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Hernia (Umbilical and Inguinal)

What is a hernia?

A hernia occurs when part of the intestine pushes through a weakness in the belly (abdominal) muscles. A soft bulge is seen underneath the skin where the hernia has occurred.

In babies, a hernia usually occurs in one of two places:

  • Around the belly button. This is called an umbilical hernia.

  • In the groin area. This is called an inguinal hernia.

What causes a hernia?

A hernia can develop in the first few months after the baby is born because of a weakness in the belly muscles. Inguinal and umbilical hernias happen for slightly different reasons.

What is an inguinal hernia?

As a male baby grows and matures during pregnancy, the testicles develop in the belly 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 belly. If this area does not close off completely, a loop of intestine can move into the inguinal canal through the weakened area of the lower belly wall, causing a hernia.

Girls don’t have testicles, but they do have an inguinal canal. So they can also develop hernias in this area. Inguinal hernias do not occur as often among girls as they do in boys.

Illustration of an inguinal hernia
Click Image to Enlarge

What is an umbilical hernia?

When the unborn baby is growing and developing during pregnancy, there is a small opening in the belly muscles. This lets the umbilical cord pass through, connecting the mother to the baby. After birth, the opening in the abdominal muscles closes as the baby matures. Sometimes, these muscles don’t meet and grow together completely. There is still a small opening there. A loop of intestine can move into the opening between abdominal muscles and cause a hernia.

Illustration of an umbilical hernia
Click Image to Enlarge

Who is at risk for developing a hernia?

Hernias occur more often in babies who have one or more of the following risk factors:

  • A parent or sibling who had a hernia as a baby

  • Cystic fibrosis

  • Developmental dysplasia of the hip

  • Undescended testes

  • Abnormalities of the urethra

Inguinal hernias occur:

  • In 3% to 5% of full term infants

  • Three times more often in premature infants

  • In children who have a family history of inguinal hernias

  • More often in infants and children with other urogenital anomalies

  • More often in the right groin area than the left, but can occur on both sides

Umbilical hernias occur:

  • More often in African-American babies

  • More often in premature babies

Why is a hernia a concern?

Occasionally, the loop of intestine that protrudes through a hernia may become stuck, and is no longer reducible. This means that the intestinal loop cannot 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 a hernia?

Hernias usually occur in newborns, but may not be noticeable for a few weeks or months after birth.

Straining and crying don’t cause hernias. But the increased pressure in the abdomen can make a hernia easier to see.

  • Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries. It may get smaller or go away when the baby relaxes. If your child’s healthcare provider presses gently on this bulge when the baby is calm and lying down, it will usually get smaller or go back into the belly.

  • Umbilical hernias appear as a bulge or swelling in the belly button area. The swelling may be more noticeable when the baby cries. It may get smaller or go away when the baby relaxes. If your child’s healthcare provider presses gently on this bulge when the baby is calm and lying down, it will usually get smaller or go back into the belly.

If the hernia can’t be pushed back into the belly, then the loop of intestine may be stuck in the weakened area of abdominal muscle. Symptoms that may be seen when this happens include the following:

  • A full, round belly

  • Belly pain and tenderness

  • Vomiting

  • Fussiness

  • Redness or discoloration near the hernia

  • Fever

The symptoms of a hernia may resemble other conditions or health problems. Always see your baby's healthcare provider for a diagnosis.

How are hernias diagnosed?

Hernias can be diagnosed by a physical exam by your baby's healthcare provider. Your baby will be examined to see if the hernia can be pushed back into the belly. Your baby's healthcare provider may order abdominal X-rays or ultrasound to check the intestine more closely, especially if the hernia can’t be pushed back into the belly.

What is the treatment for hernias?

Your baby’s healthcare provider will figure out the best treatment plan for your baby based on:

  • Your baby's gestational age, overall health, and medical history

  • The type of hernia

  • Whether the hernia can be pushed back into the belly

  • How well your baby handles certain medicines, treatments, or therapies

  • The opinion of the healthcare providers involved in your baby’s care

  • Your opinion or preference

Inguinal hernia

Surgery is needed to treat an inguinal hernia. Surgery may be done fairly soon after the hernia is 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 done before this damage can occur.

During a hernia surgery, your baby will be placed under anesthesia. A small cut (incision) is made in the area of the hernia. The loop of intestine is placed back into the belly. The muscles are then stitched together. Sometimes, a piece of mesh material is used to help strengthen the area where the muscles are repaired.

A hernia surgery is usually a fairly straightforward procedure. Healthy babies who have this surgery can often go home the same day.

Umbilical hernia

By age 1, many umbilical hernias will have closed on their own without needing surgery. Nearly all umbilical hernias will have closed without surgery by age 5.

Placing a coin or strap over the hernia will not fix it.

There are many opinions about when surgery to fix an umbilical hernia is needed. In general, if the hernia gets bigger with age, is not re, or is still present after age 3, your healthcare provider may suggest that the hernia be repaired surgically. Always see your baby's healthcare provider to figure out what is best for your child.

During a hernia surgery, your baby will be placed under anesthesia. A small cut (incision) is made in the belly button. The loop of intestine is placed back into the belly. The muscles are then stitched together. Sometimes a piece of mesh material is used to help strengthen the area where the muscles are repaired.

Healthy babies who have this surgery may be able to go home the same day.

What is the long-term outlook for this disorder?

Once the hernia is closed (either on its own or with surgery), it is unlikely that it will happen again. There may be a greater chance of the hernia happening again if the intestine was damaged.