Infant Hernia: Exploring the Types and Treatments

The last thing a parent wants to see after bringing home their bundle of joy from the hospital is an unexplained bulge protruding from their infant’s umbilical cord or genitals. But experts say hernias are quite common, especially in premature babies.

Susan Marie Thompson, mother of four from Clybucca, Australia, had no idea how common they were until her infant son developed one. “Brendan was less than 2 months old when he developed an inguinal hernia on the left side of his genitals,” Thompson says. “His intestines were making their way in and out of a hole that had formed when he was in the womb. He was six weeks early and as a result of the hernia, going to the toilet and wind made his life hell. He had surgery three weeks later, after having it brought forward due to the formation of another one [on] the right side.”

The operation to repair a hernia either in vitro or after birth is, barring any complications, simple.

After a two-hour surgery, Thompson says her son was like a different child: happy with no more physical problems. As the Thompsons discovered, the outcome for most hernias is good.

According to Dr. Edmund Kessler, attending surgeon at Columbia Eastside Medical Center and an assistant professor of surgery at Columbia University College of Physicians and Surgeons, the operation to repair a hernia either in vitro or after birth is, barring any complications, simple. If the surgery is performed in vitro, “[t]he healing process is rapid and pain relief is achieved by the administration of a small dose of long-acting local anesthesia by the surgeon into the womb at the time of surgery,” Dr. Kessler says. And if the surgery is performed at birth, “[a] small dose of infant analgesia may be required for a day or two post operatively.”

What is Hernia?

A hernia is a general term referring to a protrusion of a tissue through the wall of the cavity in which it is normally contained. More specifically, a hernia often refers to an opening or weakness in the muscular structure of the wall of the abdomen.

Types of Hernia Most Common in Infants

There are three different types of hernias commonly found in infants: umbilical hernias, inguinal hernias and congenital diaphragmatic hernias.

  • Umbilical hernia occurs when part of the intestine bulges through the abdominal muscles and is seen or felt near the navel.
  • Inguinal hernia is when part of the intestine protrudes down into a pouch, appearing as a lump in the child’s groin.
  • Congenital diaphragmatic hernia is when a protrusion of abdominal organs travels into the chest cavity through a hole in the diaphragm. These hernias are actually classified as birth defects and are quite rare.

An inguinal hernia appears as a bulge in the groin that usually swells or grows into the scrotum with straining and crying. An umbilical hernia is seen as a bulge around the naval. It is important to know that these hernias arise from the baby’s development in utero. They are not caused by crying too much, playing too roughly or constipation.

According to Dr. Kessler, inguinal hernias are the most common, especially in premature infants. Umbilical hernias are less serious but are quite frequent in some population groups.

Can Hernias Be Dangerous?

On the whole, no, but this depends on the type of hernia your child has and how quickly the problem is resolved. According to Dr. Kessler, umbilical hernias usually close up on their own by 3 to 4 years of age. Some, however, persist and never cause a problem, though there may be an issue cosmetically.

Inguinal hernias will require surgery to avoid the possibility of major bowel complications. Diaphragmatic hernias cause progressive respiratory problems, gastro-esophageal reflux and possibly intestinal obstruction when left undiagnosed and untreated.

“Inguinal hernias require surgery to avoid complications which can be life-threatening as they do not spontaneously disappear,” Dr. Kessler says. “Umbilical hernias on the other hand rarely cause a problem and most resolve on their own. Diaphragmatic hernias are of major concern and require urgent attention.”

Dr. Randy Fink, an OB/GYN with a private practice in Miami, Fla., agrees that hernias (barring the much more rare diaphragmatic hernias) are not dangerous on the whole, but should be seen by your infant’s health care provider. He also says they shouldn’t be painful.

“Hernias or bulges that are tender or appear to cause pain (such as an inconsolable baby) are those that should be evaluated immediately,” Dr. Fink says. “This potentially represents a medical emergency, so it’s a great reason to seek care. However, uncomplicated, non-incarcerated hernias are painless.”

What Is the Treatment for Hernia?

Even though many umbilical hernias resolve themselves, they should be evaluated by a doctor. Left untreated, an inguinal or umbilical hernia risks incarceration. Incarceration describes a hernia that cannot be manually relieved, and in which abdominal contents get stuck.

“When a knuckle of intestine gets stuck, the blood supply to that portion of bowel can be cut off (called a ‘strangulated hernia’), resulting in a surgical emergency,” Dr. Fink says. “No blood supply means the segment of intestine will die, or even open up inside the body. This can be catastrophic, and may also mean a portion of the intestine needs to be removed. In extreme cases, it can cause death.”

Most pediatric surgeons will recommend that Mom and Dad wait for an umbilical hernia to heal on its own, as many will. But an inguinal hernia rarely gets better on its own, so most doctors will recommend surgery.

“Waiting for surgery (i.e. hoping it will get better by itself) means you are simply waiting for complications,” Dr. Fink says. “No one, including me, likes the idea of their baby needing surgery! They seem so small and helpless, and the thought of general anesthesia and surgery is traumatic to a loving parent. However, not operating risks some very bad things.”

According to Dr. Fink, surgery complications can include a low risk of infection, bleeding or anesthesia problems. In a boy, there is a slight risk of damage to the testicle. Because there is no damage or cutting of muscles, they heal quickly and the scar is usually very hard to see as the child ages.

Though no parents like to hear that there is anything wrong with their baby, be assured that most hernias are just a blip in your child’s development, and not a major crisis.

Edited By Teri Brown