Hydrocele and Inguinal (Groin) Hernia


Hydrocele is a collection of fluid within a pouch that produces swelling in the groin region or scrotum. An inguinal hernia occurs when abdominal organs protrude into the inguinal canal or scrotum.  About 1-5% of children will have a hernia or hydrocele, including newborns. Boys are about 8-10 times more likely than girls have this condition, and it occurs about twice as often on the right side of the groin as the left.  

Premature infants, small for gestational age infants, and twins have a higher rate hydrocele and inguinal hernia. a family history of hernia also leads to an increased incidence rate.

Patients can be seen by Texas Children's experts in Urology.

Symptoms & Types

Hydrocele is accumulation of fluid around the testicle. There are 2 types:

  • Communicating: This is a defect children are born with where a channel runs from the abdomen to the scrotum, allowing fluid to move back and forth. The amount of fluid and swelling often gets larger and smaller throughout the day.
  • Noncommunicating:  In this type of hydrocele, fluid comes from the lining of the scrotum and is often a result of inflammation; these are common within the newborn period but tend to improve during the first several months of life. The amount of fluid remains constant throughout the day.

There are 2 primary types of hernia:

  • Inguinal, indirect: This is the same as a communicating hydrocele but can include cases with abdominal structures in the scrotum. If abdominal organs, such as small intestine or omentum, cannot be reduced back into the abdomen, the blood flow may be cut off.
  • Inguinal, direct: This is caused by weakness in the floor of the groin canal; this type of hernia is uncommon in children.

Diagnosis & Tests

Diagnosis is made on observation and physical exam by a doctor. A bulge or swelling will be present in the scrotum or groin, particularly when there is increased abdominal pressure (when the child is crying or straining). The swelling may be progressive throughout the day and get smaller during naps or overnight (this indicates communication of the hydrocele or inguinal hernia). Hydroceles may appear bluish; there may be presence of a “silk glove sign” when the layers of the hernia sac are palpated sliding over each other. The doctor will apply gentle pressure to assess if the swelling is reducible. Imaging studies are generally not needed, except in rare circumstances when there is concern for incarcerated hernia, or other acute scrotum pathology.

Treatment & Care

There is no medical management for inguinal hernia or hydrocele, only surgical treatment.

  • Noncommunicating hydrocele can be observed until the child is close to 1 year old, as there is a chance of spontaneous resolution (meaning he outgrows it).
  • Communicating hydrocele/inguinal hernia should be repaired surgically when diagnosed to decrease the risk of constriction. A small incision is made in the groin to gain access to the hernia sac. The sac is then tied off. The success rate for this procedure is very high, and risk of damage to the surrounding structures (the spermatic cord) is low, about 1%. In infants and children less than 2 years old, exploration of the other side for a hernia is sometimes performed.

Living & Managing

A child will usually be discharged home the same day of surgery and be prescribed pain medicine for his discomfort, but acetaminophen or ibuprofen is also helpful. He should not have full baths for a few days and avoid strenuous activities for 2-3 weeks following the surgery.

Testicular examination should be done yearly to ensure no change in position following hernia repair.

References & Sources

Baskin, Laurence and Barry Kogan, John Duckett. Handbook of Pediatric Urology. Philadelphia: Lippincott-Raven; 1997.

Abnormalities of the Testicle and Scortum. Campbell-Walsh Urology.  Wein, Kavoussi, Novick, Partin, Peters. 10th edition, vol. 1. 3582-3586.