Pediatric & Adolescent Medicine
A hernia is a hole in the abdominal wall. Most childhood hernias develop in the womb. But they may not be found until a child is of school age. Read about inguinal and umbilical hernias by expanding an option below.
An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.
An inguinal hernia isn't necessarily dangerous. It doesn't improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that's painful or enlarging. Inguinal hernia repair is a common surgical procedure.
Inguinal hernia signs and symptoms include:
- A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain
- A burning or aching sensation at the bulge
- Pain or discomfort in your groin, especially when bending over, coughing or lifting
- A heavy or dragging sensation in your groin
- Weakness or pressure in your groin
- Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum
Signs and symptoms in children
Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining during a bowel movement. He or she might be irritable and have less appetite than usual.
In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period.
Signs of trouble
If you aren't able to push the hernia in, the contents of the hernia may be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated.
Signs and symptoms of a strangulated hernia include:
- Nausea, vomiting or both
- Sudden pain that quickly intensifies
- A hernia bulge that turns red, purple or dark
- Inability to move your bowels or pass gas
When to see a doctor
Seek immediate care if a hernia bulge turns red, purple or dark or if you notice any other signs or symptoms of a strangulated hernia.
See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area.
Some inguinal hernias have no apparent cause. Others might occur as a result of:
- Increased pressure within the abdomen
- A pre-existing weak spot in the abdominal wall
- Straining during bowel movements or urination
- Strenuous activity
- Chronic coughing or sneezing
In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.
Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery.
In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.
Factors that contribute to developing an inguinal hernia include:
- Being male. Men are eight times more likely to develop an inguinal hernia than are women.
- Being older. Muscles weaken as you age.
- Being white.
- Family history. You have a close relative, such as a parent or sibling, who has the condition.
- Chronic cough, such as from smoking.
- Chronic constipation. Constipation causes straining during bowel movements.
- Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.
- Premature birth and low birth weight.
- Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you're at higher risk of developing another inguinal hernia.
Complications of an inguinal hernia include:
- Pressure on surrounding tissues. Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.
- Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.
- Strangulation. An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.
You can't prevent the congenital defect that makes you susceptible to an inguinal hernia. You can, however, reduce strain on your abdominal muscles and tissues. For example:
- Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
- Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
- Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
- Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.
An umbilical hernia occurs when part of your intestine sticks out through the opening in your abdominal muscles through which your umbilical cord passed before you were born. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the bellybutton to protrude. This is a classic sign of an umbilical hernia.
Children's umbilical hernias often close on their own in the first two years of life, though some remain open into the fifth year or longer. Umbilical hernias that appear during adulthood are more likely to need surgical repair.
An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus). In babies who have an umbilical hernia, the bulge may be visible only when they cry, cough or strain.
Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort.
When to see a doctor
If you suspect that your baby has an umbilical hernia, talk with the baby's pediatrician. Seek emergency care if your baby has an umbilical hernia and:
- Appears to be in pain
- Begins to vomit
- Has tenderness, swelling or discoloration at the site of the hernia
Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications.
During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdominal wall, an umbilical hernia may appear at birth or later in life.
In adults, too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen include:
- Multiple pregnancies
- Fluid in the abdominal cavity (ascites)
- Previous abdominal surgery
- Long-term peritoneal dialysis to treat kidney failure
Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. In the United States, African American infants appear to have a slightly increased risk of umbilical hernias. The condition affects boys and girls equally.
For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia tends to be more common in women.
For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to umbilical pain and tissue damage. If the trapped portion of intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdominal cavity, causing a life-threatening situation.
Adults with umbilical hernias are somewhat more likely to experience incarceration or obstruction of the intestines. Emergency surgery is typically required to treat these complications.