What are Hydroceles and Hernias?
Hydroceles and inguinal hernias are common surgical problems that can occur at any age.
One sign of a hernia is when a child has a bulge in the groin, or in males only, the scrotum. Inguinal hernias are much more common in males. A hernia is when the stomach contents can be felt in the groin or scrotum. In males, the contents may include the intestines. In females, the contents may include the intestines, fallopian tubes and ovaries.
A hydrocele is a collection of fluid in the scrotum around the testicle.
There is a passage between the abdomen and the groin through which the testicle passes from the abdomen to the scrotum in males around mid-pregnancy. This passage normally closes before the baby is born. When this passage does not close, a hernia or hydrocele can result.
A communicating hydrocele is when just fluid from the abdomen passes back and forth to the scrotum. This is like an indirect inguinal hernia, which means that intestinal contents are passing through the passage. From an anatomy standpoint, these are essentially the same in children. In adults, a hernia and hydrocele are different.
A simple hydrocele is common at birth and is where fluid is trapped in the scrotum but the passage is closed. These typically resolve on their own in the first year of life.
Symptoms of Hydrocele / Hernia
When a hydrocele is present, a nontender mass or bulge is seen in the groin or scrotum. A communicating hydrocele or hernia will change in size, becoming larger when a baby is crying, or if older, when the child is walking. The bulge will be smaller in size when the child is sleeping or quiet. A hydrocele or hernia is usually not painful. But, some infants do experience pain. You may notice your infant is more irritable, cries more often and pulls their legs up to their belly. Sometimes parents notice that communicating hydroceles are more swollen at the end of the day in toddlers and young children.
A communicating hydrocele should not cause any harm to the testicle, but it can enlarge over time to develop into a hernia. When there is a bulge in the groin, that can mean stomach contents like the intestines are sliding into the passage. As long as the stomach contents can be pushed back into the abdomen (called a reducible hernia), then the situation is not urgent. If, however, the stomach contents become stuck and cannot be pushed back into the abdomen, it is called an incarcerated hernia. This needs to be treated urgently. If your child begins vomiting, has extreme tenderness of the area, a black-and-blue look to the groin or scrotum, fever or diarrhea, the hernia may have become strangulated. This can result in a blockage of the bowel or damage to its blood supply and is considered an emergency to treat.
Sometimes, there is a double hernia where there is a hernia or communicating hydrocele on both sides. They may show up together or at different times.
Treatment for Hydrocele / Hernia
For a simple hydrocele, your doctor will just watch your child for any changes. If a communicating hydrocele or inguinal hernia is present, your child will need surgery. If the child is not having any pain and the hernia is reducible, then surgery can be planned at a mutually agreeable date as an elective (not emergency) procedure. If the hernia is not reducible or the child is in pain, the procedure will need to be performed urgently or as an emergency procedure.
Surgery
The procedure is performed under general anesthesia. In infants and toddlers, nothing painful happens while they are awake. Young children are put to sleep with anesthesia gas using a mask. In older children and teenagers, an IV is started in the holding area. The risk of anesthesia is a common concern for parents, but it is very safe after a few months of age in an otherwise healthy child in a children’s hospital.
In general, a one-sided hernia surgery takes about an hour. It is done as an outpatient (come in and go home the same day without spending the night in the hospital). The incision (cut) is about an inch long in the groin (below the belt line) with dissolvable sutures under the skin. Some surgeons choose to perform the procedure laparoscopically with a small keyhole incision in the belly button.
The surgery outcomes are very good and the risks of the surgery are low. Most children have only minor pain after the procedure. Numbing medicine like Novocaine is placed in the incision to help with discomfort after the procedure. Typically, just over-the-counter medications like acetaminophen and ibuprofen are used for pain control for the first few days. Some swelling in the groin and scrotum is common. Swelling usually goes away on its own in a week or two.
After Surgery Care
After surgery for a hernia/hydrocele, a clear, super-glue-like dressing called dermabond is placed over the incision. Keep the area as clean and dry as possible, with frequent diaper changes. If poop gets on the incision, clean it as well as you can with a warm wet washcloth. The dermabond gradually peels off on its own.
The following are general guidelines, but may be adjusted by the surgeon:
- No tub baths for five days after surgery.
- No straddle toys or playing in sandboxes for four weeks.
- For older, school-aged children, no gym, contact sports, or lifting more than the weight of a gallon of milk for four weeks. This could change based on your child’s age and at the doctor’s discretion.
- May return to daycare or school five days after surgery.
When to Call Your Child's Doctor
Call your doctor right away if your child has any of the following:
- progressively worsening swelling in the scrotum or groin after two to three days
- persistent pain or irritability after two to three days
- drainage or bleeding from the incision
- vomiting that lasts more than 24 hours
- fever over 101.5 degrees F
- diarrhea
