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Hernias & Hydroceles in Children

Hernias & hydroceles in children at a glance

  • A hernia in a child is the protrusion of a section of intestine through a weak spot in his or her abdominal muscles, which can occur in the first few months or years after birth.
  • An inguinal hernia can develop in the inguinal canal of a male fetus, through which his testicles normally drop from his abdomen into his scrotum before birth.
  • An umbilical hernia can develop where the umbilical cord passed through the abdominal wall of a male or female fetus, and that opening did not properly close after birth.
  • Inguinal hernias require surgical correction, while umbilical hernias may either disappear on their own or require surgery.
  • A hydrocele is a sack filled with fluid that can develop around a boy’s (or a man’s) testicle and cause his scrotum to swell.
  • Usually a hydrocele goes away a few months after a boy’s birth, but hyrdocelectomy surgery may be needed, particularly for a hydrocele that forms from an inguinal hernia.

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What are hernias in children?

A hernia is the protrusion of a section of the intestine through a weakness in the abdominal muscle. Children can experience two types of hernias, inguinal and umbilical, both of which generally form shortly after birth.

The hernia causes a soft bulge under the skin. Hernias that cannot be pushed back through the abdominal wall by a physician and do not resolve on their own can damage the intestine, due to a loss of blood necessary for intestinal health. Infection is another cause of concern.

Hernias are more likely to occur in children who:

  • Have a parent or sibling who had a hernia as an infant
  • Have undescended testicles
  • Have abnormalities of the urethra (the tube that carries urine from the body)
  • Have cystic fibrosis or developmental dysplasia of the hip.

Inguinal and umbilical hernias form in similar fashion but in different areas.

An inguinal hernia can occur in a baby boy’s groin area and results from part of his intestine breaching the abdominal muscle at the place where the inguinal canal passes through it. This canal is where his testicles descend normally from his abdomen into his scrotum before birth. If the inguinal canal does not close properly after birth, a hernia can occur.

  • Inguinal hernias require surgical repair, usually right after discovery and before they can damage the intestine.
  • They occur in about 1 to 3 percent of children and occur more often in premature infants.
  • Inguinal hernias appear more often in the right groin area, but can occur on both sides.
  • Girls also have an inguinal canal but experience inguinal hernias much less often than boys. Boys experience about 90 percent of inguinal hernias in newborns.

An umbilical hernia can form at the spot where the umbilical cord that connects the baby to the mother passes through a small opening in the baby’s abdomen. If that opening does not close properly after birth, it causes an umbilical hernia.

Many umbilical hernias resolve on their own, with most resolving in the first year. If an umbilical hernia is still present after age 3, the urologist may recommend surgical correction. Just about all umbilical hernias will have resolved by age 5, but waiting that long may cause problems for the child.

Umbilical hernias are common, affecting about 1 in 10 children. They occur more often in premature infants and African-American babies. Umbilical hernias can also occur in adults and cause abdominal discomfort.

Symptoms, diagnosis and treatment of hernias in children

Hernias may not be noticeable for several weeks or months after birth.

Inguinal hernias appear as a bulge in the scrotum or groin area and may become more noticeable when the baby strains. An inguinal hernia can cause the following symptoms:

  • A swollen or full abdomen
  • Redness or discoloration
  • Fever
  • Pain
  • Vomiting.

Umbilical hernias in children are usually not painful. Symptoms include a soft bulge around the navel that may be more noticeable when the child is straining, crying or coughing. Children known to have an umbilical hernia should get immediate medical care if they:

  • Are in pain
  • Experience swelling and discoloration of the bulge
  • Begin to vomit.

Diagnosis and treatment of hernias

Most hernias are diagnosed in a physical exam. The physician may try to push the hernia back through the abdominal wall. Sometimes x-rays or ultrasounds may be used to get a better picture of the intestines and the hernia.

Inguinal hernias require surgical repair before damage occurs to the intestine. Surgery is usually scheduled soon after the inguinal hernia is discovered. Surgery is also necessary for umbilical hernias that do not resolve on their own, causing pain, becoming enlarged or blocking the intestines.

Hernia operations are simple surgical procedures, involving the following steps:

  • The child is placed under anesthesia.
  • A small incision is made near the hernia.
  • The section of intestine is pushed back through the abdominal muscle.
  • The muscle is stitched back together and the incision is closed.
  • Often the child can go home the day of the surgery.

As with any surgery, risks are inherent in hernia surgery. They can include blood loss, infection, issues with anesthesia and pain.

What are hydroceles in boys?

A hydrocele is a fluid-filled sack that can form around a boy’s testicle and cause swelling in his scrotum. It occurs when the fetus’ inguinal canal (the tube through which the testicles normally pass from the abdomen where they are formed to the scrotum) does not close properly after birth. This results in fluid leaking from the boy’s abdomen into his scrotum.

Hydroceles are common in infant boys, occurring in about 1 to 2 percent of newborns. Premature babies are more likely to have hydroceles. The only symptom is swelling around one or both testicles. The hydrocele may feel like a water balloon.

Hydroceles usually resolve on their own, as they typically do not cause pain or harm or require treatment. Generally, if the swelling persists or if the hydrocele has not resolved on its own after a year, the child should be taken to see a doctor.

Hydroceles can sometimes occur from an inguinal hernia, usually indicated by a change in the amount of fluid they have collected. This requires surgical removal of the hernia and hydrocele.

Older boys and adults can also have hydroceles. This happens due to an abnormal accumulation of the fluid that surrounds the testicles, either because the fluid doesn’t drain properly or because the body is producing too much of it. Injury to, or inflammation of, the testicle can also cause a hydrocele.

Treatment of hydroceles in boys

Hydroceles are usually diagnosed in a physical exam. The urologist may shine a light on the swollen scrotum to illuminate the hydrocele within. Blood and urine tests may be done to check for infection. Ultrasound can be used to rule out other possible conditions, such as a tumor or hernia.

Hydrocelectomy (surgical removal of the hydrocele) may be required if a baby’s hydrocele does not disappear within a year, if it becomes infected, causes blood flow problems or swells larger. During a hydrocelectomy:

  • The patient is given general anesthesia.
  • The urologist makes an incision in the fold of the groin.
  • The surgeon may also utilize a laparoscope (thin, lighted optical instrument) to view images of the hydrocele.
  • The fluid is drained.
  • The hydrocele sac is removed.
  • A tube may need to remain in place for a few days to help with drainage.

As with any surgery, risks include blood loss, blood clots, infection, complications from anesthesia and pain.