Palpation for Hernias in a Supine Patient
When examining a supine patient for hernias, palpation should focus on the inguinal region, with the examiner feeling for a bulge or impulse while the patient coughs or strains. 1
Inguinal Region Examination Technique
- Position the patient supine on the examination table 1
- Palpate the groin area, specifically focusing on the inguinal region where hernias most commonly occur 2
- Ask the patient to cough or strain while you feel for a bulge or impulse at potential hernia sites 1
- For inguinal hernias (most common type at 75% prevalence), palpate along the inguinal canal from the internal to external ring 3
- For femoral hernias (15% prevalence), palpate below the inguinal ligament in the femoral canal area 3
- For umbilical hernias (8% prevalence), examine around the umbilicus for any protrusion 3
Enhanced Examination Techniques
- If a hernia is difficult to detect in the supine position, consider examining the patient in both supine and standing positions to increase detection sensitivity 4
- In patients with obesity, pain, or abdominal wall scarring, physical examination alone may be insufficient and imaging may be necessary 3
- For suspected occult hernias, prone positioning during examination may increase detection rates compared to supine positioning alone 4
Special Considerations
- Male patients have a significantly higher prevalence of inguinal hernias (M:F ratio 8:1) 3
- Symptomatic patients often report groin pain, burning, gurgling, or aching sensations that worsen with activity 1
- A hernia may present as a heavy or dragging sensation that worsens toward the end of the day 1
- An abdominal bulge from a hernia may disappear when the patient is in the prone position 1
When Imaging is Warranted
- Ultrasonography is indicated when the diagnosis is uncertain, with a recurrent hernia, or if surgical complications are suspected 1
- MRI has higher sensitivity and specificity than ultrasound and is useful for diagnosing occult hernias when clinical suspicion remains high despite negative ultrasound findings 2
- CT scanning in prone position has been shown to detect inguinal hernias with greater accuracy (100%) compared to supine-position CT (65.5%) 4
Common Pitfalls to Avoid
- Failing to have the patient cough or strain during examination, which may miss intermittent hernias 1
- Overlooking femoral hernias, which are less common but have higher risk of incarceration 2
- Relying solely on physical examination in obese patients or those with previous surgical scarring 3
- Missing bilateral hernias, which require thorough examination of both sides of the groin 5