Clinical Features

• Typically manifests as an ill-defined mass in the inguinal region with the following features:

  • Increases in size when coughing or straining

  • Decreases in size on lying supine

  • Inguinal pain (inguinodynia) or vague inguinal discomfort that increases with physical activity; can also be painless

• Inguinodynia with no palpable groin mass is typically the only manifestation of an occult inguinal hernia.

• Physical examination

  • Ask the patient to perform the Valsalva maneuver and observe for an expansile cough impulse in the inguinal region.

  • Palpate the inguinal canal.

    • Male patients: Invaginate the scrotal skin toward the superficial inguinal ring with the index or little finger.

    • Female patients: Palpate the area over the inguinal ligament.

    • Ask the patient to perform the Valsalva maneuver.

    • A palpable bulge confirms the diagnosis of an inguinal hernia.

  • The hernia is completely reducible and soft.

Female patients rarely present with visible bulges but often report a sensation of heaviness or dull discomfort in the groin or pelvis that is worsened by lifting, straining, or prolonged standing.

• Incarcerated hernia

  • The hernia is irreducible.

  • Skin overlying the hernia: normal

• Obstructed hernia: symptoms of mechanical bowel obstruction (sudden onset of pain, nausea, vomiting, abdominal distention, constipation or obstipation)

• Strangulated hernia

  • Sudden, severe groin pain caused by constriction and ischemia (or necrosis) of hernial contents

  • Signs of sepsis or signs of shock

  • Features of bowel obstruction if the hernia contains intestinal loops

  • Skin overlying the hernia: warm, erythematous, tender, and may appear exfoliated or blistered

Manual reduction of an inguinal hernia should not be attempted if there are any signs of strangulation!