Inguinal and Umbilical Hernias in Children
What is a hernia?
A hernia is when a part of the intestine pushes through a weak spot in the belly (abdominal) muscles. The hernia creates a soft lump or bulge under the skin.
In children, a hernia often happens in 1 of these 2 places:
- The groin area. This is called an inguinal hernia.
- Around the belly button. This is called an umbilical hernia.
What causes a hernia?
A baby can develop a hernia in the first few months of life. This happens because of a weakness in the belly muscles. Inguinal and umbilical hernias happen for slightly different reasons.
During pregnancy, all babies have an area called the inguinal canal. This goes from the abdomen to the genitals. In boys, this canal lets the testicles move from the belly to the scrotum, the sac that holds the testicles. Normally, a baby’s inguinal canal closes shortly before or after birth. But in some cases the canal doesn’t fully close. Then a loop of intestine can move into the inguinal canal through the weak spot in the belly wall. This causes an inguinal hernia. Most inguinal hernias happen in boys.
As an unborn baby develops during pregnancy, there is a small opening in the abdominal muscles. After birth, this opening closes. But sometimes, these muscles don’t fully close. A small opening is left. A loop of intestine can then move into the opening between the belly muscles. This causes an umbilical hernia.
Who is at risk for a hernia?
Hernias happen more often in children who have 1 or more of the following risk factors:
- Being born early, or premature
- Having a parent or sibling who had a hernia as an infant
- Having cystic fibrosis
- Having developmental dysplasia of the hip, a condition that is present at birth
- Being a boy with undescended testes. This means the testicles didn’t move into the scrotum before birth.
- Having problems with urinary or reproductive organs
Inguinal hernias happen
- In children who have a family history of inguinal hernias
- More often in babies and children with other urinary or reproductive problems
- More often in the right groin area than the left, but can occur on both sides
Umbilical hernias happen
- More often in African-American children
- More often in infants who were born premature
What are the symptoms of a hernia?
Hernias often happen in newborns. But you may not notice a hernia for a few weeks or months after birth.
- Inguinal hernias appear as a bulge or swelling in the groin or scrotum.
- Umbilical hernias appear as a bulge or swelling in the bellybutton area.
In both cases, the swelling may be easier to see when your baby cries, coughs, or strains to have a bowel movement. It may get smaller or go away when your baby relaxes. If your child's healthcare provider pushes gently on this lump when the child is calm and lying down, it will often get smaller. Or it may go back into the belly.
In some cases, the hernia can’t be pushed back into the belly. Then the loop of intestine may be stuck in the weak spot of abdominal muscle. When this happens, symptoms may include:
- A full, round belly
- Belly pain and soreness
- Redness or discoloration near the hernia
If the stuck intestine is not treated, blood supply may be blocked to part of the intestine. This is a medical emergency.
Hernia symptoms may seem like other health problems. Always talk with your child's healthcare provider for a diagnosis.
How is a hernia diagnosed?Your child’s healthcare provider can diagnose a hernia by doing a physical exam. The healthcare provider will see if the hernia can be gently pushed back into the belly. This is called a reducible hernia. The provider may order abdominal X-rays or an ultrasound to check the intestine more closely. This will likely be done if the hernia can’t be pushed back into the belly.
How is a hernia treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Surgery is needed to treat an inguinal hernia. In many cases surgery is done soon after the hernia is found. That’s because the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off. The intestine can be damaged.
During hernia surgery, your child will be given anesthesia. A small cut or incision is made in the area of the hernia. The loop of intestine is put back into the abdomen. The muscles are then stitched together. Sometimes, a piece of mesh material is used. This helps strengthen the area where the muscles are repaired.
Children who have surgery for an inguinal hernia can often go home the same day.
In many cases, an umbilical hernia closes on its own by the time a child is 1 year old. Almost all umbilical hernias close without surgery by the time a child is 5 years old. Because of this, there are different opinions about when surgery is needed for an umbilical hernia.
In most cases, your child's healthcare provider may suggest surgery if the umbilical hernia:
- Gets bigger with age
- Can’t be pushed back into the abdomen
- Is still there after age 3
Always contact your child's healthcare provider to see what is best for your child.
During surgery for an umbilical hernia, your child will be given anesthesia. A small cut or incision is made in the belly button. The loop of intestine is put back into the abdomen. The muscles are then stitched together. Sometimes a piece of mesh material is used. This helps strengthen the area where the muscles are repaired.
Children who have surgery for an umbilical hernia may be able to go home the same day.
What are the complications of a hernia?Sometimes the loop of intestine that pushes through a hernia may get stuck. Then it is no longer reducible. This means that the intestinal loop can’t be gently pushed back into the stomach. If not treated, blood supply may be blocked to part of the intestine. This is a medical emergency.
When should I call my child's healthcare provider?
Contact your child's healthcare provider right away if your child’s hernia:
- Becomes red or discolored
- Is painful
- Causes symptoms of vomiting or fever
If you see swelling near your child's belly button or in the groin area, have your child checked by his or her healthcare provider.
Key points about hernias
- A hernia is when a part of the intestine pushes through a weak spot in the belly muscles.
- A hernia creates a soft lump or bulge under the skin.
- A hernia that happens in the belly button area is called an umbilical hernia.
- A hernia that happens in the groin area is called an inguinal hernia.
- Surgery is needed to treat an inguinal hernia. An umbilical hernia my close on its own.
- In some cases, hernias can get stuck. Blood supply may be blocked to part of the intestine. This is a medical emergency.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.