Hernias & Hydroceles

A hernia happens when an organ or tissue pushes through a weak spot or opening in a muscle wall into a part of the body where it does not belong. Hernias look like a bulge on the body. Hernias generally do not go away by themselves and often require surgery.

A hydrocele is a fluid-filled sac around a testicle that causes swelling in the scrotum. During development, the testicles develop in the abdomen and then travel down a tube into the scrotum, alongside a thin-walled sac. This sac normally closes itself, and the body absorbs any fluid. Sometimes, the fluid remains. This is called a non-communicating hydrocele. In some cases, the sac remains open, allowing fluid to flow in and out. This is called a communicating hydrocele. Hydroceles often go away within the first two years of life and usually need no medical treatment. Hydroceles rarely cause any symptoms except for swelling, and this swelling may change in amount and frequency.

The most common hernias in children are:

• Inguinal hernia. An inguinal hernia occurs when a part of the intestines, abdominal contents, ovaries or fallopian tubes pushes into the groin area. This often happens on the right side of the body but could occur on either side. This kind of hernia is more common in boys than in girls and is most common in premature babies. Baby boys with undescended testes and children with cystic fibrosis also tend to get inguinal hernias. An inguinal hernia can pose different levels of concern:
  • Reducible hernia. With a reducible hernia, tissues only bulge out when under stress or strain, such as when a child is coughing or crying. They do not pose a serious threat.
  • Incarcerated hernia. An incarcerated hernia occurs when tissue, such as a loop of small or large intestine, becomes trapped in the groin area. This could block or slow down the movement of food through the digestive system.
  • Strangulated hernia. A strangulated hernia cuts off the blood supply to the trapped tissue (such as intestines or testicles) and must be treated immediately to save the affected area.
• Umbilical hernia. Umbilical hernias form in the bellybutton area. They are caused by an opening in the abdominal muscles at the bellybutton or by weak muscles. Membranes or intestines can push through the opening. Some umbilical hernias close on their own by age 3. Umbilical hernias often present as reducible and rarely develop into incarcerated or strangulated hernias.

Symptoms of hernias and hydroceles can range from no pain or mild pain to more severe affects. Symptoms include:

• Swelling
• Pain
• Redness
• Fever
• Vomiting

Diagnosis of Hernias & Hydroceles

Pediatricians, pediatric surgeons and pediatric urologists at Riley at IU Health perform the following exams and tests to diagnose a hernia or hydrocele:

• Clinical exam. The doctor will examine your child and any present bulges or lumps. 
  • For a hernia, the doctor will ask your child to sit and stand to see how the bulge moves in different positions. The doctor may also press on the abdomen to check for internal movement.
  • For a hydrocele, the doctor will do a similar exam as for a hernia, as well as check for swelling in the scrotal sac.
• Ultrasound. If the doctor cannot determine whether the bulge is a hernia or a hydrocele, or if other tissue is trapped in the hernia, he or she will perform a painless ultrasound exam. Ultrasound uses sound waves to create images of internal organs and tissues. This helps the surgeon see what is happening and if surgery is required.