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Hernia (Umbilical or Inguinal)

Hernia (Umbilical or Inguinal)

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What is a hernia?

A hernia occurs when a section of intestine protrudes through a weakness in the abdominal muscles. A soft bulge is seen underneath the skin where the hernia has occurred.

In children, a hernia usually occurs in one of two places:

around the belly-button
in the groin area

A hernia that occurs in the belly-button area is called an umbilical hernia. A hernia that occurs in the groin area is called an inguinal hernia.

What causes a hernia?

A hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen. Inguinal and umbilical hernias happen for slightly different reasons.

What is an inguinal hernia?

Inguinal Hernia
(click to enlarge)

As a male fetus grows and matures during pregnancy, the testicles develop in the abdomen and then move down into the scrotum through an area called the inguinal canal.

Shortly after the baby is born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this area does not close off completely, a loop of intestine can move into the inguinal canal through the weakened area of the lower abdominal wall, causing a hernia.

Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias in this area as well.

What is an umbilical hernia?

Umbilical Hernia
(click to enlarge)

When the fetus is growing and developing during pregnancy, there is a small opening in the abdominal muscles so that the umbilical cord can pass through, connecting the mother to the baby.

After birth, the opening in the abdominal muscles closes as the baby matures. Sometimes, these muscles do not meet and grow together completely, and there is still a small opening present. A loop of intestine can move into the opening between abdominal muscles and cause a hernia.

Who is at risk for developing a hernia?

Hernias occur more often in children who have one or more of the following risk factors:

a parent or sibling who had a hernia as an infant
cystic fibrosis
developmental dysplasia of the hip
undescended testes
abnormalities of the urethra

Inguinal hernias occur:

in about one to three percent of all children.
more often in premature infants.
in boys much more frequently than in girls.
more often in the right groin area than the left, but can also occur on both sides.

Umbilical hernias occur:

in about 10 percent of all children.
more often in African-American children.
more often in girls than in boys.
more often in premature infants.

Why is a hernia a concern?

Occasionally, the loop of intestine that protrudes through a hernia may become stuck, and is no longer reducible. This means that the intestinal loop cannot be gently pushed back into the abdominal cavity. When this happens, that section of intestine may lose its blood supply. A good blood supply is necessary for the intestine to be healthy and function properly.

What are the symptoms of a hernia?

Hernias usually occur in newborns, but may not be noticeable for several weeks or months after birth.

Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.
Umbilical hernias appear as a bulge or swelling in the belly-button area. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.

If the hernia is not reducible, then the loop of intestine may be caught in the weakened area of abdominal muscle. Symptoms that may be seen when this happens include the following:

a full, round abdomen
vomiting
pain or fussiness
redness or discoloration
fever

Symptoms of a hernia may resemble other conditions or medical problems. Please consult your child's physician for a diagnosis.

How are hernias diagnosed?

Hernias can be diagnosed by a physical examination by your child's physician. Your child will be examined to determine if the hernia is reducible (can be pushed back into the abdominal cavity) or not. Your child's physician may order abdominal x-rays or ultrasound to examine the intestine more closely, especially if the hernia is no longer reducible.

Treatment for hernias:

Specific treatment will be determined by your child's physician based on the following:

your child's age, overall health, and medical history
the type of hernia
whether the hernia is reducible (can be pushed back into the abdominal cavity) or not
your child's tolerance for specific medications, procedures, or therapies
your opinion or preference

Inguinal hernia:

An operation is necessary to treat an inguinal hernia. It will be surgically repaired fairly soon after it is discovered, since the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off, and the intestine can become damaged. Inguinal hernia surgery is usually performed before this damage can occur.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the area of the hernia. The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes, a piece of meshed material is used to help strengthen the area where the muscles are repaired.

A hernia operation is usually a fairly simple procedure. Children who have an inguinal hernia surgically repaired can often go home the same day they have the operation.

Umbilical hernia:
By 1 year of age, many umbilical hernias will have closed on their own without needing surgery. Nearly all umbilical hernias will have closed without surgery by age 5.

Placing a coin or strap over the hernia will not fix it.

There are many opinions about when a surgical repair of an umbilical hernia is necessary. In general, if the hernia becomes bigger with age, is not reducible, or is still present after 3, your physician may suggest that the hernia be repaired surgically. Always consult your child's physician to determine what is best for your child.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the umbilicus (belly button). The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes a piece of meshed material is used to help strengthen the area where the muscles are repaired.

A hernia operation is usually a fairly simple procedure. Children who have an umbilical hernia surgically repaired may also be able to go home the same day they have the operation.

What is the long-term outlook for this disorder?

Once the hernia is closed, either spontaneously or by surgery, it is unlikely that it will reoccur. The chance for reoccurrence of the hernia may be increased if the intestine was damaged.


		Programs that treat this condition:

		Center for General Pediatric Urology
		General Surgery Program


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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