Digestive and Gastrointestinal Conditions

Inguinal Hernia

What is an inguinal hernia?

An inguinal (pronounced ING-win-ul) hernia is a bulge of tissue near the crease between your child’s belly (abdomen) and inner thigh.

Before they are born, it’s normal for babies to have a small, thin sac that holds their intestines in place. The sac is supposed to seal shut just before birth. Sometimes the sac does not seal shut, leaving a hole. Tissue can then slide into the sac and drop into a natural tunnel in the belly wall. The tissue can be either intestine or, in girls, an ovary. This is called an inguinal hernia.

In boys, sometimes fluid enters the opening in the sac. This is called a hydrocele.

If your child has a hernia, the tunnel in the belly wall and the hole in the sac were present when your baby was born (congenital). But you may not notice a bulge for several months or even years. If the sac did not close properly, tissue may bulge through at any age.

  • There are 2 common types of inguinal hernias. One type is an emergency, and one type is not:

    • In a reducible hernia, the bulge comes and goes. You may see it only when your child cries, coughs, strains, runs or stands. This type of hernia doesn’t cause harm right away, but it does need surgery to prevent more serious problems.
    • In an incarcerated hernia, the bulge is always present and is likely painful. This type of hernia needs treatment right away. The tissue that has slipped may be trapped. Blood supply to the tissue may be cut off, causing it to die. Or, if the intestines have slipped, they may become blocked.

  • Both boys and girls get inguinal hernias, but boys are 10 times more likely than girls to have one. Between 1% and 5% of newborn boys have an inguinal hernia.

Inguinal Hernias at Seattle Children’s

Children with inguinal hernias are treated by doctors in the Hernia Program at Seattle Children’s. It is the only program in the Northwest to focus on diagnosing and treating children with inguinal hernias and umbilical hernias. For children who need surgery, most hernia surgeries can usually take place within 2 weeks of a confirmed diagnosis.

  • If your child needs surgery, you can feel confident in our expertise. Hernia Program surgeons perform several hundred inguinal hernia surgeries every year.

    Some people think that surgeons who operate on adults are also experts in the surgical care of infants, children and teens. We don’t agree. Growing bodies are different from adult bodies. The way kids react to surgery – from anesthesia to IV fluids – is different from adults. Hernia Program surgeons are board certified in pediatric surgery, and the doctors who give your child anesthesia are board certified in pediatric anesthesiology.

    Seattle Children’s has the only anesthesiology group in the region that has specialized training in pediatric anesthesia. Our anesthesiologists work only with children and teens, providing safe, family-centered care before, during and after surgery. Last year, the team provided anesthesia for more than 20,000 procedures at Seattle Children’s.

  • Most inguinal hernia surgeries are done at Seattle Children’s Bellevue Clinic and Surgery Center. From check-in through recovery, we put your child’s safety and comfort first. The operating suites are specially designed for children who need day surgeries and are healthy. Your child’s planned procedure is less likely to be delayed because complex emergency surgeries aren’t done here.

    Hernia surgeries take place at the Bellevue Clinic and Surgery Center on most Fridays (3 Fridays and 1 Monday a month). On surgery day, you and your child should plan on spending about 3 hours at the Surgery Center, from the time you walk in the door to the time you leave.

    The induction rooms (where your child gets anesthesia), operating rooms and recovery rooms are next door to each other. This means you’ll be able to be with your child right up until they are rolled into the operating room — and again as soon as they open their eyes in a private recovery room. Most children can go back to school 1 to 2 days after surgery. Your child cannot be treated at Bellevue Clinic and Surgery Center if:

    • They are 3 months old or younger
    • They have a health problem that could increase their risk of side effects or complications while under anesthesia

    In these cases, hernia surgery is performed at Seattle Children’s main campus in Seattle.

  • During surgery, your child is given general anesthesia, which causes them to sleep without pain. Seattle Children’s also uses regional anesthesia, or regional blocks, during hernia surgeries.

    With a regional block, your doctor uses ultrasound to find the nerves that supply the area being operated on. Then local anesthetics (numbing medicines) are delivered to that area through an injection or a catheter.

    Regional blocks have these advantages that many parents find comforting:

    • Your child will receive a lighter amount of general anesthesia.
    • Most kids will have less nausea and feel more alert after surgery.
    • Your child will likely need less pain medicine after surgery.

    The effects of a regional block last about 6 hours. The surgeon will send additional pain medicine home with you to make sure your child stays comfortable.

Symptoms of Inguinal Hernia

The main symptom of an inguinal hernia is a bulge or swelling that you can see under your child’s skin. The bulge is near the crease between your child’s belly and inner thigh. In boys, the swelling can extend down into the scrotum. In girls, it may extend to the labia.

Many children with a hernia seem to be comfortable and act normally. Other children are fussy or complain of pain with exercise. If the bulge comes on suddenly, your child may become cranky, cry out in pain or not want to eat.

Symptoms may depend on the type of hernia:

  • With a reducible hernia, the bulge may show up only when your child cries, coughs, strains, runs or stands. These actions create more pressure in your child’s belly. When your child is relaxed or resting, the hernia may seem to hide (retract).
  • If your child has an incarcerated hernia, the bulge is present all the time. Your child will probably have pain. They may vomit, and the bulge may feel hard. (An incarcerated hernia is an emergency, and your child will need surgery right away.)

Diagnosing an Inguinal Hernia

The doctor will review your child’s medical history and do a careful physical exam. It is very rare that any testing or imaging is needed to diagnose an inguinal hernia.

Most hernias occur on the right side. But inguinal hernias can occur on the left side or on both sides at the same time. The doctor will check both sides on your child.

Your child’s doctor will examine your child’s belly and the area between the belly and the inner thigh. In boys, the doctor will most likely examine the scrotum to feel for a hernia.

The doctor will check to see if the bulge gets bigger when your child is crying, coughing or straining, or if it is present all the time. This can help you and your child’s doctor decide on the timing of treatment.

Treating an Inguinal Hernia

An inguinal hernia, whether it comes and goes or is always present, will not go away if left alone. Even those that seem to go away can come back again and get bigger when your child cries, coughs, runs or strains during a bowel movement. This can be uncomfortable.

The first step in treating an inguinal hernia is to try to gently press the bulging tissue back through the tunnel in the belly. This is called reducing the hernia. If the doctor is able to do this (your child has a reducible hernia), we recommend your child have surgery soon, probably within a few weeks, to close the hole so the hernia doesn’t return.

If the doctor is not able to press the bulging tissue back where it belongs, your child will need surgery right away. This is an emergency because it means the tissue is trapped (your child has an incarcerated hernia). The tissue is not getting the blood and oxygen it needs to survive.

If your child has hernias on both sides (or if the surgeon suspects your child might), the surgeon will talk with you about the options for evaluation and treatment.

  • At the time of surgery, we will give your child medicine (general anesthesia) to make them sleep without pain. During the surgery for inguinal hernia, your child’s surgeon makes a very small cut (incision) on the lower belly. The surgeon gently pushes any bulging tissue back into the belly. Then the surgeon sews shut the sac that poked through the tunnel in the belly.

    In girls, the surgeon then sews shut the tunnel in the belly. In boys, the surgeon leaves the tunnel, which goes between the belly and the scrotum. They leave it because blood vessels for the testicles and tubes that carry sperm (vas) travel through the tunnel. The tunnel isn’t a problem; the hernia is fixed simply by closing the sac that poked through.

    Finally, the surgeon will close the incision in your child’s skin.

    The surgery takes about 30 to 45 minutes. Your child will be in the recovery room for 30 minutes to an hour.

    Most often, your child can go home the same day as the surgery. Premature babies who have the surgery may need to stay overnight in the hospital so we can carefully watch them.

  • After you get home, you’ll need to keep your child’s cut (incision) clean and dry until it heals. The surgery team will teach you how to care for the incision. We will also give your child pain medicine to make them comfortable.

    You will be given phone numbers so you can reach hospital staff. You can call day or night with any concerns.

    A surgery clinic nurse will call you 5 to 7 days after surgery for a phone follow-up. If all is well, you don’t need to return to the clinic. If you or the nurse has any concerns about your child’s healing, we will set up a visit for you.

Contact Us

Contact the Hernia Program at 206-987-2794 to make an appointment, get a second opinion or, if you are a physician, to refer a patient.

Providers, see how to refer a patient.