Inguinal hernias in infants and children are a type of hernia that appears in the groin region. A hernia occurs when a part of the intestines protrudes through a weak spot in the abdominal wall. The main sign of an inguinal hernia in a child is a noticeable bulge beneath the skin in the groin or scrotum. Surgery is required to correct this condition.
Overview
An inguinal hernia in a baby happens when a portion of the intestine pushes through an opening in the abdominal wall and enters the inguinal canal. The inguinal canal is a passage that extends from the abdomen to the genitals.
Normally, the inguinal canal closes before birth. However, if it remains open, a gap is left that allows the intestines to slip through, forming a visible or palpable bulge in the groin or scrotum. This bulge may only appear when the baby is crying, coughing, or straining.
Inguinal hernias most often appear on one side of the groin, typically the right side. About 10% of cases involve both sides.
Who is Affected
Inguinal hernias can occur in newborns, toddlers, older children, and even adults. In children, these hernias are most often seen in those under six years old. Approximately 90% of inguinal hernias in infants occur in boys, and they are more frequent in babies born prematurely.
How Common Are Inguinal Hernias?
Inguinal hernias are found in about 1% to 5% of healthy, full-term male infants. In premature infants, the rate can be as high as 30%.
What Are the Risks of Inguinal Hernias?
Surgery is necessary to repair the hernia. If left untreated, rare but serious complications can occur:
- Incarcerated hernia: This happens when the contents of the hernia become trapped and cannot be pushed back into the abdomen.
- Strangulated hernia: If the hernia becomes stuck, blood flow to the intestine may be blocked, leading to tissue death—a medical emergency requiring immediate treatment.
Symptoms and Causes
Signs of an Inguinal Hernia in Children:
- A noticeable bulge in the groin or scrotum, especially during crying or straining.
- The bulge may reduce or disappear when the child is relaxed or sleeping.
- Swelling on one or both sides of the groin.
Other Possible Symptoms:
- Groin pain or discomfort that improves with rest.
- Heaviness or pressure in the groin area.
- Swollen scrotum.
- A burning sensation near the bulge.
- Irritability and difficulty feeding in infants.
Emergency Symptoms (Incarcerated or Strangulated Hernia):
- Severe pain or tenderness.
- Redness or bruising at the bulge site.
- Loss of appetite.
- Fever.
- Vomiting and nausea.
- Blood in the stool.
Causes of Inguinal Hernia in Babies:
All infants are born with an inguinal canal. In males, the testicles form in the abdomen and descend through this canal into the scrotum before birth. If the canal does not close completely, it leaves an opening that allows intestines to push through, resulting in a hernia.
Though rare, inguinal hernias can also occur in girls. In female infants, the hernia may contain a part of the reproductive system, such as an ovary.
Diagnosis and Tests
A pediatric surgeon can typically diagnose an inguinal hernia through a physical exam by observing the groin or scrotum for a bulge, especially while the child is crying or straining. The surgeon may check whether the bulge disappears when the child is calm.
If the child is older, the surgeon might ask them to stand or cough to better observe the hernia. In some cases, an ultrasound may be ordered to confirm the diagnosis.
Management and Treatment
How Is an Inguinal Hernia Treated in Infants?
Surgical repair is necessary. The procedure usually takes less than an hour and is performed on an outpatient basis, meaning the child can return home the same day.
Before Surgery:
The child will be given general anesthesia by an anesthesiologist, ensuring they are asleep and pain-free during the operation.
During Surgery:
The pediatric surgeon makes a small incision in the groin area, gently pushes the hernia contents back into the abdomen, and then closes the inguinal canal to prevent recurrence. The incision is then closed with small strips of tape.
After Surgery:
Most children can go home a few hours later. However, premature infants or those with certain medical issues might need to stay overnight for observation. A follow-up appointment is scheduled within 7–10 days to check the healing process.
Post-Surgery Care
Mild discomfort or pain may occur after surgery and usually improves within one to two weeks. Pain medication may be prescribed.
- A sponge bath can be given the day after surgery.
- Avoid tub baths for two to three days.
- Do not remove the tape strips from the incision; they should fall off on their own. If not, the pediatric surgeon will remove them during the follow-up visit.
Outlook / Prognosis
What to Expect After Surgery:
Inguinal hernias in babies and children are quite common, but surgery is straightforward and usually successful. Most children go home the same day and recover quickly.
Resuming Normal Activities:
Children can begin eating normally as soon as they are able. Most can return to everyday activities within one to two weeks.
Prevention
There is no known way to prevent inguinal hernias in babies, especially if the inguinal canal remains open after birth. Hernias can develop at any time.
Living With an Inguinal Hernia
Some minor swelling around the incision site is expected and may last for a few weeks. However, contact the pediatric surgeon if your child experiences:
- Inability to urinate.
- Fewer wet diapers than usual.
- Fever above 38°C.
- Significant swelling.
- Redness at the incision.
- Bleeding from the incision.
- Increased pain.
- Vomiting.
Common Questions
How is an inguinal hernia different from an umbilical hernia?
An umbilical hernia occurs near the belly button when part of the intestine or fatty tissue pushes through the abdominal wall. These may close on their own. In contrast, inguinal hernias occur in the groin and typically need surgical repair.
What is the difference between an inguinal hernia and a hydrocele?
A hydrocele is a fluid-filled sac in the groin or scrotum that looks similar to a hernia but does not contain any tissue. Around 10% of baby boys are born with hydroceles. These usually resolve without surgery unless they cause pain. Baby girls do not get hydroceles but can develop inguinal hernias.