Hernia Repairs

Some of the more familiar hernias in children are those found in athletes, which are commonly called sports hernias and affect the groin area, or those that babies get around their belly buttons, called umbilical hernias. Another type, an epigastric hernia, is similar to an umbilical hernia but is usually found between the belly button and the chest.

Most umbilical hernias will go away by the time a child is four or five years old. In most cases of inguinal hernia (those in the groin area) and epigastric hernia, pediatric surgery is needed for hernia repairs. At WakeMed Physician Practices Pediatric Surgery, we understand that this fairly routine surgery is not routine for you or your child, and we will guide you through the diagnosis and treatment options carefully and thoroughly.

What is a Pediatric Hernia?
Hernias can occur in children, just as they occur in adults: when there's a weakness in the abdominal muscles, allowing a section of the intestine to protrude. Usually, the parent will see a soft bulge underneath the skin to indicate a hernia.

In children, hernias usually are found in two places:

• in the groin area (called an inguinal hernia)
• around the belly button (called an umbilical hernia)
• between the belly button and chest (epigastric hernia)

Many times, young male athletes will experience inguinal hernias, but all hernias can affect babies.

Inguinal Hernias
An inguinal hernia can develop if the inguinal canal does not close off completely after birth. As a baby boy matures during pregnancy, his testicles develop in the abdomen, and then move down into the scrotum through an area called the inguinal canal. After babies are born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this area does not close off completely, a hernia can be caused if a loop of intestine moves into the inguinal canal through the weakened area of the lower abdominal wall. Girls can develop hernias in this area, also, because while they do not have testicles, they do have an inguinal canal. Only about 1 to 3 percent of children are affected by inguinal hernias.

Often, activities like running and bending forward-and even coughing and sneezing-can worsen a hernia. That's why sports hernias are found most often in athletes that bend forward a lot, like hockey players, and also football and soccer players.

Umbilical Hernia
When a woman is pregnant, she and her fetus are connected by the umbilical cord. It passes from the mother to the baby through a small opening in the abdominal muscles. After birth, this opening will generally close as the baby matures. However, these muscles sometimes do not grow together completely, and when small opening exists, a loop of intestine can move into it and cause a hernia.

This is found in the belly button (umbilical ring) area, and parents usually don't notice until a few weeks have gone by. With an umbilical hernia, the belly button bulges outward. It's most noticeable when the baby is straining, coughing or crying. Umbilical hernias occur in about 10 percent of all children.

What happens when my child has a Hernia?
If your physician is able to push gently on the bulge or swelling in the groin or belly button area, and it gets smaller or goes back into the abdomen, that means the this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen. This means the hernia is considered "reducible," and generally is not cause for concern.

If it's not reducible, the physician may order x-rays or ultrasound to take a closer look at the intestine. The concern is if the loop of intestine protruding through a hernia becomes stuck, it may lose the blood supply needed to keep the intestine healthy and functioning properly.

Umbilical hernias are painless, and generally will go away naturally by the time a child is 4 or 5 years old. If they don't, or if the hernia is growing or is very large, pediatric surgery may be needed to make a surgical hernia repair. An epigastric hernia will not heal by itself, and requires repair by surgery. Usually, this can be postponed until the baby is a toddler.

If you suspect that your child has a hernia, visit WakeMed Physician Practices Pediatric Surgery for the best care for your child and your family.