Recognizing and Caring for Hernias

Like most people, you probably associate hernias with lifting heavy weights. But in fact, many young children, toddlers and babies develop hernias — and it's pretty clear that they aren't pumping iron at the gym or moving heavy furniture. In most cases, hernias are congenital, present at birth, but may not be visible till later in life.

Types of hernias

Inguinal hernias. The majority of hernias in children — about 80 percent — are inguinal hernias, which means they are in the lower part of the abdomen, near the groin. In boys, the protruding piece of intestine may enter the scrotum, which can cause swelling and pain. In girls, the swelling is usually in the labia or the groin. The most common areas for hernias to appear are in the abdomen, groin and belly button.

There are two types of inguinal hernias:

• Direct inguinal hernia. This occurs when a weak spot develops in the lower abdominal muscles and tissues are able to push through the weak spot.
• Indirect inguinal hernia. This occurs when the inguinal canal (a small passage through the lower abdominal wall) fails to close before birth. These hernias are more common in children who were born prematurely.

Umbilical hernias. These hernias are common in newborns and babies younger than 6 months. They happen when the opening in the abdominal wall, where the umbilical cord exits the abdominal wall, fails to close.  Your baby's belly button may look enlarged and swollen. Umbilical hernias usually heal on their own by the time your baby is a year old.

Epigastric hernias. In this type of hernia, which occurs most frequently in boys, there is a protrusion through the abdominal muscles between the chest and the belly button, causing a lump in that area. Surgery is required to fix this type of hernia.

Hiatal hernias. This type of hernia happens when the upper part of the stomach bulges through a weak opening in the diaphragm where the esophagus meets the stomach. While these hernias are common, oftentimes they are small and don't cause any issues. However, you child may have heartburn, chest pain and indigestion. Diet modifications and/or medications can cause relief, although sometimes these hernias require surgery.

Incisional hernias. The incisional hernia occurs after abdominal surgery. The intestines may protrude through the abdomen around a surgical incision. Your child will need another surgery to fix this hernia.

Sports hernias. Teens can develop sports hernias, an injury of the inguinal area caused by repetitive twisting and turning. This type of hernia occurs mainly in young people who play ice hockey, soccer and tennis. They can be difficult to diagnose because they may not exhibit the classic signs of a hernia. The main symptom is groin pain that may radiate into the scrotum. The pain can last for months, but the telltale bulge of tissue never appears.

Hernia symptoms

Males are six times more likely to have hernias than females. In most cases, they are diagnosed by a parent who notices a bulge or by a doctor during a routine physical exam.

Symptoms of hernias include:

• Lump in the groin near the thigh
• Persistent crying in babies
• A lump that is bigger when the child is standing or straining (such as crying or coughing) and disappears when the child is lying down or relaxed
• Pain and tenderness

Hernia treatment

Hernias need to be repaired — most often surgically — to avoid complications such as strangulation, in which a portion of the intestine becomes trapped in a hernia, cutting off the blood supply to that part of the intestine. Infants 6 months old and younger with inguinal hernias have a much higher risk of strangulation than do older children and adults. Signs that the hernia may have strangulated include:

• Nausea and vomiting
• Abdominal bloating
• A bulge that becomes enlarged and red and tender to the touch

Most older children and teens who are diagnosed with a hernia actually have had a weakness of the muscles or other abdominal tissues since birth.

The good news is that hernias are common and easily treated with no adverse long-term health effects.

Contributed by: Patrick S. Pasquariello Jr., MD