Inguinal Hernia

Learn symptoms, causes, management of paediatric inguinal hernia, and when to contact a paediatric surgeon in Singapore.

What Is Inguinal Hernia?

An inguinal hernia, also called a groin hernia, occurs when part of the intestine or other abdominal contents pushes through a weak spot in the lower abdominal wall near the groin. This creates a visible bulge or lump in the groin area that you can see and feel.
In children, inguinal hernias are almost always present from birth due to how the body develops. They're one of the most common conditions requiring paediatric inguinal hernia repair, affecting about 1-5% of all children. Boys are much more likely to have inguinal hernias than girls.
Before birth, there's a natural opening in the groin area that usually closes up. When it doesn't close completely, it creates a weak spot where intestines can push through, forming a hernia. In the male body, this opening was used when the testicles moved down from the belly into the scrotum. In the female body, the opening is smaller but can still allow a hernia to form.
The hernia may not be noticeable right away - it might show up weeks, months, or even years after birth. Once discovered, a paediatric groin hernia operation is typically recommended because of complication risks.

Common Symptoms of Inguinal Hernia

What You’ll Notice

Bulge or lump in the groin, upper thigh, or scrotum (in boys)
Comes and goes - bigger when your child cries, coughs, or stands up
Disappears when lying down or relaxed
May get bigger over time
Usually doesn't hurt when it can be pushed back in easily
In the male body: swelling that goes down into the scrotum; one side of the scrotum looks bigger
In the female body: a bulge in the groin or upper thigh area; a lump can be felt in the labia (genital area)

Emergency Symptoms

Sometimes a hernia becomes stuck and can't be pushed back in. This is a medical emergency requiring immediate groin hernia operation. Contact us immediately if you notice:

Severe pain in the groin or belly
A bulge that won't go away, even when lying down
Firm, tender lump that's painful to touch
Red or purple skin over the bulge
Vomiting
Hard, swollen belly
Baby crying non-stop
Not passing stools or gas

Treatment through paediatric inguinal hernia repair is almost always recommended.

What Causes Inguinal Hernia in Children?

Unlike adult inguinal hernias caused by wear and tear, groin hernias in children are almost always something they're born with - it's how their body developed before birth.
In the male body, testicles form inside the belly, then move down through a passage - the inguinal canal - into the scrotum before birth. This passage usually closes after the testicles move down. When it doesn't close completely, it leaves an opening where the intestine can slide through, creating a hernia.
The female body also has an inguinal canal, but smaller. Sometimes the tissue around it doesn't close properly, leaving a space for a hernia.
The exact reason why the passage doesn't close in some children isn't fully understood, but several factors increase risk:

Premature babies are much more likely to have hernias because the passage normally closes near the end of pregnancy.
Inguinal hernias tend to run in families, suggesting a genetic component to how the abdominal wall develops.
Some conditions affecting connective tissue can increase hernia risk.
Conditions that increase abdominal pressure (like chronic coughing, constipation, or urinary problems) may make a hernia more noticeable, but don't actually cause the underlying weakness.

Parents need to note that you didn't cause this. It's a developmental variation that occurs during pregnancy, and there's nothing that could have been done to prevent it. However, this structural problem can be fixed through paediatric inguinal hernia repair.

Consequences of Untreated Inguinal Hernia

Inguinal hernias in children don't go away on their own and won't heal without treatment. Unlike some hernias in adults that can be watched, paediatric groin hernia conditions should be repaired because of serious complications.

Incarceration

The most common serious complication is incarceration. This happens when the intestine or other tissue gets stuck in the hernia sac and can't be pushed back into the abdomen. The opening acts like a trap - contents can slide down but get stuck and can't return.
Incarceration causes:

Severe pain and discomfort
A firm, tender lump that won't go back in
Vomiting
Abdominal swelling
Inability to pass stool or gas
Need for emergency treatment

The risk of developing incarceration is highest in babies under 1 year old. This is why paediatric inguinal hernia repair is typically recommended soon after diagnosis rather than waiting.

Strangulation

If an incarcerated hernia isn't treated quickly, it can progress to strangulation. This is a life-threatening emergency where the blood supply to the trapped intestine gets cut off. Without blood flow, the intestine starts to die within hours.
Signs of strangulation include:

All the symptoms of incarceration
Dark red or purple discolouration of the skin over the hernia
Extreme pain
Fever
Signs of shock (pale, sweaty, rapid heart rate)
Rapid deterioration

Strangulated hernias require emergency operation. If the intestine has died, part of it must be removed, which is a much more serious operation than simple inguinal hernia paediatric treatment.

Damage to Reproductive Organs

In the male body, if a hernia contains a testicle or if an incarcerated hernia presses on blood vessels to the testicle, it can cause:

Damage to the testicle
Testicular atrophy (shrinking)
Potential fertility issues in the future

In the female body, if a hernia contains the ovary or the fallopian tube, complications can include:

Damage to the ovary from loss of blood flow
Loss of the ovary if strangulation occurs
Potential impact on future fertility

Discomfort and Activity Limitations

Even without serious complications, untreated hernias can cause:

Ongoing discomfort or pain
Limitations on physical activity
Risk that increases over time as your child grows and becomes more active

How to Treat Inguinal Hernia in Children

The treatment for an inguinal hernia in children is surgical repair. At The Little Surgery, we provide expert paediatric inguinal hernia repair, offering a safe and effective operation.

Why Surgery is Needed

Unlike some conditions that can be watched or treated with medicine, inguinal hernias in children require surgery because:
The hernia won't heal or close on its own
There's no effective non-surgical treatment
The risk of complications (incarceration, strangulation) is significant
The hernia often gets worse over time
Surgery is safe and highly successful when performed by experienced paediatric surgeons
Trusses (support garments) that are sometimes used in adults are not recommended for children. They don't fix the problem and can actually cause complications.

Diagnosis and Evaluation

Dr. Ong will examine your child's groin area to feel the hernia, assess the size and location, check if the hernia can be reduced (pushed back in), and evaluate the other side (since hernias can occur on both sides).
Usually, inguinal hernias are diagnosed by physical examination alone. Occasionally, an ultrasound may be done if the diagnosis is uncertain or to check for any complications.
We'll discuss your child's overall health, any previous surgeries or medical conditions, and timing for paediatric inguinal hernia repair.

Paediatric Inguinal Hernia Repair Surgery

For most children with inguinal hernias, surgery is scheduled within weeks to a few months of diagnosis. The timing depends on your child's age, whether any incarceration has occurred, and their overall health.
If your child has an incarcerated hernia that can't be reduced, an emergency groin hernia operation is performed as soon as possible, usually within hours.
The standard procedure is called herniotomy - surgical repair of the hernia. It is performed under general anaesthesia, so your child is completely asleep and comfortable. The operation typically takes 30-60 minutes, and your child can go home on the same day. Babies under 6 months, especially premature babies, may stay overnight for monitoring.

Recovery After Surgery

After a paediatric groin hernia operation, your child goes to the recovery room where they wake up from anaesthesia gradually. You can usually go home 2-4 hours after surgery once your child is awake, comfortable, able to drink fluids, and urinating normally.
At home, your child may have some discomfort for 2-3 days. Prescribed pain medication (acetaminophen or ibuprofen) usually controls it well. Your child should avoid rough play, climbing, or jumping for the first few days.
Some swelling and bruising in the groin or scrotum is normal and resolves within a week or two. Most children return to daycare or school within a week. We schedule a follow-up visit 2-3 weeks after the inguinal hernia paediatric treatment to check healing, ensure everything looks good, and answer any questions.

Why Choose The Little Surgery for Inguinal Hernia Repair

We provide expert paediatric inguinal hernia repair, offering safe and effective operation, typically performed as convenient day surgery.

Experienced Paediatric Surgeon

Dr. Ong Lin Yin has over 20 years of experience in paediatric surgery. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has extensive experience with routine paediatric groin hernia operations in all age groups, emergency repair of incarcerated hernias, and other complex cases.

Comprehensive Care

We provide thorough pre-operative evaluation, clear instructions to prepare your child for surgery, expert surgical operations, and follow-up care. For children with incarcerated hernias or complex cases needing urgent treatment, we provide emergency operations and coordinate with specialists to ensure your child receives expert care at every step.

Family Support

We understand that surgery can be scary for children and parents. We provide clear explanations of your child’s condition, detailed discussions on surgery, and compassionate support throughout the treatment journey.
As a mother herself, she understands family concerns and ensures you feel informed and comfortable.

Contact The Little Surgery Today

If your child has an inguinal hernia or groin bulge, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.