Hernia Assessment

Symptoms and questions to discuss

• A groin, scrotal, navel, or scar bulge that grows when you stand or cough
• Aching, pulling, burning, or heaviness at that site
• A bulge that stays out, or pain with nausea or vomiting

What we check

• Where it is, how long it has been there, and whether it reduces
• Pain, vomiting, bowel changes, prior repair, pregnancy, cough, and straining
• Standing examination with a cough, and whether imaging can wait

Treatment options by class

Your provider reviews appropriate options and follow-up based on your assessment.

• Examination, with observation only if the type and symptoms allow it
• Activity advice without belts or attempts to force the bulge back
• Surgeon referral when observation is not the right plan

When we refer

Take emergency signs to the emergency department. Do not force the bulge or wait on a referral. A painful hernia, one that will not go back, a suspected femoral hernia, or a groin hernia in a woman who is not pregnant should be discussed with a surgeon instead of long observation. Any imaging is outside, and the surgeon may choose it. Referral does not create an accepting surgeon or a surgery date. This program does not repair hernias.

What examination can decide

Inguinal and femoral hernias are the groin types. In many men, history and examination identify an obvious hernia, so imaging is not automatic. Ultrasound is more useful if the exam is unclear, if a woman has groin symptoms without a visible bulge, or if pain may have another cause. Magnetic resonance imaging may be next if suspicion remains after a negative ultrasound. Name who will read an outside report. The image alone does not choose repair.

Initial care and its limits

Some men with an inguinal hernia that barely hurts and reduces easily may be observed and reviewed if pain starts. That is not the usual plan for a painful hernia, a femoral hernia, or a groin hernia in a woman who is not pregnant. A very small, comfortable, reducible umbilical hernia is sometimes watched. Sudden sharp pain with vomiting is emergency care. A belt over the bulge is not treatment and can make reduction harder.

Follow-up and result review

New or worsening pain should move the plan toward a surgeon. Bring outside reports to the ordering provider and ask who checks each one. Until a surgeon accepts the referral, these warning signs still apply. Update the referral if symptoms change. A sent form does not prove an outside office has given you a date.

Urgent signs and handoff

Use emergency care now if a bulge turns hard, severely painful, or red, stops going back, or comes with vomiting, bloating, or severe abdominal pain. Trapped tissue or lost blood flow needs emergency surgery. Do not force it in. Checking a soft bulge that reduces is not a home push on a stuck one. Call 911 if travel is unsafe. No surgeon, hospital, or repair method is promised.

Frequently asked questions

Sources

• Inguinal Hernias: Diagnosis and Management — American Academy of Family Physicians
• Inguinal (Groin) Hernias — patient information — American Academy of Family Physicians
• Adult Inguinal and Femoral Groin Hernia Repair — American College of Surgeons
• Adult Umbilical Hernia — American College of Surgeons
• Inguinal Hernia — National Institute of Diabetes and Digestive and Kidney Diseases