During childhood, it is common for some children to develop lumps in the groin area. This lump may be an inguinal hernia, and its occurrence is more common in children than in adults, as at least one in every 20 children born will be predisposed to this type of hernia, especially boys and premature infants.

What is an Inguinal Hernia?

An inguinal hernia is a soft bulge located in the groin, resulting from an unusual opening in the abdominal wall1. The abdominal wall muscles are weak and the hernia pushes the intestine, which in turn presses against the abdominal wall, causing it to shift into the inguinal canal. The inguinal hernia appears as a lump in the groin, as mentioned earlier, and that area becomes somewhat protruded, especially if the child stands up or does any physical effort. Its appearance is more common in children due to a malformation, which is why it is important and essential for mothers to be attentive to anything unusual on their little ones. Seeing a doctor should be the first step when noticing anything strange on children’s bodies.

IMPORTANT: During diaper changes, baths, and other child care routines, an inguinal hernia is easily noticeable, so parents should always be alert to any signs on the child’s body.

Causes of Inguinal Hernia in Children

During pregnancy, the baby’s intestine is not formed and developed inside their body. Until the first three months of pregnancy, the baby’s intestine develops separately, meaning outside their body, and only later does the body move it inside. In boys, in addition to this fact about the intestine, the testicles are formed inside the abdomen. The testicles descend through the inguinal canal after they have developed. That is why the appearance of inguinal hernia is more frequent in them, as the testicles develop until the seventh month of gestation, and right after birth, the inguinal canal through which the testicles descended closes, leaving only a small opening for the spermatic cord to pass through, called the inguinal ring. However, what leads to the appearance of the inguinal hernia is an improper opening that forms in the muscle wall of the abdomen, since the inguinal canal of the abdominal wall is very fragile. This opening is responsible for the appearance of the hernia, as it allows part of the intestine to pass through it, thus forming a soft lump in the groin area2. In girls, the round ligament passes through this canal. The appearance of this hernia in girls may not be as common as in boys, but that does not mean they cannot also develop it. The inguinal canal does not close properly in some cases, as the area around the inguinal ring is vulnerable. As a result, part of the intestine finds an opening and settles in the groin, and in some more specific cases, in boys, the inguinal hernia may even appear in the scrotal sac.

Types of Inguinal Hernia

There are two main types of inguinal hernias: indirect inguinal hernia and direct inguinal hernia. However, depending on its size, pediatric inguinal hernia may cause, in addition to discomfort, serious complications in children. Usually, when pushed with a finger, the inguinal hernia will go back to the abdominal area, or even when the child lies down. However, it’s important to be alert to these signs, because if you do this and the hernia remains stuck, it may be an incarcerated or strangulated inguinal hernia.

Indirect Inguinal Hernia

Indirect inguinal hernia is more common in males, especially in babies and those born prematurely. The hernia develops due to the intestinal loop passing into the scrotal sac, through the hernial ring, which finds an opening as a result of weakness of the abdominal wall muscles.

Direct Inguinal Hernia

Direct inguinal hernia forms in the weakened abdominal wall itself and appears only in males, developing throughout life. Through this (irregular) opening in the abdominal wall, part of the intestine finds a passage through this hole and settles in the scrotal sac. Inguinal hernia is simple to treat and its only treatment is surgery, which is usually very effective.

Incarcerated Hernia

Incarcerated hernia occurs when a segment of the intestine or the abdominal fat gets trapped, meaning it does not move and remains stuck in the groin even if the doctor tries to push it back into place.

Strangulated Hernia

Strangulated hernia, besides the intestine not returning to place as it is stuck, the tissue in that region can become compromised, possibly causing irreversible damage. This is because the blood supply becomes blocked and cannot reach the area; as a result, the blood can become gangrenous, affecting the tissue, which, if not dead already, could soon be. Therefore, in the last two cases, emergency surgery is needed to remove the inguinal hernia, and especially if complications have reached the last stage—strangulated hernia—which is even more serious. So, if you suspect your child has an inguinal hernia and it is in the conditions described above, it is important not to hesitate to consult a pediatrician. The child’s life may be at serious risk if nothing is done.

Symptoms

It is important for mothers to pay close attention to certain symptoms that can be observed in children suspected of having an inguinal hernia:

  • Soft bulge in the inguinal area;
  • Becomes visible when coughing, crying, lifting weight, straining to have a bowel movement, or any other physical effort;
  • Pain and discomfort in the area, especially when exerting;
  • Sensation of weakness or pressure in the groin

Therefore, if you notice a prominent lump in the child’s groin, consult a pediatrician promptly, as it may be an inguinal hernia. The only effective treatment is surgical intervention3. However, depending on the case, this surgery should not be delayed, especially if it is an incarcerated or strangulated inguinal hernia, as this can cause irreversible damage and compromise the muscle tissue in the area. So as soon as it is diagnosed, surgery should be scheduled immediately for the child’s health and well-being. See Also: Photo: White77, Agaricpro