GROIN AND GENITAL AREA
Inguinal hernia in children
A very common condition in boys, often present from birth, which is corrected with a short and safe surgical procedure.
Inguinal hernia in children
An inguinal hernia in children is a condition caused by the persistence of a small canal present from birth, called the processus vaginalis in boys and the canal of Nuck in girls. This canal connects the abdomen with the scrotum in boys or with the labium majus in girls.
When the canal remains open, part of the abdominal contents, such as intestine, fatty tissue or, in girls, the ovary, may protrude towards the groin, causing an inguinal or inguinoscrotal swelling. If fluid passes through this canal, the condition is called a hydrocele.
In children, an inguinal hernia is therefore usually a congenital condition: it is not caused by strain, as is more often the case in adults. In older boys, however, a form similar to adult hernia, related to straining factors, may also occur.
Symptoms and signs to look out for
The most common sign is the appearance of a swelling in the groin, which may extend to the scrotum in boys or to the labium majus in girls.
The swelling may be more noticeable when the child cries, coughs, moves or strains, and may reduce or disappear at other times. In the case of hydrocele, the swelling mainly affects the scrotum and may be related to the presence of fluid.
The hernia may be painless, but it can also be associated with discomfort, irritability or local pain. The presence or absence of pain is not enough to determine how serious the problem is: even a painless swelling deserves a specialist paediatric surgery assessment.
CAUSES OR ASSOCIATED FACTORS
In children, an inguinal hernia is usually linked to the failure of the processus vaginalis or canal of Nuck to close spontaneously. This canal should normally close after birth; if it remains open, it can allow abdominal contents to pass towards the groin.
A paediatric inguinal hernia is therefore not, in most cases, the result of physical activity, crying or straining. These may make the swelling more visible, but they are not the main cause of the hernia.
When to book a consultation
It is advisable to request a paediatric surgery consultation whenever an inguinal, inguinoscrotal or scrotal swelling appears, even if the swelling tends to disappear on its own.
The specialist assessment is important because it makes it possible to distinguish between inguinal hernia, hydrocele and other conditions that may present with swelling in the same area.
The child should instead be assessed urgently if the swelling:
Assessment and diagnosis
The specialist assessment begins with collecting the child’s clinical history and observing the symptoms reported by the parents: when the swelling appears, whether it increases at certain times, whether it reduces spontaneously and whether it causes pain or discomfort.
This is followed by a physical examination, during which the paediatric surgeon assesses the location and characteristics of the swelling and the possible presence of an inguinal hernia or hydrocele.
In many cases, the diagnosis is clinical. Any further investigations are assessed by the specialist based on the child’s clinical picture.
At the end of the consultation, the most appropriate care plan is discussed, including timing, treatment options and any follow-up checks.
The paediatric surgeon analyses the symptoms reported by the parents, evaluating when the swelling appears, how it changes over time, and whether it causes pain or discomfort.
During the visit, the location and characteristics of the swelling are examined, checking for the possible presence of an inguinal hernia or hydrocele.
In most cases, the diagnosis is clinical. Any further diagnostic tests are prescribed based on the child's specific condition.
At the end of the evaluation, the most appropriate treatment, the relevant timeline, and any follow-up checks are discussed.
How it is treated
In the case of an inguinal hernia, the only treatment is surgery. Once the diagnosis has been confirmed, the child may be placed on a waiting list to schedule the operation.
An inguinal hernia does not tend to resolve spontaneously with growth, and there are no medical therapies, trusses or exercises that can close the canal responsible for the problem.
In the case of hydrocele, the approach may be different: in many children, it is possible to wait until the age of 3–4 years, because spontaneous resolution may occur. If the hydrocele persists beyond this age, surgery may be indicated.
When surgery is needed and what it involves
In the case of an inguinal hernia, surgery is indicated after diagnosis and consists of closing the processus vaginalis, the canal through which abdominal contents can descend towards the groin or scrotum.
The operation may be performed with an open technique, through a small groin incision, or with a laparoscopic technique, according to the paediatric surgeon’s assessment.
In older boys, in selected cases, the placement of a prosthesis, commonly known as a mesh, may also be indicated.
Over one year of age, the operation can be performed as day surgery, with discharge on the same day. Under one year of age, an inpatient admission with one night of observation is generally planned.
Anaesthesia may be general, especially if the procedure is performed laparoscopically, or may involve deep sedation combined with a locoregional anaesthetic block, according to the anaesthesiological and surgical assessment.
Recovery and useful instructions
After surgery, instructions may vary depending on the child’s age, the technique used and the individual case.
In general, Dr Rapuzzi advises:
Parents’ most common questions
No. In children, the size of the swelling does not determine its severity. Even a small, intermittent swelling or one that appears only at certain times can correspond to an inguinal hernia and should be evaluated by a pediatric surgeon.
No. When it is a true inguinal hernia, the canal causing it does not close spontaneously with growth, and surgical treatment is required.
In most cases, no. In children, an inguinal hernia is congenital and is linked to the persistence of the processus vaginalis. Crying, coughing, or straining can make it more noticeable, but they are not the primary cause.
Yes. It is common for an inguinal hernia to appear and disappear. Even if the swelling goes back in on its own, a pediatric surgical evaluation is recommended.
No. Both can be linked to the persistence of the processus vaginalis, but in a hernia, abdominal contents pass through, whereas in a hydrocele, fluid is present, mainly causing swelling of the scrotum.
It is important to seek urgent medical evaluation if the swelling does not go back in, becomes hard or very painful, or if the child exhibits inconsolable crying, vomiting, severe irritability, or a worsening of their general condition.
Generally, physical activity should be avoided for about 3-4 weeks, unless otherwise instructed by the specialist based on the specific case.
Note: The information on this website is provided for guidance only and does not replace a specialist medical assessment. In case of acute symptoms, significant pain or a worsening general condition, you should contact a doctor or go to the Emergency Department.
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