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Inguinal Hernia

What is inguinal hernia?

A hernia is a bulging of tissue through an opening, usually in the abdomen. An inguinal (pronounced ING-win-ul) hernia occurs near the crease between the belly (abdomen) and leg.

All people have a normal opening in the abdomen in this spot. In girls, the opening is there but usually seals shut. In boys, the testicle comes through this opening and moves into the scrotum. A lining in the abdomen comes through of the opening with the testicle and forms a sac. This sac is supposed to seal shut before birth. If the opening does not seal shut in a girl or the sac does not seal shut in a boy, then organs inside the abdomen, like the intestine (or in girls an ovary) can come through. This shows up as a bulge in the groin.

You may notice that the swelling or bulge comes and goes. You may see it only when your child cries, coughs, strains or stands. These actions create more pressure in your child's belly. When your child is relaxed or resting, the hernia may seem to hide (retract). A hernia that does this is called reducible. This type of hernia doesn't cause harm right away. But it does need treatment to prevent more serious problems.

If a hernia doesn't retract, this may mean the bulging tissue is trapped (incarcerated). This can be harmful and requires immediate attention. For example, if a segment of intestine gets trapped, then the intestine becomes blocked. If the tissue is trapped tightly, its blood supply may be cut off (strangulated). Without blood, the tissue doesn't get oxygen and will die. In this case, surgeons must operate right away to free the tissue and restore blood flow.

Sometimes in boys no tissue bulges through the opening, but fluid passes through it and collects in the scrotum, causing swelling. This is called communicating hydrocele. It needs to be treated like an inguinal hernia.

Who gets inguinal hernia?

Between 1% and 5% of newborn boys have an inguinal hernia. Boys are 10 times more likely to have an inguinal hernia than girls. The opening in the abdomen and the sac poking through it are present at birth (congenital), but the bulge may not be noticed for several months or sometimes even many years. At any age from birth onward, tissue may bulge through the opening if the sac is present.

What are the symptoms?

An inguinal hernia causes a bulge or swelling that you can see under the skin in the groin area. The swelling can extend down into the scrotum in boys or the labia in girls.

Many children with a hernia seem to be comfortable and act normally. Other children are fussy or complain of pain with exercise. If the bulge comes on suddenly, your child may become cranky, cry out in pain or not want to eat.

If bulging tissue is trapped, your child will probably have pain. They may vomit, and the bulge may feel hard.

How do you diagnose inguinal hernia?

The surgeon will carefully examine your child's belly area, the groin and in boys the scrotum to feel for a hernia. Most hernias occur on the right side. But they can occur on the left side or on both sides at the same time. So the surgeon will check both sides on your child.

What is your experience with inguinal hernia at Children's?

Our surgeons treat many children with inguinal hernias. In fact, this is the most common nonemergency (elective) surgery that our General Surgery Department does. Our surgeons perform several hundred operations to fix inguinal hernias every year.

When you come to Children's, you have a team of people to care for your child before, during and after surgery. Along with your child's surgeon, you are connected with nurses, child life specialists, social workers and others. We work together to meet all of your child's health needs and help your family through this experience.

Since 1907, Children's has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.

How do you treat inguinal hernia?

An inguinal hernia will not go away if left alone. Activities such as running, crying or straining for a bowel movement can make the hernia appear larger and be uncomfortable.

Reducing the hernia

The first step in treating an inguinal hernia is to try to gently press the bulging tissue back through the opening. This is called reducing the hernia. If the doctor is able to do this, then we recommend your child have surgery soon, probably within a few weeks, to close the opening so the hernia doesn't return.

If the doctor is not able to press the bulging tissue back where it belongs (irreducible hernia), your child will need surgery right away. This is an emergency because it means the tissue is trapped and is not getting the oxygen it needs.

Surgery

Your child will have general anesthesia. This means we will give your child medicine to make them sleep without pain during the surgery. Most often, your child can go home the same day they have surgery to repair an inguinal hernia. If your child is a premature infant, they may need to stay overnight in the hospital to be carefully watched after anesthesia.

The surgery is done through a very small cut, or incision, on the lower abdomen. If there are hernias on both sides, or if the surgeon suspects there might be, the surgeon will discuss with you how to evaluate and treat this; there are various ways to do it. During surgery the surgeon will gently push any bulging tissue back into the abdomen and then close the sac that poked through the opening. In girls, the surgeon will also sew shut the opening. In boys, surgeons must leave it open because blood vessels to the testicle and vas come through there. The opening isn't the problem — just the sac that poked through — so by sewing the sac closed the hernia is fixed.

Finally, the surgeon will close the incision in the skin. The surgery takes about 30 to 45 minutes. Your child will then be in the recovery room for 30 minutes to one hour.

After surgery

We will give your child pain medicine to make them comfortable. You'll need to keep the incision clean and dry until it heals. The surgery team will teach you how to care for the incision and will tell you if you should limit your child's activity for a while.

About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.

Resources

Read more about what to expect when your child visits a clinic at Children's, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child's care team. You can also take a virtual tour of our surgery rooms and other parts of the hospital.

To learn more about this condition, you may want to visit our resource list.