Inguinal Hernia and Hydrocele

  • Overview

    If a child has a hernia, a section of his intestine has protruded through a weakness in his abdominal muscles.

    Inguinal Hernia

    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

    A hydrocele is a collection of fluid in the scrotum around the testicle.

    • Hydroceles aren’t harmful to the testicles in any way.
    • They don’t cause discomfort.
    • They are sometimes present at birth or may develop later.
    • They can occur on one or both sides of the scrotum.
    • The fluid typically makes the scrotum look large.

    Is surgery necessary?

    If your child has an inguinal hernia, our surgeons can probably correct it using a relatively simple procedure; your child will most likely be able to go home the same day that she has the surgery.

    Hydroceles usually go away on their own and no treatment is typically needed. If the hydrocele has not disappeared by the time your child is age 1 or it becomes very large, your child may need a simple surgery to remove it.

    »
    Boston Children's Hospital 
    300 Longwood Ave
    Boston MA 02115

     617-355-7800


  • In-Depth

    Why does my child have a hernia?

    A hernia can develop during the first few months after your baby is born because of a weakness in the muscles of her abdomen.

    What is an inguinal hernia?

    As a male fetus grows and matures in the womb, 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 doesn’t 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.

    Why is an inguinal hernia a concern?

    Sometimes, the loop of intestine that protrudes through a hernia may become stuck and can’t 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 an inguinal hernia?

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

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

    How did my son get a hydrocele?

    During the eighth month of pregnancy, the testicles move from the abdomen into the scrotum. When the testicle travels downward, it brings a sac with it. The sac allows fluid to surround the testicle. This sac usually closes before birth, and the fluid is absorbed in the body.

    Closed hydroceles

    When the sac closes, but fluid stays in the scrotum, the hydrocele is called non-communicating or closed. This type of hydrocele is often found in newborns. In most cases, the fluid is absorbed by your son’s body and goes away in time. It may take up to a year for this to happen.

    If your son is older and has a non-communicating hydrocele, it may indicate other problems, such as infection, torsion (twisting of the testes) or a tumor.

    Open hydroceles

    When the sac doesn’t close, the hydrocele is called communicating or open. This means that the fluid around the testicle can flow back up into the abdomen. You might notice that the hydrocele looks smaller when your son’s doctor presses on his scrotum. The pressure causes the fluid to flow back into the abdomen.

    Are hydroceles dangerous?

    Hydroceles aren’t harmful to the testicles in any way and they don’t cause your son any pain.

    Sometimes, if the sac remains open, a loop of intestine can push through the opening. This makes the scrotum look even larger. If your son’s scrotum suddenly appears very large and hard and he won’t stop crying, call your doctor right away; your son may need immediate attention.

  • Tests

    How is an inguinal hernia diagnosed?

    Hernias can be diagnosed by a physical examination by your child's physician. Your child will be examined to determine if the hernia can be pushed back into the abdominal cavity or not.

    Your child's physician may order abdominal x-rays or an ultrasound to examine the intestine more closely, especially if the hernia cannot be pushed back into the abdominal cavity.

    How is a hydrocele diagnosed?

    Your son’s doctor will likely notice his swollen scrotum. Often, the testicle can’t be felt because of the fluid surrounding it.

    A hydrocele can be easily diagnosed by shining a light through the scrotum. If the scrotum is full of fluid, it will light up. Your son’s doctor may then want to perform an ultrasound just to confirm the diagnosis.

  • How will my son's inguinal hernia be treated?

    Your child will need an operation to fix his inguinal hernia. It will be surgically repaired fairly soon after it's 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.

    Surgery

    A hernia operation is usually a fairly simple procedure and your child will probably be able to go home the same day.

    • 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.

    How will my son's hydrocele be treated?

    Hydroceles usually go away with time in infants.

    If the hydrocele has not disappeared by age one or becomes very large, your son may need surgery. You will see both the surgeon and the anesthesiologist before the operation on the day of surgery. During the operation, your son will receive general anesthesia, which means that he won't feel pain during the surgery.

    Most children go home the same day as the operation. However, some spend a night in the hospital for observation. After surgery, your son will stay in the recovery room until he's ready to go home. Parents are welcome to stay with their children in the recovery room.

    What happens after the surgery?

    • The nurse in the recovery room will show you how to care for your son before you go home and will give you written instructions.
    • Most children have some pain after surgery, so your child's doctor may prescribe some pain medicine.
    • There are usually no stitches to remove. The stitches are under the skin and dissolve on their own.
    • A clear, waterproof bandage will cover the incision in the groin area.
    • Your son may shower or have a sponge bath at home. Do not give your child a tub bath or allow swimming until seven days after the surgery.
    • Your son shouldn't use straddle toys or bicycles, play sports or go to gym class for three weeks after surgery.
    • Your doctor will want to see your son about two weeks after the surgery to check how the area is healing.

    What's my child's long-term outlook?

    Once your child's hernia or hydrocele is closed, either spontaneously or by surgery, it is unlikely that either problem will reoccur.

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