What is an Inguinal Hernia in Children?
An inguinal hernia is a lump in the groin (inguinal region) caused when part of the intestine, internal fat or other tissue pushes through a small opening in the abdominal muscles. It’s much more common in boys, however, it can also occur in girls. An inguinal hernia often becomes more noticeable when the child strains, cries, or is active, and may disappear when the child is calm or resting.
Inguinal hernias in children are different from those in adults. In children, there is no muscle weakness that requires mesh for repair. Instead, the hernia is usually a congenital condition, meaning it has been present since birth.
Why Does an Inguinal Hernia Occur?
An inguinal hernia occurs when there is an opening in the abdominal muscles that did not fully close during fetal development. This opening allows tissues, such as parts of the intestine or other abdominal contents, to bulge out and cause a lump in the groin area. In some cases, the bulge may become visible when a child strains, cries, or is active, and then disappear when the child is resting or calm. This is known as a reducible hernia, meaning the contents of the hernia can move back and forth through the opening.
Inguinal hernia is most often an isolated condition, although it can be associated with other medical conditions.
Premature infants are at a higher risk of developing inguinal hernias because their abdominal tissues are not fully developed at birth. This immaturity makes it more likely for the opening in the abdominal wall to remain and for tissues to protrude. In some cases, if a hernia is identified in a premature infant, surgery to repair the hernia may be done before the baby is discharged from the neonatal unit.
Although the hernia may seem to “come and go,” it will not heal on its own. The underlying opening in the abdominal muscles remains, and surgical intervention is required to close it permanently and prevent future complications, such as the hernia becoming trapped (‘incarcerated’ hernia).
Inguinal Hernia in Boys
In boys, an inguinal hernia happens because during fetal development (while the baby is growing in the womb), sometimes the opening between the abdominal muscles where the testicles descend from the abdomen to the scrotum doesn’t close properly. If this occurs, it leaves an opening that allows the intestines or fat from the abdomen to bulge through, causing the hernia.
A different condition related to the same process is a hydrocele. Like an inguinal hernia, it occurs due to the opening between the abdominal muscles, but instead of tissue creating a bulge, it involves fluid collecting around the testis. A hydrocele is generally harmless and often resolves on its own by the age of 1 to 2 years. In contrast, an inguinal hernia requires surgical repair.
Inguinal Hernia in Girls
Although less common, inguinal hernias can also occur in girls. In these cases, tissue can bulge through the same opening in the abdominal wall, creating a visible lump in the groin. In girls, the tissues involved may be intestines or fat, but they can also include the ovary or fallopian tube.
Similar to boys, the hernia may become more visible when the child strains or cries and may disappear when lying down. This leaves an empty sac (see below). However, the hernia will not heal on its own and requires surgical repair to prevent potential complications.
What is an Empty Sac in an Inguinal Hernia?
An “empty sac” refers to the situation where the contents of the hernia, such as the intestines in boys or the ovary in girls, have retracted back into the abdominal cavity, leaving the hernia sac empty. Although the hernia may seem to disappear, the opening in the abdominal wall is still present, and the hernia can reappear.
Even though the sac is temporarily empty, surgical repair is still necessary to prevent future complications.
Do Inguinal Hernias Need Repair?
Inguinal hernias do not resolve on their own, so they do need surgical repair. Due to the risk of future damage to the intestine, testis or ovary, it is worthwhile to repair a hernia once the diagnosis has been made.
If the hernia becomes stuck or irreducible, an emergency repair may be required.
For more detailed information on the surgical procedure, recovery time, and what to expect after surgery, visit our Inguinal Hernia Surgery for Children page.
Is an Inguinal Hernia Dangerous?
Inguinal hernias can be dangerous – they can cause problems in about 10% of children.
If an inguinal hernia becomes ‘incarcerated’ – meaning the contents get stuck and cannot be pushed back into the abdomen – this can lead to the blood supply to the intestines or ovary or other contents is cut off, causing serious harm. This is called ‘strangulation’. This can become dangerous and needs emergency care.
When an Inguinal Hernia becomes Dangerous: What to look for and what to do
An inguinal hernia that has become incarcerated will look like a firm lump that doesn’t reduce (go away), that becomes tender and a little red. Vomiting may also occur.
If you notice these symptoms, please take your child straight to the nearest emergency centre for assessment. Do not give your child a feed, because sometimes emergency surgery is required, and this is much safer if your child has an empty stomach.
FAQs About Inguinal Hernias in Children
What if the hernia seems to be stuck?
If you notice a bulge in the groin that is not reducing (coming and going), it may be irreducible. If it stays this way for a few hours the content (bowel / testis / ovary) may become injured. This is called strangulation, and your child will require emergency treatment.
Try to stay calm, and take your child to the nearest children’s hospital. Do not give your child a feed, as if they need emergency surgery, it is safer for them to have an empty stomach. The emergency team and surgical team will look after your child.
Will my child need surgery for an inguinal hernia?
Yes, most inguinal hernias require surgical repair to prevent complications.
Can an inguinal hernia heal on its own?
No, inguinal hernias do not resolve without surgery.
What is the risk of complications with an inguinal hernia?
Around 10% of children with an inguinal hernia may experience complications, such as the hernia becoming irreducible or strangulated. Complications of inguinal hernia can be very serious.
What does surgery for inguinal hernia involve?
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