Inguinal Hernia and Hydrocele

What is an inguinal hernia and hydrocele?

During normal pre-birth development, the testis descends though the groin into the scrotum, bringing with it part of the lining of the abdomen. This tube-like communication between the abdomen and the scrotum usually closes off by the time a child is born. If the communication does not close off, fluid is free to move back and forth from the abdomen into the scrotum – this is called a communicating hydrocele or an inguinal hernia. This is typically characterized by intermittent swelling of the scrotum that may extend into the groin. 

If the communication is small only fluid can pass and this is a hydrocele, however if the communication is large enough, bowel can move into the hernia sac and is called a hernia.  

Why come to The Children’s Hospital for treatment of this condition?

The professionals at The Children’s Hospital in Aurora, Colorado are dedicated to caring for kids. The members of the urology team are experts in pediatric urologic conditions and our surgeons are specialized in both pediatrics and urology. We strive to help patients and families feel educated about their condition, prepared for treatment and fully cared for by our urology team. 

What are the signs and symptoms?

A non-communicating hydrocele usually causes scrotal swelling that gradually decreases in size.

A communicating hydrocele, or inguinal hernia, usually causes intermittent swelling of the scrotum that may extend into the groin. This is usually best appreciated when the child is crying or having a bowel movement, or at the end of the day. 

A hydrocele does not typically cause any pain or problems. These conditions are usually identified shortly after birth. However, a communicating hydrocele, or inguinal hernia, may present later in life following periods of increased straining.

An incarcerated inguinal hernia usually presents with a firm mass within the groin that may extend into the scrotum, it occurs when bowel gets stuck in the hernia sac.   It is usually tender to the touch, and may be associated with nausea and vomiting or a change in bowel habits. This is an emergency, and should be addressed immediately.

How do you diagnose it?

A medical history will be taken and a physical examination will be performed to diagnose these conditions. Usually, this is all that is needed to make the diagnosis. Occasionally, a scrotal ultrasound is obtained to confirm the diagnosis.

How is it treated?

A hydrocele is usually observed during the first year or two of life as it will often go away on its own. If it persists, surgical correction may be necessary.

An inguinal hernia, is treated surgically. A small incision is made in the groin, through which the urologist ties off the hernia sac with a suture. If the fluid around the testis does not decompress, the testis is delivered through the incision and the fluid-filled sac around the testis – a non-communicating hydrocele – is opened.   The testis is then returned to the scrotum and the incision is closed.

Who gets it, and can it be prevented?

Approximately 1% to 3% of children are diagnosed with a communicating hydrocele, or inguinal hernia, with a higher incidence in premature and low birth weight infants.

When should I seek medical attention?

Signs or symptoms of a communicating hydrocele, or inguinal hernia, should prompt further evaluation by a pediatric urologist. Signs or symptoms of an incarcerated inguinal hernia should be evaluated immediately.