There
are three points to remember if your child has been diagnosed
with an inguinal hernia or a hydrocele: 
-
An inguinal
hernia (or hydrocele) is a different problem in a child than
it is in an adult.
-
Inguinal
hernias and hydroceles are not caused by exercise, crying,
or any other physical activity.
-
Inguinal
hernias and hydroceles are not hereditary; they are basically
developmental glitches.
Inguinal hernias
form as a direct consequence of normal events in fetal development.
At about 12 to 14 weeks of gestation, the gonads (testicles or
ovaries) are formed near the kidneys. They gradually descend through
the abdomen as the baby develops. If the baby is a boy, the testicles
pass through an opening low in the abdomen and into the scrotum;
if the baby is a girl, the gonads stop near this opening, and
develop into ovaries.
In about
5 % of children in the United States, this opening does not close
properly. This happens more commonly in boys than in girls, and
even more often in premature babies. (As a result, about 8 boys
will develop inguinal hernias for every girl who does so, and
10-30% of premature infants will be found to have hernias.) The
failure of this opening to close potentially allows the contents
of the abdomen to travel down into the scrotum (in a boy) or the
labia (in a girl). The contents of the abdomen include the intestines,
the ovaries, and the clear fluid in which the intestines normally
float. If the scrotum or labia are found to contain intestines
or an ovary, this is termed an inguinal hernia. If they contain
only fluid, this is a hydrocele. The difference between the two
is usually just the size of the opening; the basic anatomy is
the same in both cases.
There are
two periods of time when this condition is typically discovered:
during the first year of life, and at 3 to 4 years of age, after
the child has been upright and walking. It is unusual to find
childhood inguinal hernias after the age of 10.
The primary
sign to look for in children is a bulge in the groin extending
toward the scrotum or labia. Your child may also complain of pain
in that area. If there is firmness or tenderness in the bulge,
it may be a sign that an abdominal organ has become trapped (or
incarcerated); in this case, the child needs immediate medical
attention. When abdominal organs get trapped in hernias, the blood
supply to that organ may become choked off. This can result in
the loss of an ovary or intestine.
Surgery is
the only treatment option for hernias; they do not resolve on
their own. In general, we recommend that inguinal hernias be repaired
at the earliest convenient time, because of the risk of incarceration
and potential injury to organs.
Epigastric
hernias are also congenital conditions (the children are born
with them). These hernias occur as tiny defects in the upper
anterior abdominal wall (in the midline, between the umbilicus
and the sternum, or breastbone). Often they are noticed
because a little piece of intra-abdominal fat becomes trapped,
or incarcerated, in the hernia. This incarcerated tissue
is palpable as a tiny knot just beneath the skin. While
epigastric hernias may be asymptomatic, they are often quite tender,
and the child may complain of pain at the site.
We
generally recommend that epigastric hernias be repaired when they
are diagnosed, as they will not resolve on their own and may cause
more problems as time progresses.
Umbilical
hernias form at the site where the umbilical cord passed through
the abdominal wall of the developing baby. Usually, the
abdominal wall seals off this "passageway" after birth.
However, in some children this does not occur, and the opening
in the abdominal wall persists as an umbilical hernia.
Umbilical
hernias are more common in girls than in boys, and are often seen
in infants. They are usually obvious, noticed as protrusions
at the umbilicus, which may bulge as the child strains or cries.
More rarely, the defect will be tiny and less visible; the child
may be brought to the attention of a doctor because a little piece
of trapped intra-abdominal tissue in the hernia is causing pain
at the site.
Many
of these hernias (unlike inguinal or epigastric hernias!) will
close off as the child grows, so immediate surgery is not often
recommended for infants with this condition. However, if
the initial hernia is unusually large, is causing the child discomfort,
or if the child has reached the age of four or five years without
closure, we will generally recommend surgery.
Top
What
should parents expect after their child has inguinal, epigastric,
or umbilical hernia surgery?
Most children
are able to undergo most hernia repairs in an outpatient
setting. We generally use a local anesthetic to block the
pain-sensing nerve in the surgical area, and most children will
be nearly pain-free after the procedure. The sutures we use are
absorbed gradually by the body after the hernia repair has healed,
and the dressings don't need to be changed. The child can usually
go back to school in the next day or two. The surgeon will usually
want to see your child about 1-2 weeks after surgery, to check
that the incision has healed properly.
If a small
child has a relatively large inguinal hernia
repaired, it is very common for the scrotum to swell after surgery
(sometimes it looks almost as if the hernia has recurred). This
is part of the normal response of the tissues to surgery, and
will gradually resolve on its own (usually over the next few weeks).
Because the
skin over an umbilical hernia may
have been stretched to accommodate the hernia, there will often
be redundancy (or extra skin folds) at the repair site.
This redundancy usually becomes less and less apparent over time
as the child grows, so that the umbilicus gradually resumes a
more normal appearance.
Can
my child's hernia come back?
It is rare
for any childhood hernias to recur. You do not need to restrict
your child's activities or prevent him/her from participating
in sports. Children who are at higher risk for recurrence
of inguinal hernias include those
who need emergency hernia surgery, premature infants, and children
who have increased pressure in the abdomen (such as children with
ventriculo-peritoneal shunts or peritoneal dialysis).
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