Definition

• A hernia is a bulge in the groin or upper scrotum
• The bulge contains a loop of intestine. It slides through a defect in the muscles of the lower abdomen.

Health Information

Symptoms

• The swelling comes and goes
• It bulges out with crying straining or hard coughing
• The hernia also commonly comes out when standing and goes away with lying down
• It normally goes away completely when quiet
• If you touch it, the bulge feels squishy. Reason: You are feeling fluid and air in the intestine.
• Most hernias occur in males. The bulge goes into the scrotum.
• Hernias rarely happen in females. If they do, the bulge goes into the labia next to the vagina.
• If the hernia doesn’t slide back in, it could be a surgical emergency. This is called an incarcerated hernia.

Cause

• Born with a defect (opening) in the muscle wall of the lower abdomen
• Affects 4% of term infants and 13% of preterm infants. (Preterm means born less than 33 weeks.)
• Sometimes, hernias come on later. With these, a weak area in the muscle wall gives way and becomes larger. This can happen with screaming. It can also happen with straining to pass a stool.
• Surgical repair is always needed. Reason: Inguinal hernias do not close on their own.

Care Advice

1. Overview:
   • The hernia normally will come and go. It slides through the defect in the muscle wall.
   • Hernias that don’t cause any symptoms don’t need any urgent treatment.
   • You don’t need to check on the hernia unless your child is crying.
   • Here is some care advice that should help.
2. Reduction:
   • If the hernia is causing pain or crying, try to reduce it.
   • Help your child to lie down with the feet slightly up. Try to help your child play quietly or relax. Usually, this will relax the muscles. Then the hernia should slide back in on its own.
   • If this fails, have your child lie down in a tub of warm water. It should help relax the muscles.
3. Surgery:
   • All hernias need surgery to repair them. Reason: Inguinal hernias do not close on their own.
   • The operation is a simple one. The surgeon will close off the defect in the muscle wall in the abdomen. Most children can go home the same day. Recovery is quick.
   • You can usually choose a time when to have hernia surgery. It’s rarely urgent.
   • Timing of Repair. In term infants, shortly after diagnosis. This usually means within 1 week. In preterm infants, hernia repair is usually performed just before discharge from the NICU.

Call Your Doctor If

• You can’t reduce the hernia
• Unexplained pain or crying occurs for over 1 hour
• Unexplained vomiting occurs
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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