A hernia occurs when an organ or fatty tissue pushes through a weak spot in the muscle or tissue wall that normally contains it. While often associated with males, hernias are common in girls and require medical attention. In pediatric cases, hernias are typically congenital, meaning the defect was present from birth, and require evaluation to determine the appropriate course of action.
Types of Hernias Common in Girls
The two most common types of hernias in girls are the inguinal hernia and the umbilical hernia. An inguinal hernia appears in the groin area where the abdomen meets the thigh, sometimes extending into the labia. This type is caused by the failure of the processus vaginalis structure to completely close during development.
The processus vaginalis is a pouch of the abdominal lining that accompanies the round ligament of the uterus down the inguinal canal (the canal of Nuck). If this pouch remains open, abdominal contents, such as a loop of intestine, ovary, or fallopian tube, can slide into the opening, creating the bulge. Inguinal hernias in children do not resolve spontaneously, and surgical repair is necessary to prevent complications.
The second common type is an umbilical hernia, which occurs at the navel. This happens when the opening in the abdominal muscles, which allowed the umbilical cord to pass through during fetal development, does not fully seal after birth. Umbilical hernias affect girls and boys equally, presenting as a soft, protruding bulge at the umbilicus. Unlike inguinal hernias, most small umbilical hernias close on their own by the time a child reaches five years of age, often requiring only observation.
Recognizing the Observable Signs
The most recognizable sign of a hernia is a bulge or swelling in the groin or near the belly button. This lump is typically soft and may appear only when the child is straining, crying, coughing, or standing. When the child relaxes or lies down, the bulge often becomes smaller or disappears completely. This change is characteristic of a reducible hernia, meaning the protruding tissue can easily be pushed back into the abdominal cavity.
Parents must observe the hernia closely for signs of an incarcerated hernia, which is a medical urgency. Incarceration occurs when the tissue becomes trapped in the opening and cannot be pushed back. Signs include a bulge that is hard, firm, and does not disappear when the child is relaxed. Immediate medical attention is required for severe pain, tenderness, redness or discoloration of the skin over the bulge, vomiting, or fever. An incarcerated hernia risks having its blood supply cut off, known as strangulation, which can lead to tissue damage.
Diagnosis and Surgical Repair
A pediatric healthcare provider usually diagnoses a hernia through a physical examination. The doctor looks for the characteristic bulge, often asking the child to cough or strain to make it visible. They may gently attempt to push the contents back into the abdomen to assess if the hernia is reducible. If the diagnosis is unclear or to identify the contents of the sac, an imaging test such as an ultrasound may be used.
The standard treatment for an inguinal hernia is a surgical procedure called a herniorrhaphy. This operation is scheduled electively soon after diagnosis to eliminate the risk of incarceration. The procedure is typically performed on an outpatient basis under general anesthesia. The surgeon makes a small incision, returns the herniated tissue to the abdomen, and closes the opening to prevent recurrence.
For umbilical hernias, surgery is usually reserved for those that persist past age five, are particularly large, or are causing symptoms. The surgical approach is straightforward, involving a small incision at the base of the navel to close the opening in the muscle layer with stitches. Recovery from pediatric hernia surgery is quick, with most children returning home the same day and resuming normal activity shortly thereafter.