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A hernia or a hydrocele is typically characterized by intermittent swelling of the scrotum that may extend into the groin.
If the opening is small, only fluid can pass through, and this is called a hydrocele. However, if the opening is large enough, bowel movement can move into the hernia sac, and is called a hernia.
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.
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.
Learn about the Department of Pediatric Urology at Children's Hospital Colorado.
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 most noticeable 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. Signs or symptoms of a communicating hydrocele, or inguinal hernia, should prompt further evaluation by a pediatric urologist.
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.
Occasionally, a scrotal ultrasound is obtained to confirm the diagnosis.
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, as both a hernia and hydrocele have a very typical appearance.
A hydrocele is usually observed during the first year and 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.
The pediatric urology surgeons at Children’s Hospital Colorado have significant experience in diagnosing and treating hernias and hydroceles. We understand the difference between a hydrocele and a hernia and when they need to corrected. We work in a specialized environment specifically designed for children, with the purpose of minimizing any fear or discomfort they may have.
Urology - Pediatric
Certified Pediatric Nurse Practitioner