Hernia in Babies

A hernia is a lump that is visible under the skin in the tummy or groin and develops in variable sizes. A hernia mostly appears in the abdomen region but can also be found in the areas of the upper thighs, belly button and groin. Generally, the muscles across the tummy area and the pelvic region form a wall that holds the organs like gut and intestines within its boundaries.

What is Hernia?

Babies have a small opening in their abdominal tissues to allow the umbilical cord to pass through. It connects the mother to the baby when the baby is inside the womb; at birth or later as the baby matures this opening in the muscles closes. In some cases, where the muscles do not meet and complete their growth, a small gap is created in the region. If a loop of intestine squeezes in through this opening, it results in a hernia.

Types of Hernia in Babies and Young Children

A hernia is a condition where a fatty tissue or an organ pushes through a gap in the surrounding muscular wall. Often, babies are born with certain small openings inside their body, but these usually close at some point. Meanwhile, if the nearby connective tissues squeeze in through these openings, they result in a hernia. The two most common kinds of a hernia that occurs in babies and young children are:

Umbilical Hernia

This kind of a hernia occurs around the belly button; sometimes, babies are born with an opening in the abdominal muscles circling the belly button inside the skin. The abdominal membrane or small intestines may protrude from this weakened spot, causing a soft bulge known as an umbilical hernia. Its size ranges anywhere between 2 centimetres and more than 6 centimetres. Usually, an umbilical hernia in newborn babies don’t cause any discomfort and can be pushed back in easily by the doctor. Most umbilical hernias tend to disappear on their own as the gap in the muscular wall gets closed by the age of two.

Inguinal Hernia

The primary cause of an inguinal hernia in infants depends on the gender of the baby. The protrusion of a portion of the intestine or membrane from the abdomen is the cause of an inguinal hernia in boys.This hernia may extend beyond the groin into the scrotum – the gland that holds testicles. For girls, this bulge is from the ovary or fallopian tube through an opening into the groin and may extend up to one of the outer labia around the vagina.

What Are the Causes of Hernia in Babies?

Hernias are generally found when the baby’s abdominal muscles do not get fully developed. In cases like premature infants, the opening at the groin may be caused by the fact that the baby’s muscles are not matured enough or not capable of holding the pressure of abdomen.

Causes of Umbilical Hernia

At birth, babies are born with a ring of muscular tissues surrounding the umbilical cord. This ring usually gets closed before birth. In cases where it does not close, such an opening becomes the weak spot which results in an umbilical hernia.

Causes of Inguinal Hernia

Its primary cause is the formation of a sac which is left open in the inguinal ring during foetal life. This sac should close on its own at birth. But if it doesn’t, the sac allows abdominal muscles to squeeze through the ring into the groin. In case of boys, the organ trapped may be a loop of the bowel, while for girls; it may be a part of the bowel or ovary.

Signs and Symptoms of a Hernia in a Child

In infancy and childhood, the tissues generally protrude only while applying physical pressure or straining oneself. These situations include instances of crying, coughing, or sneezing. In these cases, the visible bulge usually retracts or disappears on its own. A hernia in this state is harmless and can be reduced.

Umbilical Hernia

Umbilical hernias mostly disappear on their own as the child matures; except in some cases where it may have become trapped. The symptoms include fever, constipation, severe abdominal pain, vomiting, redness, discolouration, and a bulging or rounded abdomen.

Inguinal Hernia

In an inguinal hernia, the lump does not disappear, but instead gets caught in the opening and stays bulged out the whole time. As a sign, the baby doesn’t stop crying as the lump becomes hard and painful for the baby. The inguinal hernia symptoms in babies are as follows: The groin area suddenly begins to swell. In the case of a reducible hernia, the bulge appears when the baby takes some strain, but disappears otherwise. In case of a strangulated or incarcerated hernia, the child may be in pain, become fussy, vomit, and cry uncontrollably.

Diagnosis of a Hernia

The diagnosis of a hernia is a simple procedure for the doctor. During the checkup, he examines the child’s belly, the area between the belly and inner thigh, both the sides of the groin and the scrotum for the boys. He checks whether or not the bulge enlarges when the child coughs, cries or strains, and decides whether a surgery is required. He will see if the hernia can be pushed in and whether it is trapped or incarcerated. He may perform an X-ray and ultrasound on the belly to check for complications and may prescribe blood test to check for infections.

Treatment for Hernia in Babies

The need for hernia surgery in babies depends on the severity of the case; for some, the hernia may be simply pushed in, while for some, surgery is required. The surgery lasts for an hour and is done under the effect of general anaesthesia.

Umbilical Hernia

For an umbilical hernia, surgery is only performed to prevent any further development of complications. Before opting for surgery, the doctor checks matters like whether the hernia is painful, doesn’t shrink after a year, doesn’t disappear till the child turns 3 or 4 years old, or gets trapped. The surgery includes an incision that is made at the belly button or at the location of the bulge, where the intestinal tissue is pushed back through the stomach wall, and the opening is then closed with stitches.

Inguinal Hernia

Infants having inguinal hernia hold a higher risk of strangulation than older children. Hence, surgery for an inguinal hernia in babies is better if not delayed. The procedure involves the surgeon making a small incision of 2 to 3 cm in the skin fold of the groin, then pushing the intestine back to its proper position. The muscle wall is then stitched to prevent another hernia.

Risks and Complications

A hernia can occur without any specific reason. The pressure applied to the abdomen makes the hernia visible and it may go away when the pressure is released.

Risk factors for a parent or sibling infected with a hernia as an infant: an inguinal hernia is majorly found in premature infants. It occurs in 1 to 2 percent of children and mostly affects boys rather than girls. An umbilical hernia is more common and affects about 10 percent of children. This kind of a hernia is more common in girls and premature babies.

An inguinal hernia may involve some complications and will need to be followed up closely. The bowel may get trapped and turn into an incarcerated or strangulated hernia. This part of the intestine, if unable to be pushed back through the stomach wall, may lack adequate blood supply. In such cases, doctors recommend immediate surgery to repair the hernia before the situation worsens.

Recovery After Baby’s Hernia Surgery

Generally, the surgery for umbilical hernia repair in a child is done within an hour; most babies can be taken home within a few hours of the umbilical surgery. Once the child is home, he needs to stay indoors and avoid day-care or school for some days, to get the adequate rest. Your child can also be prescribed pain medications for few days. Recovery from baby hernia surgery takes 2 to 3 days until the child feels normal. The baby should be given a sponge bath for 2 days after surgery until the stitches heal. The child may feel some twinges or pulling effect at the groin area while moving.

Are There Any Home Remedies for Treating Hernia in Babies?

When the baby is suffering from a hernia, apart from the normal treatments, you can help your child with certain remedies. Some of the home remedies for treating an umbilical hernia are mentioned below:

• Water: Provide your baby with adequate amounts of water after every feed. Water is known to keep the system clean and can reduce the problem of an umbilical hernia. It improves the blood circulation and can reduce the strain during bowel movement.
• Aloe Vera: You may extract aloe vera juice and add it to the food prepared for your child if he is above 6 months of age. If he is younger, you may give him few teaspoons of extracted juice after consulting doctor.
• Coconut oil & Olive Oil: Coconut oil & olive oil are considered highly effective in reducing the occurrence of an umbilical hernia in babies. It is recommended that you regularly massage the child’s abdomen with coconut or olive oil 5 to 6 times per day.
• Berries: Berries are considered one among the best natural cure for an umbilical hernia, as they are rich in antioxidants and have a high content of fibre which improves the immune system.
• Green vegetables: Fresh green vegetables such as broccoli, capsicum, cucumber and spinach possess a high degree of fibre content, vitamins and minerals that can help to guard against the condition of a hernia.

Hernias can be painful for your child even if they are not very dangerous. It is best to identify the symptoms early on and get it looked into before it turns dangerous.