T. Ernesto Figueroa, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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