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.
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.