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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Inguinal hernias

Inguina herniasHernias are fairly common in children. Babies, especially preemies can be born with a hernia. Hernias occur, when part of an organ or tissue in the body protrudes through an abnormal opening or weak spot in a muscle wall, in an abnormal way. There are different types of hernias that require individual levels of medical care. The two most common hernias in children are inguinal hernias, occurring in the groin area (the area where the abdomen meets the top of the thigh) and umbilical hernias in the belly-button area.

Inguinal or groin hernias occur when part of the intestine bulges through a weakened area in the abdominal opening at the inguinal canal. The inguinal canal is a passageway through the abdominal wall near the groin. Inguinal hernias are ten times more common in males than females due to their pre-birth development. Initially, the testicles develop within the abdomen and then move down the inguinal canal into the scrotum. After birth, the inguinal canal closes, leaving sufficient room for the spermatic cord to pass through but not enough to allow the testicles to return to the abdomen. Sometimes the canal doesn’t close properly, resulting in an inherent weakness in the inguinal area.

Types of hernia

There are two types of inguinal hernias, direct and indirect. Indirect inguinal hernias occur when the internal opening of the inguinal canal remains open after birth. This allows a portion of the intestine to slip through the inguinal canal. The condition is generally diagnosed in the first year of life but may show up in adulthood. Indirect inguinal hernias affect between 1% and 5% of normal newborns and up to 10% of premature infants.

Direct inguinal hernias are less common in children and occur when a portion of the intestine protrudes through a weakened or injured area in the abdominal muscles, situated in the inguinal canal.


Weakness can develop in the abdominal wall, due to injury or a surgical procedure in the abdominal cavity. Extra pressure in the abdominal area from straining, heavy lifting, pregnancy or excess weight, with or without inherent weakness can cause a hernia.

In infants, hernias mostly occur when a loop or portion of intestine or a fold of membrane from the abdomen, or from an ovary or fallopian tube in girls, protrudes through an opening into the groin. The opening is caused by the presence of a fold in the peritoneal membrane (the membrane that lines the abdominal wall and covers the abdominal organs), which produces a sac. The membrane is a closed sac in males. The ovaries and fallopian tubes open into the peritoneal cavity in females. Within this sac, part of an organ or tissue (such as a loop of bowel) can protrude, resulting in a bulge in the groin area.

In boys, inguinal hernias may extend beyond the groin into the sac that holds the testicles (scrotum). In girls, it can extend into the larger lips of tissue around the vaginal opening (outer labia). In these cases, the swelling or enlargement extends from the groin into the scrotum or labia.

Unlike hernias in adults, which result from weakness, strain or injury to the muscle wall, hernias in children may occur when normal small openings in the body have not yet closed.


  • A bulge or lump near the crease between the abdomen and inner thigh.
  • In boys, the swelling can extend into the scrotum. In girls, it may extend into the labia.
  • The bulge or lump may become more prominent on coughing, crying, straining or standing
  • Depending on the type of hernia, the bulge or lump may retract or go away at other times (such as when lying down or resting). This may indicate a reducible hernia.
  • Discomfort or tenderness to touch
  • The bulge may feel hard to the touch.
  • A feeling of heaviness or pressure may be experienced in the groin.
  • The affected area may appear red or discoloured.

Other symptoms include:

  • Pain
  • Inflammation
  • Vomiting
  • Irritability
  • Constipation
  • Fever


Most hernias are discovered by seeing or feeling a bulge. When a hernia is suspected the patient is referred to a surgeon, to confirm the diagnosis and discuss a treatment plan. Although additional tests, such as ultrasound and x-rays are available, careful examination by an experienced surgeon is crucial in diagnosing hernias. Testing is rarely necessary and merely adds further risks, stress and expense to the child’s care. Imaging is only necessary if the doctor is concerned about complications, such as a strangulation or an incarceration; cannot feel the hernia during the physical exam, or is concerned that the swelling in the groin is related to another condition. Tests may include an abdominal x-ray, abdominal ultrasound, or CT scan.


Since inguinal hernias will not close without surgical intervention, repair is generally recommended. The primary reason for fixing hernias is to prevent problems that arise if the hernia becomes strangulated or incarcerated. Surgery to correct inguinal hernias is performed on children of all ages and is one of the most commonly performed operations by pediatric surgeons.  Inguinal hernia surgery is usually performed on an outpatient basis, however some children, especially young infants, may be kept in the hospital overnight for observation.

When assessing the risks, benefits, alternatives and outcomes of the various treatment options, your surgeon will classify the hernia. Hernias fall into three categories. Most hernias are reducible. This means that the bulging intestine can be pushed back through the hole in the muscular layer. When the hernia is pushed back in (reduced/compressed), one can often feel or hear a “squish”. In many cases, the hernia pops back out when the doctor lets go, especially if the child is crying. Reducible hernias are usually mildly uncomfortable rather than painful.

Hernias that cannot be pushed back in are classified as incarcerated. Incarcerated hernias are painful because the intestine or tissue protruding through the muscle wall is stuck. The bulge may be swollen and red, tender to the touch, and accompanied by abdominal pain and vomiting. Incarcerated hernias are a medical emergency, as the child is at risk for strangulation. Sometimes a surgeon can push the bulge back in for temporary relief; otherwise immediate surgery is required.

Strangulated hernias are dangerous because they cut off the blood supply to the intestine. Immediate surgery is necessary to repair the hernia and restore blood supply to the bowel. Strangulated hernias are potentially life threatening and may be accompanied by nausea, vomiting and fever; rapid heart rate, and sudden pain that intensifies quickly. If a hernia bulge turns red, purple or dark seek immediate medical care.

There are three different surgical approaches to pediatric hernias. Open repair involves making an incision just below the belt line and dissecting down to the hole in the muscle layer. The hernia is closed/repaired with stitches. The deeper tissues and skin are sewn together with dissolvable stitches under the skin. In some cases, it may be necessary to reinforce the area with a small piece of synthetic mesh material to prevent another hernia.

Open repair with laparoscopic exploration, involves the same procedure with the addition of a small camera being inserted through the hernia hole, before it is closed. The camera is passed into the abdomen to explore the groin on the other side, to rule out a potential hernia. If a second hernia is detected, a matching incision is made on the opposite side and the hernia is repaired.

Laparoscopic hernia repair is a hernia closure technique involving the use of small incisions, telescopes and a patch if necessary. The surgeon makes three small incisions in the abdominal wall and inflates the abdomen with harmless gas. A laparoscope is then inserted through the incisions. A laparoscope is a tube-like instrument with a small video camera (3-mm or 5-mm) and surgical instruments. There are a number of laparoscopic hernia repair techniques that can be used in children, such as eversion technique, intracorporeal suturing technique, and single stitch technique. Your surgeon will decide what technique is best depending on your child’s particular needs and health circumstances.

Risk factors

Inguinal hernias are more common on the right side and occur more frequently in males than females. About one in four men develop a hernia at some point in life. Premature babies, boys with undescended testicles and children with cystic fibrosis are at increased risk. Familial history of hernia may play a contributory role.


Indirect inguinal hernias in children cannot be prevented. As an adult, you can reduce your risk by: maintaining a healthy body weight, exercising to strengthen your abdominal muscles, avoiding straining while urinating or defecating, and not lifting heavy objects.


Inguinal hernia surgery is generally safe and effective.  Pain post-operatively is usually controlled with over-the-counter medication, but prescription pain medication may be necessary. Children tend to recuperate fairly quickly, with most children returning to school after 1 week of rest. Your child may need to refrain from full strenuous activity, such as bike riding or tree climbing, for 6-8 weeks to allow the muscle and tissue to heal completely. Always follow your doctor’s advice in this regard. If you notice any problems post-operatively, such as bleeding, swelling or fever, contact your surgeon immediately.