palpation of the hernia
Last reviewed 01/2018
Any suspected hernia should be palpated while the patient coughs to test for a cough impulse. The hernia should be examined in a standing and lying position.
One should attempt to reduce the hernia:
- those reducing above and medial to the pubic tubercle are inguinal hernias
- those reducing below and lateral to the pubic tubercle are femoral hernias
- if the hernia cannot be reduced the probable identity of the hernia is: femoral > indirect inguinal > direct inguinal
- if the hernia reduces spontaneously on reclining then the probable identity of the hernia is: direct inguinal > indirect inguinal > femoral
With the hernia reduced one should attempt to control the hernia with pressure over the internal inguinal ring:
- with one or two fingers over the internal ring ask the patient to cough
- if the herniation is controlled then the hernia is an indirect inguinal hernia
- if the herniation is not controlled then the hernia is a direct inguinal hernia (or a femoral hernia)
The scrotum should be examined:
- if there is a mass in the scrotum which one cannot get above, it is most likely to be an indirect inguinal hernia
- other scrotal pathology may be detected e.g. hydrocoele
Any hernia should be palpated to determine consistency, temperature, tenderness and fluctuance.