Many people don't think of hernias as health problems that can occur in children. But hernias are fairly common in kids. Babies (especially premature babies) can even be born with them. In fact, hernia repair is the one of the most common surgeries performed on children.

Hernias can be treated. But it's important to recognize the symptoms of the different types of hernias so that you can get your child the appropriate medical care and prevent the hernia from leading to other medical problems.

What Causes Hernias?

When part of an organ or tissue in the body (such as a loop of intestine) pushes through an opening or weak spot in a muscle wall, it can protrude into a space where it does not belong. This protrusion is called a hernia. A hernia may look like a bulge or lump.

Some babies are born with various small openings inside the body that will close at some point, but have not closed yet. Nearby tissues can squeeze into such openings and become hernias.

Sometimes tissues can squeeze through muscle wall openings that are only meant for arteries or other tissues. In other cases, strains or injuries create a weak spot in the muscle wall, and part of a nearby organ can be pushed into the weak spot so that it bulges and becomes a hernia.

How Serious Are Hernias?

There are different types of hernias, and each of them requires different levels of medical care.

Early in many infant and childhood hernias, the herniated tissues protrude only during moments of physical pressure or strain. You may only notice a prominent bulge when your child is crying, coughing, or straining, and it may seem to retract or go away at other times. Hernias in this state are called reducible and are not immediately harmful to a child.

Sometimes tissues become trapped in an opening or pouch and do not retract. This is called an incarcerated hernia, and it's a serious problem that requires immediate medical attention. For example, a loop of intestine that is caught and squeezed in the groin area may block the passage of food though the digestive tract. The symptoms of an incarcerated hernia can include pain, vomiting, and irritability. If you touch the bulge that the incarcerated hernia has created, it may feel hard.

A doctor can usually free the trapped tissues by gently squeezing the lump and trying to force it back into the body opening. Because incarcerated hernias can be painful, the doctor usually provides pain medication during this procedure. Surgery is usually required within a few days to prevent another incarcerated hernia from developing.

The most serious kind of hernia is a strangulated hernia, in which the normal blood supply is cut off from the tissue that is trapped. Without that blood supply, the strangulated tissues cannot get oxygen and will die. Surgery is required immediately to dislodge that tissue so that oxygen can get to it again.

Different Types of Hernias

The two most common hernias that occur in children are umbilical hernias, in the belly-button area, and inguinal hernias, in the groin area.

Umbilical Hernias

Some babies are born with a weakness or opening in the abdominal muscles around the belly button (under the skin) through which some abdominal membrane or small intestine protrudes.

The soft bulge this creates is an umbilical hernia. It is most obvious when the baby cries, coughs, or strains. Umbilical hernias are more common in female, African-American, and low birth weight babies. These hernias range in size from less than 1/2 inch (2 centimeters) to more than 2 inches (6 centimeters).

In most instances an umbilical hernia causes an infant no discomfort. Usually, a doctor can easily push it back in. An infant's umbilical hernia (unlike an adult's) rarely obstructs or strangulates. In fact, most umbilical hernias, even the larger ones, tend to close up on their own by age 2. That's why the doctor usually advises waiting and watching this kind of hernia in an infant rather than operating.

Surgery is necessary only if the hernia is very large, grows in size after age 1 or 2, fails to heal by age 4 or 5, or your child develops symptoms of obstruction or strangulation, like swelling, bulging, vomiting, fever, and pain. If such symptoms develop, call the doctor immediately.

Inguinal Hernias

In infants, an inguinal hernia is most often caused by a protrusion of a loop of intestine or a fold of membrane from the abdomen - or in girls, an ovary or fallopian tube - through an opening into the groin (the area where the abdomen meets the top of the thigh).
The hernia is apparent as a bulge in the groin area, especially when the child cries, coughs, or stands.

Sometimes, in boys, the inguinal hernia extends beyond the groin into the scrotum (the sac that holds the testicles). In girls, it can extend to one of the outer labia (the outer labia are the larger of two pairs of lips of tissue around the vaginal opening). In these cases, an enlargement or swelling can be seen that extends from the groin into the scrotum or labium.

Inguinal hernias are more common on the right side, but they can occur on either side or both sides. Inguinal hernias occur far more often in boys than girls and are most common in children with cystic fibrosis, undescended testicles, a urethra that opens on an unusual part of the penis, or in premature infants. Children with a family history of hernias are also at risk.

Other conditions that may look like inguinal hernias, but are not:

• A hydrocele is similar to a hernia, except that fluid is the reason for the bulge rather than a protruding tissue. Depending on the location of the hydrocele, it may be left to disappear in a year or 2 or it may be treated as a hernia - with surgery. In young infants, the hydrocele may not require surgery, as many of them go away by the second birthday.
• Occasionally, a retractile testicle (a testicle that retracts from the scrotum from time to time) causes a bulge in the groin area.
• A femoral hernia is rare in children and can be confused with an inguinal hernia. It consists of tissues that have pushed in alongside an artery into the top of the thigh. It appears as a bulge at the top of the thigh, just below the groin.

What Are Signs and Symptoms of a Hernia?

If you think that your child may have a hernia, you should immediately call your child's doctor. And you may want to ask yourself the following questions:

• Is there a bulge that is present when your child is straining, crying, coughing, or standing, but absent when your child is sleeping or resting? This could indicate a reducible hernia.

• Is the bulge present all the time, but with no other symptoms? This could be a hydrocele or something else.

• Has the groin area suddenly begun to swell? Do you notice any discoloration of the bulging area or a "swollen" abdomen? Is your child irritable, complaining of pain, constipated, or vomiting? These are signs of an incarcerated hernia, which calls for immediate attention. See a doctor immediately or take your child to the emergency department.

• Is the area swollen, red, inflamed, and extremely painful? Has your child developed a fever? These might be symptoms of a strangulated hernia. You may want to call your child's doctor and proceed directly to the hospital emergency department.

Treating Hernias

Once an inguinal hernia is diagnosed, surgery should be done to prevent the hernia from becoming incarcerated. During surgery, the herniated tissue is put back into its proper space, and the opening or weakness that permitted the hernia to form is closed or repaired.

Surgery to correct inguinal hernias is performed on children of all ages, sometimes even on premature babies.

Inguinal hernia surgery in children is usually performed on an outpatient basis with no overnight stay in the hospital, but some kids, particularly young infants, may be kept in the hospital overnight for observation.

The period of recuperation for children is fairly short. Most children can resume normal activities about 7 days after surgery, with the doctor's approval. Until that time, it's a good idea for your child to avoid strenuous activity such as bicycle riding and tree climbing. Of course, if you notice any signs of problems after the surgery, such as bleeding, swelling, or fever, call your child's doctor.

Reviewed by: T. Ernesto Figueroa, MD

Date reviewed: May 2005