What is an inguinal hernia?
If the channel that forms when the testicle moves down into the scrotum before birth (processus vaginalis) does not close, bowel from the abdomen, or sometimes an ovary in girls, can push through this open channel into the groin or scrotum. This is called an inguinal hernia.
It occurs in about 1–5% of children and more often in those born prematurely. It is about 6 times more common in boys than in girls and occurs more often on the right side.
Signs
- a soft bulge in the groin or scrotum,
- the bulge gets bigger when the child cries, strains or coughs,
- it gets smaller or disappears when the child is calm or lying down,
- it is usually painless.
Incarcerated hernia
The most dangerous complication of a hernia is incarceration: the bowel or ovary in the hernia cannot go back, and its blood supply is cut off. This happens most often in the first year.
Signs:
- the bulge becomes hard, painful and doesn’t go back in,
- redness or bluish discoloration over it,
- vomiting, bloating, nonstop crying.
This is an emergency. The doctor can often carefully push the hernia back by hand, and surgery is then done within 1–3 days. If it can’t be pushed back, emergency surgery is needed.
Treatment
An inguinal hernia does not go away on its own. The only treatment is surgery, and because of the risk of incarceration it is done without much delay after diagnosis.
There are two methods:
- Open method: through a 1.5–2 cm incision in the groin crease, the open channel is found and closed.
- Laparoscopic method: with a small camera through the belly button, the channel is closed from the inside, and the other side is checked at the same time.
Both methods are safe, and the child usually goes home the same day. More: inguinal hernia surgery.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- The groin bulge has become hard, painful and doesn't go back in
- Redness or bluish discoloration over the bulge
- Vomiting, bloating, a baby crying nonstop
- A hard, painful lump in the groin in a girl (may be an ovary)
Note for pediatricians and family doctors
Inguinal hernia in children is of the indirect type and is related to a patent processus vaginalis. The risk of incarceration is highest in the first year, especially in preterm infants; therefore elective repair should be scheduled soon after diagnosis. An incarcerated hernia can usually be reduced by careful manual reduction, followed by surgery within 24–72 hours. If a gonad is found in the hernia sac of a girl, androgen insensitivity syndrome should be considered.
What happens at the visit?
- The groin and scrotum are examined standing and lying down.
- A photo or video of the bulge taken by the parent is very helpful.
- The surgical method (open or laparoscopic), timing and anesthesia are explained.
Frequently asked questions
The bulge only appears when my child cries, then disappears. Is it still a hernia?
Yes, this is a typical inguinal hernia. Even if it is not visible during the examination, the parent's description or a photo can be enough for the diagnosis.
Can a truss or belt be used?
In children, a truss does not treat the hernia and does not prevent incarceration. It is not recommended.
Can there be a hernia on the other side too?
Some children, especially babies, also have an open channel on the other side. Laparoscopic surgery makes it possible to look at both sides and close them at the same time if needed.
Related topics
Sources
- EAU Guidelines on Paediatric Urology, 2025.
- Olesen CS et al. Timing of inguinal hernia repair in children: a systematic review. Ann Surg, 2019.
This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.