Hernias

What is it?

"Hernia" is the word doctors use to describe a soft part of the body slipping out of the space that it normally occupies. When most people speak of hernias, they mean hernias involving some part of the abdomen and its contents. Those are the hernias we’ll talk about in this Aftercare Instruction.

Many newborn babies have an "umbilical hernia." This hernia happens when a small amount of intestine (gut) slides into the opening where the umbilical cord used to be. Umbilical hernias are almost always easy to push back in. Most babies’ umbilical hernia closes on its own after a few weeks or months of age. In about 5% of Black children, an umbilical hernia remains until after five years of age. In those cases doctors recommend a surgical repair.

The most common kind of hernia outside of the newborn period is the "inguinal"(in-gwinn-al), or groin hernia. More than 95% of these hernias are on the right side only, and if there’s a left-sided hernia, there’s always one on the right too. Boys get these much more commonly than girls do. They can appear at any age, although they are most common in toddlers and young children. Inguinal hernias appear as a bulge in the groin. Larger hernias may push all the way into the scrotum. All hernias bulge out much more obviously when the child is crying. Lifting a heavy weight doesn’t produce a new hernia, but it can cause a small and undiscovered hernia to become obvious.

"Femoral" hernias are an unusual hernia in which some of the bowel pushes its way out of the abdomen and up through the muscles of the upper thigh. These are more common in girls than in boys. All inguinal and femoral hernias eventually must be repaired with surgery.

The biggest concern with any hernia is to keep it from becoming trapped in the space that it came through. Since the hernia usually contains bowel (and occasionally an ovary in a girl), it is important to protect its blood supply. Most hernias are easy to push back into the abdomen with a little firm but gentle pressure. These are called "sliding" hernias. Your doctor will recommend elective surgery for an inguinal or femoral hernia that slides easily back into place. If a hernia becomes impossible for a parent to push back in with gentle pressure, doctors refer to it as an "entrapped" hernia. Doctors can often push such a hernia in ("reduce" it) with a number of maneuvers. Surgeons recommend operating within a few days on a hernia that was entrapped but could be reduced. If a hernia gets entrapped and cannot be reduced at all, doctors call it an "incarcerated hernia." These hernias are a problem because there is a risk of cutting off their blood supply and causing damage to the intestine. If that happens, the hernia is called "strangulated," and it can burst, causing a dangerous infection in the abdomen. For these reasons, surgeons will operate on a child with an incarcerated hernia as soon as possible to prevent strangulation.

For umbilical hernias in children under five years old, surgery is not required. Most doctors recommend watching them closely and only doing an operation if the hernia is still present after the age of five. For inguinal and femoral hernias, surgery is always the treatment. The surgeon makes a very small cut in the skin over the hernia and sews up the hole in the abdominal wall that the hernia came through. After that the surgeon closes the skin with tiny sutures, and checks the other side to be sure there’s no hernia there. Your surgeon will give you specific instructions for taking care of the incision. In general you will keep the skin clean and dry, and leave the surgical dressing in place until your follow-up visit within a few days.

If your child has a sliding hernia and surgery is not planned until later, you will want to check the hernia once in a while. Please be sure you can always push it back into place easily. This is a sensitive area, so some children will cry when you push. If you find it hard to push it in, or if your child seems to be in pain, please check with your doctor.

If a surgeon has already repaired your child’s hernia, please watch for signs of infection, such as:

• Extreme redness or swelling along the incision
• Pus, blood, or fluid draining from the incision
• Red streaks leading away from the incision
• Fever
• Vomiting

If your child has not yet had the hernia operation, please watch out for signs of an entrapped or incarcerated hernia:

• A hernia that you cannot push back in easily
• Tenderness over the hernia
• Any discoloration (blue, purple, green) over the hernia area
• Vomiting without diarrhea
• Sudden lack of a bowel movement for more than a day
• Any of the above along with fever or extreme fussiness or sleepiness

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Some families traditionally tape a coin over an umbilical hernia in the belief that this helps it to heal. While this probably doesn’t help, it will not hurt as long as the child is old enough not to try to swallow it! Please remember that many coins these days contain the metal nickel. Some children develop a reaction to nickel and the skin can blister and peel. You can read about nickel allergies in our Aftercare Instruction on Contact Dermatitis.

The groin area contains lymph nodes (blood filters) that become swollen and red when they become infected or inflamed. A swollen lymph node is a common occurrence, and it is easy to mistake for a hernia. Lymph nodes are usually quite tender, and there may be redness over the area. A doctor should examine the area to determine if there is a need for antibiotics or other treatments. In teenagers, sexually transmitted infections can cause swollen lymph nodes.

Boys with inguinal hernias often have some fluid that collects in the scrotum. This is called a "hydrocele" (high-droe-seal). Often the hydrocele is visible before the bulge of the hernia is. The surgeon will repair the hydrocele at the same time as s/he repairs the hernia.

Other causes for swelling in the scrotum include twisting of the testicle around its blood vessels (testicular torsion, a painful emergency), a tangle of blood vessels called a "varicocele" (very-koe-seal), or a bruise after trauma. Some very rare causes of swelling in the scrotum are tuberculosis and testicular cancer. Both are extremely rare in young boys and teenagers. Any swelling in the scrotum is a reason to see your doctor.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.