Hernia In Children: What Parents Need To Know

Hernia is formed when the contents of the abdomen protrude through a weak area in the abdominal wall. A hernia consists of a sac and this sac has its contents and coverings. The contents of a hernia are usually the loops of small intestine.

Common Types Of Hernia In Children

The type of hernia is determined by examining where the abdominal contents find a weak spot in the abdominal wall. 

The most common types of hernia in children are:

• Inguinal Hernia: The bulging of abdominal contents into the groin region or scrotal sac is called inguinal hernia. It travels from the abdomen towards the scrotum through a path called inguinal canal. Inguinal hernia is a very common condition; every five out of 100 babies have inguinal hernia.
• Umbilical Hernia: Umbilical herbia refers to the protrusion of bowel loops through the navel. It occurs a few weeks after birth and can be seen in the naval area.
• Other less common types include para-umbilical hernia, epigastric hernia and incisional hernia, depending upon the location.

Signs And Symptoms Of Hernia In Children

Hernia presents with a soft reducible swelling. This swelling can be seen in the groin or scrotum in case of inguinal hernia and in the navel in case of umbilical hernia. A peculiar feature of this swelling is that it is reducible when pressed manually with a hand, and comes out again if the hand is removed. The swelling can be both felt and seen. This swelling becomes more prominent when the child cries, sneezes, coughs or defecates. All these things increase pressure inside the abdomen. The swelling is less prominent when the child is sleeping or relaxed.

Hernia is usually painless, but if it presents with pain, you should immediately consult a doctor. Since we are talking about children, mothers tend to play a greater role in the diagnosis. Mothers should carefully observe the children and look for any swelling coming out of these sites, especially the swelling is accompanied by pain. 

Complications Of Hernia

When the neck of a hernia is trapped in its “hole” and the blood supply of the sac is compromised, it is called a strangulated hernia. The ischemia of the sac causes tremendous pain, accompanied by nausea, vomiting and absent bowel movements. The site of hernia becomes tender and discolored. If this continues for four or five hours, gangrene may occur. This is considered a surgical emergency and you should take your child to the nearest emergency room. 

Another complication of hernia is obstructed or irreducible hernia. This means that the sac is stuck and doesn't return back to the abdomen either, due to an adhesion between the sac and its contents or overcrowding of the contents. This can lead to strangulated hernia, therefore you should visit a doctor immediately.

READ Everything You Need To Know About Umbilical Hernias In Children             

Hernia In Kids: When Should You Seek Help And What Are The Treatment Options?

Mostly, hernias are painless and sometimes get overlooked in children, so parents should keep a close on their children and look for a bulge or swelling coming out of the groin or umbilical regions. A doctor’s appointment should be made if you suspect a hernia.

When To Seek Immediate Help?

If there is only a soft and painless bulge in groin or navel, then make a doctor’s appointment and the doctor will manage it accordingly. If you see any of the following signs, take your child to the nearest ER immediately:

• The swelling becomes painful suddenly
• The child vomits
• The swelling becomes hard and bigger
• Child gets a fever
• The site of hernia becomes discolored (reddish)

Treating Hernia In Children

Hernia treartment largely depends on the type of hernia.

Umbilical Hernia is mostly managed non-surgically. More than 95 percent of umbilical hernias resolve spontaneously in the first three years of life without any treatment. If a large umbilical hernia persists after the third birthday then a minor surgery is performed. A small incision is made just below the navel. The loop of the small intestine is put back in place and the sac is ligated and excised. The skin and fascia are then closed with absorbable sutures.

Inguinal Hernia is almost always treated with surgery; there is no medicinal treatment for inguinal hernia.

READ Hernia Operation: Recovery After Hernia Surgery

Here's what you need to know if your child is going to undergo hernia surgery:

• Pre-operative Care: The surgery is performed under general anesthesia so the child should not eat anything for six hours before the surgery to avoid the risk of vomiting during surgery. 
• Herniotomy: This means excision of the sac of hernia. After general anesthesia becomes active, an oblique small skin crease incision is made on the inguinal canal in the groin area. The skin and fascia are retracted and the hernia sac containing the loop of intestines is identified and separated. The loop is pushed back into its original position in the abdomen and the sac is the removed.
• Herniorrhaphy means repair and strengthening of the area after the removal of the sac so that hernia does not form again. There are chances of recurrence of hernia on both sides. So, after a herniotomy, a surgeon assesses the area and decides to reinforce one or both sides accordingly. Herniorrhaphy is usually done either with sutures or a prosthetic mesh. It is placed in the posterior wall of inguinal canal so that the hernia does not pop out of it again.
• After the surgery: If everything goes well, the child is discharged a few hours after the surgery on the same day. The child can resume their normal eating habits immediately and have a bath after one or two days. Do not pull off the tapes on the incision site. They will dissolve on their own after some time.
• A follow up appointment is made seven to 10 days after the surgery just to check the incision site and recovery.