From the Guidelines
The sign described is known as reducibility, which is a characteristic feature of many hernias, and it is crucial to evaluate these hernias promptly to prevent potential complications such as strangulation or incarceration 1. When a hernia appears while standing but disappears when lying down, it indicates that the hernia contents can move back into the abdominal cavity with positional changes. This occurs because gravity helps pull the hernia contents outward when standing, while lying down allows them to naturally return to their normal position.
Key Points to Consider
- Reducibility is an important clinical finding that typically suggests the hernia is not currently strangulated or incarcerated, which would be medical emergencies 1.
- Even reducible hernias should be evaluated by a healthcare provider as they can progress to become incarcerated or strangulated over time.
- The diagnosis can be confirmed through physical examination where the clinician may ask you to stand, cough, or perform a Valsalva maneuver (bearing down) to make the hernia more visible.
- This positional appearance of hernias is particularly common in inguinal, femoral, and umbilical hernias, and helps distinguish them from other masses or swellings in the affected area.
Importance of Prompt Evaluation
It is essential to evaluate hernias promptly to prevent potential complications, as delayed diagnosis can lead to severe consequences, including strangulation of the bowel and subsequent perforation, causing severe peritonitis, sepsis, and multi-organ failure, which is a surgical emergency having a high mortality 1.
From the Research
Hernia Characteristics
- A hernia that is not visible while lying down but appears when standing is likely to be a reducible hernia 2, 3.
- This type of hernia can be pushed back into the abdomen when in a supine position, but may protrude again when standing or coughing.
Clinical Significance
- The fact that the hernia is not visible while lying down but appears when standing suggests that it may be an inguinal hernia, which is a common type of hernia that occurs in the groin area 2.
- Inguinal hernias can be asymptomatic or may cause discomfort, pain, or swelling in the groin area, especially when standing or straining.
Relevant Studies
- A study published in 2019 found that the risk of incarceration and strangulation of inguinal hernias in children is substantial, and that surgical repair is recommended to prevent these complications 2.
- Another study published in 2009 found that taxis (hernia reduction) can be a safe and effective treatment for incarcerated hernias in adults, and that it may reduce the risk of complications and mortality 3.
- However, a study published in 1977 on the stability of synergy in agonists during voluntary movement is not directly relevant to the topic of hernias 4.