Learn facts about hernia, a common condition in babies, and how surgery can treat this swelling in the groin.

Hernias are common in young children and babies, some are born with this condition. This occurrence is also more common in premature babies, and males are 10 times more likely to develop this condition.

Though there are various types of hernia, the most common are inguinal hernia and umbilical hernia, in which the intestine protrudes through the abdominal cavity. Approximately one in 100 children develop an inguinal hernia.

What is a hernia?

The medical definition of a hernia is the protrusion of an organ through the walls of the cavity containing it.

Is it possible for me to tell if my baby has an inguinal hernia?

An inguinal hernia is an abnormal bulge or protrusion that can be seen and felt in the groin area, especially when your little one strains such as during a poop, cries or coughs. Such hernias can occur on either side of the groin and, occasionally, on both sides. 

As parents, it can sometimes be difficult to ascertain if your baby has an inguinal hernia. Paediatric surgeon Dr Nidhu Jasm notes that a common sign would be if the groin looks unequal. If your baby is crying incessantly, she adds, do check your little one for any unusual swelling during diaper changes. Other symptoms include swelling that comes and goes.

Hernia occurs when the intestine protrudes through a weak spot in the abdomen along the inguinal canal and can be present at birth.

What should I do if I spot this swelling on my baby?

You can try to push the swelling back gently. If the swelling is recent, you’ll most probably be able to push it back, which should resolve the situation temporarily. However, do bring your baby to a doctor for a check-up as soon as possible. If the swelling does not subside, bring your baby to the nearest doctor immediately.

Why does hernia occur?

Hernia occurs when the intestine protrudes through a weak spot in the abdomen along the inguinal canal and can be present at birth. The inguinal canal is a passage in the lower front abdominal wall that, in males, allows passage of the spermatic cord and in females, the round ligament.

In some cases, it is sizeable enough to allow the intestine to come through. If these intestinal contents get trapped in the canal, it becomes an emergency as the blood supply to the intestine gets compromised.

Are there any medical treatments for inguinal hernia? Does it go away with time?

Currently, surgery is the only treatment for hernia.

What does hernia surgery involve?

Your child will need to be admitted and be given a short general anaesthetic. For open surgery, an incision will be made in the groin area to repair the hernia. The stitches used are dissolvable and pain relief will be prescribed to ensure that your child will remain comfortable. 

For infants, this surgery can be done under spinal anaesthesia. The laparoscopic (keyhole) approach is reserved for older children and will be offered during the doctor's discussion with the parents on the benefits and risks. 

Does my child need to be admitted overnight for monitoring?

For a straightforward procedure, your child will be discharged on the day of the surgery. Children with prior medical history and/or premature may require overnight monitoring.

Are there any risks involved in the surgery?

The risks are different for males and females. For males, there is a possibility of injury to blood supply to the testis and the tube that carries sperm. For females, the risks are generally less. Should the ovary enter the inguinal canal, there is a small chance of injury to the ovary and the fallopian tubes.

Injury to the intestine and urinary bladder are rare and more likely to happen if the child develops a stuck hernia. This means that the contents of the hernia bulging through the abdominal wall cannot be massaged back inside the tummy prior to surgery.

There is also a possibility that the surgery might fail, although the risk is small. If the procedure fails and the hernia recurs, a subsequent surgery will be needed to repair it.

After hernia on one side has been repaired, what are the chances that a hernia can develop on the other side?

Premature children have a 30 to 50 per cent chance of suffering a hernia on the opposite side than full-term babies, whose risks are small. The more premature the child, the higher the chances.

Dr Nidhu notes that she would discuss with parents as to when to carry out pre-emptive hernia surgery on the opposite side of the child’s body. She adds, however, that in Singapore, which has a reliable healthcare system and parents that are generally well-informed, she prefers conservative management^ for the child, highlighting instead to the parents what symptoms to look out for.

^ Avoiding invasive measures such as surgery or other invasive procedures, usually with the aim of preserving function or body parts.

For more info, call Thomson Surgical Centre at 6846-6766 or e-mail surgicalcentre@thomsonmedical.com

Photo: iStock

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