If you’ve noticed a bulge or protrusion in your baby’s groin area, it’s undoubtedly raised some red flags. Could it be a tumor or a cyst or could they have a hernia?
Many people associate hernias with heavy lifting or straining, but adults aren’t the only ones who are susceptible to getting them. Hernias are common in babies and children too. Unlike adult hernias that are usually caused by muscle strain, children are typically born with them.
One of the most common hernias found in babies and children are inguinal hernias.
What is an inguinal hernia?
An inguinal hernia happens when part of the intestine slips into the groin (where your belly meets your upper thigh)—instead of staying put in the belly. There are two types of inguinal hernias: direct, which are rare in children, and indirect, which are often discovered in the first year of life.
“The most common type in children is an indirect inguinal hernia, which occurs when the inner opening to the inguinal canal – a small passage through the lower abdomen – doesn’t close as it should have,” said Ravindra Vegunta, MD, a pediatric general surgeon with Banner Children's. “It can affect up to 5% of newborns and up to 30% of prematurely born baby boys.”
What causes inguinal hernias?
Inguinal hernias occur because of a problem with the development of the lower belly wall. Straining and crying don’t cause hernias, but coughing, crying or straining can increase pressure in the belly, making hernias more visible.
Inguinal hernias can occur at any age but are more common in young children, especially in those who are born prematurely. Boys are much more likely to get inguinal hernias. An inguinal hernia occurs when the inner opening of the inguinal canal fails to close completely by the time of birth. This allows a portion of the intestine to slip through and cause an indirect hernia.
In boys, the intrusion can cause swelling in the groin and sometimes it extends into the scrotum. In girls, the swelling is usually in the groin or labia.
How do I know if my child has an inguinal hernia?
Being able to recognize an inguinal hernia early on can prevent the development of serious complications. Here are some important signs and symptoms to watch out for:
- A smooth lump in the groin and/or scrotum or labia area that comes and goes
- A bulge or swelling that becomes more noticeable when your baby is crying or straining
- In older children, the swelling may be seen while they stand but disappears when they lie down
- Usually painless or causes mild discomfort, although strenuous exercise can cause swelling and discomfort in older children
How are inguinal hernias diagnosed and treated?
If your child has any pain or swelling, it’s important to call their health care provider right away. They can do a physical exam on your child to see if the bulge in the groin is caused by a hernia and if it can be pushed back into the abdomen (reducible).
“If the hernia is not reducible, the child will need to be evaluated as an emergency to see if an emergency surgical repair is necessary,” Dr. Vegunta said. “However, all inguinal hernias will require surgery.”
That’s because once an inguinal hernia develops, it will not close and will need to be fixed. Your child’s pediatrician will refer your child to see a pediatric surgeon or urologist who will correct the defect and prevent damage to any organs.
The timing of the surgery will happen pretty quickly after the hernia is found because there is a risk that the intestine can become stuck in the inguinal canal. If this occurs, it can cut off blood to the intestines causing what is called an incarcerated inguinal hernia. If it has, then a piece of the bowel may need to be removed and the bowel sewn back together.
“If you suspect that the hernia may be incarcerated, you should bring your child to a pediatric emergency room for evaluation and management,” Dr. Vegunta. “If the hernia isn’t reducible, your child will need an emergency surgical repair.”
What type of surgery is done to repair an inguinal hernia?
Inguinal hernia repair surgery is one of the most common types of surgery done on babies and children and can be performed surgically or laparoscopically, a less invasive surgical procedure.
“The majority of repairs are done as open operations without using mesh, but some surgeons use a laparoscopic (scope) approach,” Dr. Vegunta said. “In both approaches, children will need general anesthesia for the repair.”
Can an inguinal hernia return?
After having an inguinal hernia repair surgery, most children don’t have any problems again. However, there is a small chance that a hernia can come back.
“The risk of another one occurring after surgery is about 3%,” Dr. Vegunta said. “And in premature babies it’s about 6%. Recurrence is really uncommon.”
Final words: Don’t delay treatment
Inguinal hernias are very common in babies and children but are treatable. If you are concerned about the possibility of a hernia in your child, get them evaluated quickly by their health care provider. To find a Banner Health specialist near you, visit bannerhealth.com.