A hernia happens when part of an internal organ (usually the bowel) pushes through a weak spot in the muscles covering the abdomen (tummy). Hernias show up as a lump or bulge under the skin.

An inguinal (in-gwin-al) hernia is a hernia that occurs in the groin. In boys, an inguinal hernia may extend into the scrotum (pouch of skin containing the testes). Boys are up to eight times more likely than girls to have an inguinal hernia.

A doctor should always see your child for a hernia diagnosis. In some cases, inguinal hernias can become life-threatening, and require urgent medical attention.

Signs and symptoms of an inguinal hernia

If your child has an inguinal hernia, they may have swelling or a visible lump in the groin, or a swelling in the scrotum. The swelling:

• is usually painless (but there may be some mild discomfort)
• is soft and smooth in texture
• may disappear or reduce in size when your baby is relaxed and lying flat
• may be more noticeable or increase in size when your baby is crying, coughing or straining.

Inguinal hernias are slightly more common on the right side, but may occur on the left or on both sides of the groin or scrotum.

In a simple inguinal hernia, the bowel can move freely in and out of the opening in the muscle wall. This is described as being reducible.

Strangulated inguinal hernia

Sometimes there are inguinal hernia complications. If part of the bowel gets stuck outside the muscle wall, it is at risk of having its blood supply cut off. This is then no longer reducible and is described as a strangulated hernia, which requires urgent medical attention.

You should call an ambulance if your child has an inguinal hernia and they develop any of the following symptoms:

• being generally unwell
• pain in the groin
• nausea and vomiting
• bloating or full abdomen
• fever
• a swelling that is red or pale blue-grey in colour and is noticeably tender
• a swelling that does not change in size when your child is crying.

When to see a doctor

If you think your child has a hernia of any kind, you need to see a GP. The GP will examine your child's groin on both sides. The examination may include feeling the hernia and attempting to reduce it. If the hernia is not visible at the time of the visit, your doctor may try to bring it out by pressing lightly on your child's abdomen.

If your child shows signs of a strangulated hernia, they need urgent surgical treatment at a specialist paediatric hospital.

Treatment for inguinal hernia

Surgical hernia repair (a herniotomy) is always necessary in cases of inguinal hernia – even simple inguinal hernias are at risk of becoming strangulated. A herniotomy will prevent the hernia from coming back. If the inguinal hernia is detected and corrected early, there should be no long-term complications.

Hernia surgery is done under anaesthesia. Anaesthetic may be either general (where your child will be asleep), or spinal (where your child will be completely numb from the chest down during the operation). The type of anaesthetic used depends on the child and will be discussed with you.

If your child has an inguinal hernia on one side only, there is a small possibility of developing a hernia on the other side. Your surgeon may suggest surgery on the unaffected side to stop future hernia development.

Hernia repair is usually a day procedure, but in some circumstances, your child may need to stay overnight in the hospital for observation. This might happen because:

• the hernia repair was performed as an emergency
• your child is less than six weeks old (or corrected age if born premature)
• your child has a pre-existing illness
• the hernia was strangulated and the surgery was difficult to perform.

Complications are rare in inguinal hernia surgery, but may include:

• injury to the testicle, resulting in a smaller testicle in the long-term (however, if a hernia is strangulated, the testicle may already have been damaged from lack of blood supply)
• damage to the vas deferens (the tube that carries sperm from the testicle)
• nerve damage that can result in numbness over the wound.

Care at home

After your child's surgery, you will be given some post-operative care instructions. Contact your child's surgeon or the hospital if:

• your child develops a fever of 38.5ºC or higher
• the wound becomes infected (i.e. appears red, swollen, or is leaking fluid)
• you are worried for any other reason.

Your doctor will arrange a follow-up appointment in the weeks following your child’s surgery. A doctor will need to check on your child’s wound and, if necessary, examine their testicles. This check-up may be performed as an outpatient at the hospital; or if you live far away, by a local GP with consultation from a surgeon.

There is no set time for when your child may return to normal activities. Your child will begin to do things when they feel comfortable. However, it is recommended that your child does not play sports for two weeks. Speak with your child's surgeon if you need more information about when normal activities may be resumed.

Key points to remember

• A hernia is a bulge under the skin through a weakness or opening in the muscle wall of the abdomen. An inguinal hernia is a hernia in the groin.
• Once the diagnosis of an inguinal hernia is made, surgical repair (a herniotomy) will be performed.
• Strangulated hernias require urgent surgical treatment.
• Inguinal hernia repair is usually a day procedure. In some circumstances, your child may need to stay overnight in the hospital for observation.

For more information

• The Royal Children's Hospital Surgery Department fact sheet: Anaesthesia and Pain Management

Developed by The Royal Children's Hospital Paediatric Urology and Surgery departments. We acknowledge the input of RCH consumers and carers.

Reviewed March 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.