Further instrumental examinations are not usually necessary as part of hernia diagnostics. If a hernia is not recognizable at first glance, the doctor may resort to such procedures. The following are then used
These procedures also help to rule out other diseases as part of the differential diagnosis. They also play an important role in planning a hernia operation in advance.
Taking a medical history is the first step in hernia diagnostics. It is necessary in order to make a reliable diagnosis and to be able to initiate appropriate measures for targeted treatment. The doctor must therefore obtain all important information about the patient, their symptoms and their medical history.
To do this, the doctor asks the patient about their medical history in a personal interview (anamnesis interview). Among other things, this involves
- whether other illnesses are known,
- whether the patient is currently taking certain medications or
- whether he or she suffers from drug intolerances or allergies.
Documents brought along by the patient about previous examinations and treatments such as
- medical reports,
- X-ray findings or
- laboratory values
can be very helpful.
The doctor will also ask the patient to describe the symptoms in detail. For example, he will ask
- when the symptoms occur,
- the nature of the symptoms,
- whether they are permanent, and
- what may be causing the pain.
If the patient describes symptoms that are typical of a hernia, this is a first clue for the treating doctor.
If the suspicion of a hernia is confirmed, this is followed by a physical examination. This usually includes
- A detailed examination of the patient,
- palpation of the abdominal cavity,
- listening to suspicious areas with a stethoscope.
Examination of the hernia sac
If an abdominal wall hernia is suspected, the doctor checks - usually with the patient standing - whether there is
- a protrusion and
- any skin changes
are visible. If the protrusion, i.e. the hernia sac, is painful, this is an important symptom. In addition, he palpates
- the hernial orifice,
- the hernial canal and
- the contents of the hernia sac.
The doctor also checks whether the hernia sac can be repositioned through the hernial orifice to its original position in the abdominal cavity(repositionability). Depending on where the hernia is located, the skin at the affected area is tucked inwards.

This pronounced umbilical hernia in a newborn baby can be recognized at first glance © marritch | AdobeStock
A hernia can usually be easily diagnosed during such a physical examination. The protrusion is usually easy to see and the hernia site is easy to feel.
The doctor may also ask the patient to cough or push to make an inconspicuous hernia sac stand out more clearly during the examination and be easier to feel.
More precise determination
The next step is to determine whether there are intestinal loops in the hernia sac and whether they are trapped. To do this, the doctor listens to the suspected regions with a stethoscope. If he hears bowel sounds, this indicates bowel loops and a possible incarceration.
In the final step, the doctor palpates and taps the patient's entire abdomen. In this way, he can get an impression of the overall condition of the abdominal wall. Sometimes this reveals additional hernias.
The doctor determines what type of hernia it is based on the region in which the hernial orifice occurs:
An ultrasound examination(sonography) can be carried out in addition to the physical examination. It can be used to check or confirm the findings.
It is particularly necessary if the hernia is a small or internal hernia. These are not easy to recognize at first glance during a physical examination or can hardly be felt. This can be the case, for example, in severely overweight people or with a barely palpable femoral hernia.
Ultrasound devices provide precise images of the inside of the body that make even small changes in the organs visible.
Sonography is completely painless for the patient and also very gentle. No X-rays are used.
X-ray examination is an imaging procedure in which the tissue is x-rayed. An X-ray examination makes the smallest structures inside the body visible and can therefore also clearly detect hernias.
In some X-ray examinations, contrast agents containing iodine or barium are also used. This is the case, for example, with the gastrointestinal passage (MDP) described below.
Gastrointestinal passage for the diagnosis of a hernia
The gastrointestinal passage is a contrast-enhanced X-ray examination of the upper digestive tract. It visualizes the stomach and small intestine and makes it easier to identify pathological changes in this area. Loops of intestine that have prolapsed into a hernia sac can also be visualized and diagnosed.
The gastrointestinal passage is particularly helpful in the diagnosis of diaphragmatic hernias and internal hernias.
However, the gastrointestinal passage is associated with a relatively high radiation exposure. It is therefore only used if no alternative examination methods are available to make an accurate diagnosis.
Performing an X-ray examination
The patient first takes a contrast medium and a gas-forming granulate or powder. The latter is used to fill the organs of the digestive tract with gas. This unfolds their wall structures and irregularities can be better recognized.
X-ray images are then taken continuously. The patient assumes various body positions until all the sections to be examined have been captured in the X-ray images. The doctor follows the X-ray images taken in parallel on a monitor.
Due to the contrast medium, the patient may suffer from diarrhea and flatulence for a short time. The patient should be fasting for the examination, as this is the only way to achieve a good examination result.
The patient should not eat any flatulent food the day before the examination. On the day of the examination, the patient must not eat anything until the gastrointestinal passage has been completed.
They should also refrain from
smoking. Medication should only be taken later on the day of the examination in consultation with the doctor.
Computed tomography, or CT for short, is a computer-aided, imaging X-ray examination. CT depicts the human body layer by layer in cross-sectional images (sectional imaging).
It is mainly used in the diagnosis of
are used. The aim of the examination is to determine the extent and severity of the diagnosed hernia.
During the examination, the patient lies in a tube-shaped CT scanner. The X-rays are attenuated to different degrees as they pass through the various tissues. Special detectors record these radiation intensities and the device uses them to calculate a CT image.
A conventional X-ray image only captures coarse structures and bones. A CT also shows soft tissue in detail. Even the smallest details can be seen very clearly on these CT images.
Magnetic resonance imaging is also known as magnetic resonance imaging. Like computer tomography, it is one of the so-called sectional imaging procedures. These image the human body layer by layer.
In contrast to computer tomography, however, magnetic resonance imaging does not work with X-rays, but with strong magnetic fields and radio waves.
Objects containing metal such as
- jewelry,
- wristwatches,
- hearing aids or
- glasses
must therefore be removed before the examination. If a patient has a pacemaker or carries metal objects such as plates, screws and nails in their body, they must inform the doctor before the examination.
Gastroscopy, also known as a gastroscopy, is an imaging examination procedure. It can be used to
from the inside. If necessary, tissue samples can also be taken for further diagnosis during a gastroscopy using small instruments.
An endoscope is used for this. This is a thin, tube-shaped examination device with a mini camera at the tip. The doctor pushes the endoscope through the patient's mouth up to the stomach. The stomach should therefore be completely empty for this examination. The images from the mini camera are transmitted to a monitor.
Gastroscopy is primarily used to diagnose diaphragmatic hernias: it enables the doctor to distinguish between
- a sliding hernia with reflux of gastric acid into the oesophagus(reflux disease) and
- a paraesophageal hernia, in which part of the stomach slides up into the chest,
into the chest. This differentiation is essential in order to be able to plan an optimal surgical procedure.
Gastroscopy is generally a procedure that is not very stressful for the patient. However, if the patient is anxious about the examination, they can be given a mild sedative or an anaesthetic on request. The examination is then usually relaxed and painless.
In rare cases, reflux disease, i.e. diaphragmatic hernia (hiatal hernia), cannot be clearly diagnosed by gastrointestinal passage or gastroscopy.
In this case, a so-called 24-hour pH-metry must also be carried out. This involves measuring the pH value of the gastric juice over a period of 24 hours.
During this examination, a probe is inserted into the oesophagus during a gastroscopy and left there for 24 hours. This makes it possible to determine how much stomach acid rises into the oesophagus.
Under normal conditions, the pH value in the oesophagus is rarely below 4. If pH values are measured during the examination that remain below 4 for a longer period of time, this indicates a disease.