Examination techniques for hernia

Definition: A hernia is the protrusion of an organ or structure through the abdominal wall due to some weakness or defect in the support of the abdomen. There are several types of herniae: Umbilical, Abdominal, Femoral, Direct and Indirect inguinal herniae.

Test procedure: It best to observe the patient both lying supine and then standing to see if there any obvious changes in the outline of their abdominal wall. By standing they increase the pressure on the abdominal wall and any protrusions becomes more prominent. Ask the patient to lower their pants so that you can visualise the inguinal folds and testicles.
If you discover any protrusions then place your fingertips over it and ask the patient to cough or do the val salva manoeuvre. By raising their intra-abdominal pressure you will be able to feel the transmission of the impulses.

An abdominal hernia may protrude as a lump anywhere on the abdominal wall, usually due to muscular weakness, whether developmental or acquired. An indirect inguinal hernia travels from the internal inguinal ring, through the inguinal canal, to the external inguinal ring.

Test findings: Protrusions may be visible on standing and may subside when supine. Positive signs can also include in the case of a direct inguinal hernia, manifestation of weakness of the abdominal wall close to the pubic tubercle. In cases of a hernia the patient may experience pain (not always) when asked to cough.
Furthermore the patient can be asked to cough while the examiner with fingertips placed over the suspected protrusion ascertains if there are any transmission of impulses suggesting a potential positive sign.

Considerations: Be aware that most hernias are reducible on palpation in contrast to other masses such as lipomas and cysts.