Palpation of the hernia

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.