When the testicles travel down from the abdomen into the scrotum during fetal development, they travel along an open channel. This channel usually closes before birth. However, if the channel remains open, the child may develop a hernia or hydrocele. A hernia occurs if the channel is wide enough for a portion of the intestine to slide down into it. If the channel is open but narrow, fluid from the abdominal cavity can get into it. This fluid can get into the testicle and surround the scrotum, forming a hydrocele.
How common is a hydrocele?
Hydroceles are quite common in newborn boys, and they can grow to be very large. The size of a hydrocele can change as fluid goes in and out of them. Fortunately, hydroceles do not cause injury to the testicles. Since the open channel is usually narrower with a hydrocele than with a hernia, it may close off by itself before the child is a year old. After it closes, the fluid in the scrotum will gradually disappear.
What are the signs and symptoms?
Hernia signs and symptoms: A hernia can cause a bulge in the groin area that you may see when your child coughs, strains or cries. That bulge may disappear on its own or when you apply gentle pressure to it. If the bulge does not disappear, you should take your child to the doctor immediately. If a portion of the intestine gets stuck in a hernia channel, your child may become feverish or fussy and may start vomiting.
Hydrocele signs and symptoms: If your child has a hydrocele without any other issues, the scrotum on the side of the hydrocele will be enlarged and may appear bluish. Hydroceles do not cause any bulges in the groin area, and your child may not experience any symptoms.
Are hernias more common in certain children?
Boys who had or have an undescended testicle or who were born prematurely are more likely to have a hernia. There is also a higher risk in children who have surgical shunts from the brain to the abdomen.
How do you treat hernias and hydroceles?
When hernias are found early, doctors recommend surgical repair between 3 and 6 months of age. During hernia surgery, your child will have general anesthesia. Once your child is asleep, the surgeon will make an incision in the groin area. If possible, the incision will be in a natural skin fold. Once the incision is made, the surgeon will separate the open channel away from other tissues and tie it off, or close it. If there is a hernia on one side, the risk of developing one on the other side later is increased. The risk of developing a second hernia is about 10 to 20% greater if your child is less than 12 months old and is about 5% greater if he is 12 months or older when the hernia is found. Your child’s doctor will discuss whether he or she recommends operating on the other side as well.
For most children with hydroceles, we recommend postponing surgery until about 12 months of age to find out whether the hydrocele will disappear on its own. If it’s still present after 12 months, we will perform surgery to close off the channel just like we do for a hernia. If the hydrocele is very large or it continues to shrink and expand after six months of age or if there is also a hernia present, we may recommend surgery earlier.
What does surgery involve?
Both hernia and hydrocele repair are usually done on an outpatient basis, so your child will not have to stay in the hospital overnight. Both procedures an hour or less to perform. The surgeon will use dissolvable stitches under the skin, and the dressing to protect the incision from infection will fall off on its own after surgery.
Although there isn’t normally a lot of pain after surgery, your child may need either plain Tylenol or Tylenol with codeine every 4 to 6 hours for pain. Make sure your child avoids strenuous activity for at least three weeks after surgery, and don’t allow him to bathe for at least 48 hours.
Many children are able to return to school within 2 to 3 days after surgery, depending on how they feel. On the day of surgery, you should make a follow-up appointment with your son’s doctor for two weeks after surgery. Complications of this surgery are very rare, but if they do occur, they may include hernia recurrence or retraction of the testicle to the top portion of the scrotum.
At Beaumont, we make sure every child receives care that is tailored to his or her condition and symptoms. No matter what treatment(s) your child needs, we will keep you informed at all times. You are an important part of your child’s treatment team, and we value your input.