An inguinal hernia is a bulge in the groin or scrotum where fat or part of the intestine pushes through a weak spot in the lower belly wall. Boys can be born with that weak spot and not notice a hernia until years later. That’s why the video above recommends a yearly hernia check for teenage boys: the doctor feels the groin while the boy coughs, which can push a hidden hernia out where it can be felt. It doesn’t hurt, and it can find a hernia a boy didn’t know he had.
Hernia or emergency? At a glance
| Inguinal hernia | Stuck or strangulated hernia | Testicular torsion | |
|---|---|---|---|
| What you notice | A soft bulge in the groin or scrotum that may come and go; may ache with lifting, coughing or standing | A bulge that won’t go back in, gets bigger, firm, red or dark, with pain, nausea or vomiting | Sudden, severe pain in one testicle, often with swelling, belly pain, nausea or vomiting |
| What’s happening | Fat or intestine pushes through a weak spot in the belly wall | Tissue is trapped and may lose its blood supply | The cord that holds the testicle twists and cuts off its blood flow |
| What to do | See a doctor; surgery is the only permanent fix | Get emergency care | Go to the emergency room right away |
The table is a guide, not a diagnosis. Any new bulge or pain in the groin or scrotum should be checked by a doctor.
What the video explains
The video says teenage boys need to be checked for hernias, and that the check is done in the genital area. It describes a hernia as a bulge of the small intestine through a weak area in the muscles low in the groin, near the scrotum.
During the exam, the doctor places a finger (usually the little finger) near the scrotum and gently pushes up into the canal where the weakness can occur. Then the boy is asked to cough. Coughing raises the pressure inside the belly and pushes the intestine outward, so the doctor can feel whether there’s an abnormal bulge.
If there is a bulge, the video says it doesn’t always have to be treated right away. If it isn’t growing, doesn’t hurt and isn’t bigger than about a silver dollar, it can be watched. The video acknowledges that young men don’t like being checked. It doesn’t hurt, it’s just a little embarrassing, and the speaker calls it a good idea to have it done every year.
What is an inguinal hernia?
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), an inguinal hernia happens when tissue from inside the belly bulges through a weak area at one of the two inguinal canals, one on each side of the groin. Most contain fat or part of the small intestine. They often slide in and out, and they’re more common on the right side.
They’re common: the NIDDK estimates that about 27% of men will have one at some point, and males are 8 to 10 times more likely to get one than females.
Why boys get them
Before birth, a boy’s testicles move down from the belly into the scrotum through a passageway. The American Academy of Pediatrics (AAP) explains that this passageway normally closes. If it stays open, intestine or fluid can slip into the groin. The NIDDK notes that a hernia linked to this opening may not show up until many years later, and MedlinePlus says some children have no symptoms until they’re adults.
Symptoms of an inguinal hernia
The NIDDK lists:
- a bulge in the groin or scrotum
- discomfort, pain, heaviness or burning in the groin
- symptoms that get worse with straining, lifting, coughing or standing for a long time, and better with rest or lying down
Some hernias cause few or no symptoms, and MedlinePlus notes that in children the bulge may be hard to see except during coughing or crying.
The hernia check and the cough test
A doctor usually diagnoses a hernia with a physical exam. The NIDDK says the doctor may ask the patient to stand and cough or strain, which can make the bulge easier to see or feel. If the diagnosis isn’t clear, an ultrasound, CT scan or MRI may help.
Whether a groin check is part of every physical can vary. The AAP recommends that a teen’s sports physical be done by his own pediatrician as part of a regular checkup, rather than at a mass screening, partly for privacy. A review in American Family Physician, the journal of the American Academy of Family Physicians, says a genital exam at a sports physical may be done in boys who have symptoms or a history of genital or urinary problems. If you’re not sure whether your son was checked, ask the doctor. Boys may be embarrassed to mention a bulge or pain, so let your son know he can speak up.
Treatment
Surgery is the only treatment that permanently fixes a hernia, according to MedlinePlus. The surgeon pushes the bulging tissue back into place and closes or reinforces the weak spot, either through a small cut in the groin (open surgery) or through a few small cuts using a camera (laparoscopic surgery).
For children, the AAP says inguinal hernias need surgical repair, usually by a pediatric surgeon or pediatric urologist, and the timing depends on how severe the symptoms are. For adult men with few or no symptoms, the NIDDK says surgery can sometimes be safely delayed with regular checkups, though about 70% go on to need surgery within 5 years. Ask your son’s doctor whether his hernia should be repaired now or watched.
Hernia repair is usually same-day surgery. The AAP says most children can return to normal, non-strenuous activities in about 1 to 2 weeks, or once they’re pain-free. Your son’s surgeon will say when he can go back to sports.
Emergency: a stuck or strangulated hernia
A hernia can get stuck outside the belly wall (incarcerated). If its blood supply is cut off (strangulated), the trapped tissue can die, which the NIDDK calls life-threatening. Get emergency care if a hernia:
- suddenly gets bigger, or used to go back in and no longer does
- becomes red, purple or dark, or firm and tender
- causes sudden or severe pain
- comes with fever, nausea, vomiting, a swollen belly, or trouble passing gas or having a bowel movement
Emergency: sudden testicle pain (testicular torsion)
Testicular torsion happens when the cord that holds a testicle twists and cuts off its blood supply. The AAP says it most often affects teenage boys shortly after puberty. It can happen at any time, even during sleep, and sometimes follows a sports injury. Signs include sudden, severe pain, usually on one side, a swollen, red or tender scrotum, belly pain, and nausea or vomiting.
Time matters. The AAP says treatment within 6 hours of the pain starting gives better than a 90% chance of saving the testicle; after 24 hours, the chance falls below 10%. Go to an emergency room right away for sudden testicle pain, and don’t wait to see if it goes away. MedlinePlus advises the emergency room rather than urgent care, because surgery may be needed right away. Wearing a cup during contact or high-impact sports may help prevent it.
When to see a doctor
Make an appointment if your son has:
- a bulge or swelling in the groin or scrotum, even if it doesn’t hurt
- groin pain or a feeling of heaviness, especially with lifting or coughing
- a hernia that is getting bigger or more uncomfortable
Get care right away for a hernia that won’t go back in or is red, dark or very painful, for a painful bulge with nausea, vomiting or fever, or for any sudden pain in the testicle or scrotum. If you think it’s an emergency, call 911.
Find a doctor
Start with your son’s pediatrician or family doctor, who can check for a hernia at his yearly physical. If a hernia needs repair, a general surgeon, pediatric surgeon or urologist can help. Doctors on Best Docs Network who treat these conditions include:
- Dr. Thomas Roshek, general surgery, Dallas-Fort Worth
- Dr. Robert Pollard, general surgery, Dallas-Fort Worth
- Dr. Dan French, urology, Dallas-Fort Worth
More videos on this topic: Men’s Health and Children’s Health.
Frequently asked questions
Why do doctors ask you to cough during a hernia check?
Coughing raises the pressure inside the belly. If there’s a hernia, that pressure pushes tissue into the weak spot, so the doctor can feel a bulge.
Will an inguinal hernia go away on its own?
No. Surgery is the only way to permanently fix a hernia. Some small, painless hernias can be watched for a while, but most eventually need repair. Ask your son’s doctor which approach is right for him.
Can a teenage boy have a hernia without knowing it?
Yes. A hernia can be present from birth and not cause a bulge or symptoms until years later, which is one reason doctors check for them.
Is testicle pain an emergency?
Sudden, severe testicle pain should be treated as an emergency until a doctor rules out torsion. Go to an emergency room right away.
How long is recovery from hernia surgery?
Repair is usually same-day surgery. The AAP says most children return to normal, non-strenuous activities in about 1 to 2 weeks.
Sources
- NIDDK (National Institutes of Health): Inguinal Hernia
- MedlinePlus (National Library of Medicine, NIH): Hernia
- MedlinePlus: Testicular torsion
- HealthyChildren.org (American Academy of Pediatrics): Inguinal Hernia in Infants & Children
- HealthyChildren.org (American Academy of Pediatrics): Testicle Pain & Testicular Torsion: Why It’s an Emergency
- HealthyChildren.org (American Academy of Pediatrics): Sports Physical: When, Where, Who Should Do It?
- American Family Physician (American Academy of Family Physicians): The Preparticipation Sports Evaluation
This page is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
