UH Rainbow Medina Pediatrics

Inguinal and Umbilical Hernias in Children

What are hernias in children?

A hernia is when a part of the intestine or other tissue pushes through an opening 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 or scrotum area. This is called an inguinal hernia.
Around the belly button. This is called an umbilical hernia.

What causes a hernia in a child?

A baby can develop a hernia in the first few months of life. It 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 or other tissue can move into the inguinal canal through the opening in the belly wall. This causes an inguinal hernia. Most inguinal hernias happen in boys, but they can occur in girls.

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 or other tissue can then move into the opening between the belly muscles. This causes an umbilical hernia.

Which children are 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

This type of hernia happens more often in children:

Who have a family history of inguinal hernias
Who have other urinary or reproductive problems

This type of hernia happens more often in the right groin area than in the left. But it can occur on either side.

Umbilical hernias

This type of hernia happens more often in:

African-American children
Babies who were born premature

What are the symptoms of a hernia in a child?

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 belly button 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 they are 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
Vomiting
Fussiness
Redness or discoloration near the hernia
Fever
Firm and tender bulge

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 in a child?

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. Such tests will likely be done if the hernia can’t be pushed back into the belly.

How is a hernia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Inguinal hernia

Your child will need surgery 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 that happens, the blood supply to the intestine can be cut off and the intestine can be damaged.

During hernia surgery, your child will be given general anesthesia. This is so they will not feel pain and will sleep during the procedure. A small cut (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. It helps strengthen the area where the muscles are repaired.

Children who have surgery for an inguinal hernia can often go home the same day.

Umbilical hernia

In most 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 to 5 years

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 general anesthesia. This is so they not have pain and will sleep during the procedure. A small cut 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. It 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 possible complications of a hernia in a child?

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 their healthcare provider.

Key points about hernias in children

A hernia is when a part of the intestine or other tissue pushes through an opening 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 or scrotum area is called an inguinal hernia.
Surgery is needed to treat an inguinal hernia. An umbilical hernia may 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.

Next steps

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 directions 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 healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.