Inguinal Hernias

What Are Inguinal Hernias?

An inguinal hernia happens when part of the intestines pushes through an opening in the lower part of the abdomen called the inguinal (IN-gwuh-nul) canal. Instead of closing tightly, the canal leaves a space for the intestines to slide into.

Doctors fix inguinal hernias with surgery.

What Causes Inguinal Hernias?

Some children are born with a weakness or hole in the muscle wall that holds the intestines in place. The abdominal lining bulges out through the hole or weak area, forming a sac, that part of the intestine pushes into. This can cause swelling and pain under the skin, especially when the child coughs, bends over, or lifts something heavy.

If an inguinal hernia isn't fixed, part of the intestine can get stuck in the muscle wall (an "incarcerated" hernia). This can cause severe pain, nausea, and vomiting, and make it hard for the child to have a BM. Blood flow to an incarcerated hernia can get blocked (a "strangulated" hernia), damaging the intestine. So doctors operate on hernias to fix the space in the muscle wall before they become an emergency.

Who Gets Inguinal Hernias?

People of all ages can get an inguinal hernia. In kids, they're much more common in boys, but girls can get them too.

• In boys, the inguinal canal is a passageway between the belly and the scrotum. The spermatic cord passes through it.
• In girls, the inguinal canal is the passageway for a ligament that holds the uterus in place.

Children who are born early (preemies) are more likely to have an inguinal hernia.

What Are the Signs & Symptoms of an Inguinal Hernia?

The main sign of an inguinal hernia is a visible bump under the skin in the groin (where the belly meets the upper leg). A child can have a bump in one or both sides of the groin. 

Other signs include:

• pain, especially when bending over, straining, lifting, or coughing
• pain that improves during rest
• weakness or pressure in the groin
• in males, a swollen or enlarged scrotum
• burning or aching feeling at the bump site

The hernia can get bigger and smaller:

• It can get bigger when a child does something that creates pressure in the belly, like standing up, crying, coughing, or straining to poop. 
• It can get smaller again when the child lies down and is calm.

In babies, the hernia might be visible only when the infant cries, coughs, or strains to poop. Parents also might notice that the baby is cranky and eating less than usual.

How Are Inguinal Hernias Diagnosed?

If your child has any pain or swelling in the groin, call your doctor. The doctor will do an exam and ask about your child's medical history.

To feel the hernia as it moves into the groin or scrotum, the doctor might have your child stand and cough. The doctor will gently try to massage the hernia back into its proper place in the abdomen. A hernia that can be massaged back into place is called a "reducible" hernia. But these also need surgery because they won't stay in place.

If the hernia is not reducible, the doctor may order an X-ray or an ultrasound to get a better look at the intestine.

How Are Inguinal Hernias Treated?

Inguinal repair surgery is one of the most common types of surgery done on kids and teens.

In this operation:

• The child gets anesthesia to sleep through the procedure and not feel any pain.
• The surgeon makes a small incision (cut) in the skin, then puts the part of the intestine inside the hernia back where it belongs.
• The surgeon closes the opening in the muscle wall by sewing the edges of healthy muscle tissue together. This can help prevent another hernia.
• Small tape strips will cover and close the incision site. These will fall off on their own in 1–2 weeks.

Babies younger than 1 year old who have an inguinal hernia on one side are at risk for a hernia on the other side. So doctors often strengthen the other inguinal area during the surgery by adding stitches to the muscle wall.

What Happens After the Surgery?

Most children can go home a few hours after the surgery. Things to know:

• Your child should have a sponge bath for the next day or two rather than a tub bath or shower.
• Your child may have some swelling and bruising near the surgery area. Boys may have swelling of the scrotum. Apply cool compresses (a cloth dipped in cold water, a freezer pack, or a bag of ice) to the area to reduce swelling. Wrap it in a towel to protect the skin.
• Your child can eat normally and go back to usual activities as soon as he or she feels up to it, usually in a few days.
• Your child should not ride a bicycle or use a riding or straddle toy until the surgeon says it's OK.
• Some kids get constipated (have trouble pooping) after surgery. Offer plenty of liquids (such as water and prune, pear, and apple juice), plus high-fiber fruits and vegetables (such as pears, strawberries, and sweet potatoes). Avoid cheese, bananas, and white rice.
• Your child should not climb, play sports, or lift objects heavier than 10 pounds (about the weight of a gallon of milk) until the surgeon says it's OK.
• Give any prescribed medicine or over-the-counter pain medicine exactly as directed. 
• If the tape strips don't fall off on their own, the doctor will take them off at your child's follow-up visit after surgery.

When Should I Call the Doctor?

Call the surgeon if your child had surgery and:

• has a fever of 101.5°F (38.6°C) or higher for more than 24 hours
• has redness that spreads around the surgery area
• has bleeding, swelling, or drainage from the surgery area
• has severe, lasting pain at the surgery area
• can't pee within 8–12 hours after surgery
• is vomiting