Gerald R. Jerkins MD
UT Le Bonheur Pediatric Specialists
Memphis Tennessee

Inguinal Hernia Hydrocele

On this page:
Overview
About Inguinal Hernia
Treatment for Inguinal Hernia
Care After Inguinal Hernia Repair
Frequently Asked Questions
Helful Links

Overview


If you notice a small lump or bulge in your child's groin area or an enlargement of the scrotum, you may have discovered an inguinal hernia. This condition, which is present in five of every 100 children (most commonly in boys), occurs when an opening in the lower abdominal wall allows the child's intestine to squeeze through.

A hernia in a child is due to a failure of normal protrusions from the peritoneum to close properly before birth. The peritoneum is a large, balloon-like sac that surrounds all the organs within the abdomen. Before birth, this sac has two fingerlike projections through the muscle walls which, in boys, lead into the scrotum alongside the testicles and, in girls, lead into the labia. Normally, these projections separate from the rest of the peritoneum before birth, producing in boys protective sacs for the testicles inside the scrotum. When these extensions do not close properly, a small portion of the bowel may push through into the groin or scrotum, producing a hernia. If the opening is very small and only abdominal fluid comes down into the sac, it is called a hydrocele.

About Inguinal Hernia


Hydroceles and Inguinal Hernias
Hydroceles and inguinal (groin) hernias can create problems in males. But do they cause pain and dysfunction? When and how should they be treated? The following information should help you talk to a urologist about these two conditions.

What causes hernias and hydroceles?
Testicles develop near kidneys in the abdomen and descend from that location to their normal position in the scrotum towards the end of pregnancy. In order for the testicles to leave the abdomen, a muscle ring in the groin on each side opens and allows the testicles to drop down to the scrotum. As the testicle descends, the lining of the abdomen also drops to line the scrotum. This channel closes in most boys. If that channel remains open, or reopens, a small amount of fluid can go from the abdomen to the scrotum through this passage. This results in hydrocele. If the channel remains opens or reopens widely, then a portion of the intestine can pass down the channel towards the scrotum. This results in an inguinal hernia.

Hydroceles can also develop due to inflammation or injury within the scrotum. These sometimes resolve over a few months but many remain and require medical attention. Hernias can also be the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall - straining during bowel movements, heavy lifting, coughing, sneezing or obesity.

What are the symptoms of a hernia?
Only about 25 percent of hernias cause pain or discomfort. However, you may be able to see and feel the bulge that often occurs at the junction of the thigh and groin. About 1 percent of boys develop hernias with premature infant males having a higher incidence. Sometimes, the protruding intestine enters the scrotum and causes pain and/or swelling in the scrotum.

What are the symptoms of a hydrocele?
About 10 percent of male infants have a hydrocele at birth. Seldom causing symptoms, this swelling of the scrotum does not bother a baby and usually disappears in the first year of life, even though the appearance may worry new parents. In older males, a hydrocele usually remains painless but may cause discomfort due to the increased size of the scrotum.

How are hernias treated?
Surgery to repair the muscle ring that did not close properly is recommended for a hernia in a child. Hernias do not go away on their own and may cause problems with digestion leading to emergency surgery. In infants and children, a small incision is made in the groin through which a urologist sutures or sews the channel shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teenagers and adults, laparoscopic surgery may be considered.

How are hydroceles treated?
Hydroceles require surgical repair if they cause symptoms, such as growing large or changing size significantly during the day. If the hydrocele is uncomplicated, an incision is made in the scrotum . The hydrocele is cut out, removing the tissues involved in the hydrocele. If there are complications, such as a hernia, an incision is made in the inguinal (groin) area. This approach allows repair of hernias and other complicating factors at the same time.

What can be expected after treatment for hernias and hydroceles?
After surgery, there will be discomfort that will require pain medication. In most cases, pain is reduced during the first week so that pain medication is no longer necessary. It may be necessary to restrict full activity for several weeks, depending on your child's age and whether or not both sides were treated. If your son still plays on straddle toys, such as a rocking horse, he may have to avoid them for a time. The testicle and scrotum may stay swollen for several weeks after surgery before returning to normal. After surgery, less than 1 percent of cases have a hernia or hydrocele return.


Treatment of Inguinal Hernia


Most hernias do not cause any discomfort, and you or the pediatrician will discover them only by seeing the bulge. While this kind of hernia must be treated, it is not an emergency condition. You should, however, notify your doctor, who may instruct you to have the child lie down and elevate his legs. Sometimes this will cause the bulge to disappear. However, your doctor will still want to examine the area as soon as possible.

Rarely, a piece of the intestine gets trapped in the hernia, causing swelling and pain. (If you touch the area, it will be tender.) This condition is called an incarcerated (trapped) hernia, and does require immediate medical attention.

Even if the hernia is not incarcerated, it still needs to be surgically repaired as soon as possible. The surgeon also may check the other side to see if it, too, needs to be corrected, since it is very common for the same defect to be present there.

If the hernia is causing pain, it may indicate that a piece of intestine has become trapped or incarcerated. In that case, your pediatrician will want to be consulted immediately. He may try to move the trapped piece of intestine out of the sac. Even if this can be done, the hernia still needs to be surgically repaired soon thereafter. If the intestine remains trapped despite the physician's efforts, emergency surgery must be performed to prevent permanent damage to the intestine.

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

Copyright 2000 American Academy of Pediatrics


Care After Inguinal Hernia Repair


INCISION CARE: The incision (cut) is covered with a small bandage. It will begin to peel off in two or three days. Do not scrub the incision if it becomes dirty. Wipe it off with a damp washcloth and blot it dry.

DISCOMFORT: Your child may have some discomfort for a few days. If your child is irritable or uncomfortable, give acetaminophen with codeine (example: Tylenol with codeine). If your child has a fever(102F or less) give acetaminophen (example: Tylenol). Follow the directions on the bottle. If your child's fever is 102F or above call Dr. Jerkins(see the number below). Give your child plenty of fluids. Some swelling in the scrotum is common for the first two weeks after surgery.

ACTIVITY: Keep your child quiet for the first two days after surgery, then your child can do normal activity as he/she feels like it. Do not let your child play hard, participate in sports or P.E. class, or ride a bike until the doctor gives permission. Your child may usually return to school two to three days after surgery.

DIET: Your child should have cool, clear liquids (examples: water, apple juice, sodas) the first few hours after surgery. If your child tolerates the fluids well, then you can give your child a normal diet. If vomiting occurs, stop the food or fluids for a couple of hours and then begin with fluids again.

BATHING: Give your child sponge baths for the first 48 hours. Then he/she may take a bath or shower.

CALL THE DOCTOR IF YOU SEE:
  • Fresh bleeding from the incision
  • Bad odor or pus from the incision
  • Excessive swelling or blueness at the surgery site
If you have questions when you get home, call Dr. Jerkins' office at 901-751-0500.
REMEMBER: Call following surgery within a week to make an appointment for follow up usually in 2-3 weeks.


Frequently asked questions:


Are hernias or hydroceles hereditary?
No. Hernias and hydroceles are common. And while several family members may experience them, there is no evidence that they are inherited.

Is there anything a parent did to cause a hernia or hydrocele in their child?
No.

What is the likelihood of a hernia developing on the other side?
This depends on the age of the child. Younger children treated for a hernia are much more likely to develop a hernia on the other side than older children. In younger children, sometimes a laparoscope is used to look at and evaluate the opposite side. If the examination shows that a hernia is present or likely to occur, then surgical repair is done on both sides as a preventive course of action.

What is the likelihood of a hydrocele developing on the other side?
The risk of developing a hydrocele on the other side is about 5 percent. Because of this low risk, many times the laparoscopic evaluation is not performed.

Do girls develop hydroceles and hernias?
Girls do not develop hydroceles. They can develop hernias but because of their anatomy, girls are 10 times less likely than boys to develop hernias.

Helpful Links


http://www.healthychildren.org/ - Hernias