Hernia Diagnostics: Information & Hernia Diagnostics Specialists

Taking the patient’s medical history is the first step in hernia diagnosis. It is necessary to make a definitive diagnosis and to initiate appropriate measures for targeted treatment. For this reason, the doctor must gather all relevant information about the patient, their symptoms, and their medical history.

To do this, the doctor interviews the patient in a face-to-face consultation (medical history interview) to discuss their medical history. Among other things, the doctor will ask

• whether there are any other known medical conditions,
• whether the patient is currently taking certain medications, or
• whether they suffer from medication intolerances or allergies.

Documents brought by the patient regarding previous examinations and treatments, such as

• doctor’s notes,
• X-ray reports, or
• lab results

can be very helpful in this regard.

In addition, the doctor will ask for a detailed description of the current symptoms. For example, he or she might ask

• when the symptoms occur,
• what kind of symptoms they are,
• whether they are persistent, and
• what might trigger the pain.

If the patient describes symptoms typical of a hernia, this serves as an initial clue for the treating doctor.

If the suspicion of a hernia is confirmed, a physical examination follows. This typically involves

• a thorough assessment of the patient,
• palpation of the abdomen,
• auscultation of suspicious areas with a stethoscope.

Examination of the hernial sac

If an abdominal wall hernia is suspected, the doctor checks—usually while the patient is standing—whether there is

• there is a bulge and
• any skin changes

are visible. If the bulge—i.e., the hernial sac—is tender to pressure, this is an important symptom. In addition, the doctor palpates

• the hernial orifice,
• the hernial canal, and
• the contents of the hernial sac.

The doctor also checks whether the hernial sac can be pushed back through the hernial orifice into its original position in the abdominal cavity (reposability). Depending on where the hernia is located, the doctor does this by tucking the skin at the affected site inward.

A hernia can usually be easily diagnosed during such a physical examination. The bulge is usually clearly visible, and the hernia site is easy to palpate.

To make a hernia sac that is otherwise inconspicuous stand out more clearly during the examination and be easier to feel, the doctor may also ask the patient to cough or strain.

More Detailed Assessment

The next step is to determine whether there are loops of intestine in the hernial sac and, if so, whether they are strangulated. To do this, the doctor listens to the suspicious areas with a stethoscope. If bowel sounds are heard, this indicates the presence of intestinal loops and a possible strangulation.

In the final step, the doctor palpates and percusses the patient’s entire abdomen. This allows the doctor to assess the overall condition of the abdominal wall. Sometimes, additional hernias are detected during this process.

The doctor determines the type of hernia based on the region where the hernial orifice is located:

• A hernia in the groin area is called an inguinal hernia.
• A hernia on the inner side of the thigh is called a femoral hernia.
• A hernia in the navel area is an umbilical hernia.
• A hernia that occurs along the midline of the upper abdomen is called an epigastric hernia.

An ultrasound examination (sonography) can be performed in addition to a physical examination. It can be used to verify or confirm the findings of the physical examination.

It is particularly necessary when the hernia is small or internal. These are not easily visible at first glance during a physical examination or are difficult to palpate. This can be the case, for example, in severely obese individuals or with a femoral hernia that is barely palpable.

Ultrasound machines provide precise images of the body’s interior, revealing even small changes in the organs. 

For the patient, an ultrasound is completely painless and also very gentle. No X-rays are used.

An X-ray examination is an imaging procedure in which tissue is penetrated by X-rays. An X-ray examination makes even the smallest structures inside the body visible and can thus 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 transit study (GIT) described below.

Gastrointestinal Transit Study for the Diagnosis of a Hernia

A gastrointestinal transit study is a contrast-enhanced X-ray examination of the upper digestive tract. It visualizes the stomach and small intestine and facilitates the identification of pathological changes in this area. Intestinal loops that have prolapsed into a hernial sac can also be clearly visualized and diagnosed in this way.

The gastrointestinal series is particularly helpful in diagnosing diaphragmatic hernias and internal hernias.

However, the gastrointestinal transit study involves relatively high radiation exposure. Therefore, it is used only when no alternative examination methods are available to make an accurate diagnosis.

Conducting an X-ray Examination

The patient first ingests a contrast agent as well as a gas-forming granule or powder. The latter serves to fill the organs of the digestive tract with gas. This causes their wall structures to expand, making irregularities easier to detect.

Afterward, X-ray images are taken continuously. The patient assumes various body positions until all sections to be examined are captured in the X-ray images. The doctor monitors the X-ray images in real time on a screen.

Due to the contrast agent, the patient may experience temporary diarrhea and bloating. The patient should have an empty stomach for the examination, as this is the only way to ensure accurate results.

On the day before the examination, the patient should avoid foods that cause bloating. On the day of the examination, the patient must not eat anything until the gastrointestinal contents have been completely passed.

In addition, they should avoid

• coffee,
• milk, and
• smoking

. Medications should be taken later on the day of the examination, as directed by the doctor.

Computed tomography, or CT for short, is a computer-assisted X-ray imaging procedure. A CT scan depicts the human body in cross-sectional images, layer by layer (slicing technique).

It is primarily used in the diagnosis of

• incisional hernias,
• parastomal hernias, and
• diaphragmatic hernias

. The goal of the examination is to determine the extent and severity of the diagnosed hernia.

During the examination, the patient lies inside a tube-shaped computed tomography (CT) scanner. As X-rays pass through different tissues, they are attenuated to varying degrees. Special detectors measure these levels of X-ray intensity, and the machine uses this data to generate a CT image.

A conventional X-ray image captures only coarse structures and bones. A CT scan also provides detailed images of soft tissues. Even the smallest details are very clearly visible on these CT images.

Magnetic resonance imaging is also known as MRI. Like computed tomography, it is one of the so-called cross-sectional imaging techniques. These techniques image the human body layer by layer.

Unlike computed tomography, however, magnetic resonance imaging does not use X-rays, but rather strong magnetic fields and radio waves.

Objects containing metal, such as

• jewelry,
• wristwatches,
• hearing aids, or
• glasses

must therefore be removed by the patient before the examination. If a patient has a pacemaker or has metal objects implanted in the body, such as plates, screws, and pins, they must inform the doctor of this before the examination.

A gastroscopy, also known as an endoscopy, is an imaging examination. It allows for the examination of

• the esophagus,
• the stomach, and
• the duodenum

from the inside. If necessary, tissue samples can also be taken during a gastroscopy using small instruments for further diagnostic purposes.

An endoscope is used for this procedure. It is a thin, tube-shaped device with a miniature camera at its tip. The doctor inserts the endoscope through the patient’s mouth and advances it to the stomach. The stomach should therefore be completely empty for this examination. The images from the miniature camera are transmitted to a monitor.

Gastroscopy is primarily used to diagnose diaphragmatic hernias: it allows the doctor to distinguish between

• a sliding hernia with reflux of stomach acid into the esophagus (reflux disease) and
• a paraesophageal hernia, in which a portion of the stomach slides up into the chest cavity,

. This distinction is absolutely essential for planning the optimal surgical approach.

A gastroscopy is generally a minimally invasive procedure for the patient. If the patient is nevertheless anxious about the procedure, a mild sedative or anesthetic can be administered upon request. The procedure then usually proceeds in a relaxed and pain-free manner.

In rare cases, reflux disease—specifically a hiatal hernia—cannot be definitively diagnosed through gastrointestinal transit studies or gastroscopy alone.

In such cases, a so-called 24-hour pH monitoring test must also be performed. This involves measuring the pH level of gastric juice over a 24-hour period.

During this procedure, a probe is inserted into the esophagus during a gastroscopy and left in place for 24 hours. This allows for the determination of how much stomach acid refluxes into the esophagus.

Under normal conditions, the pH level in the esophagus rarely falls below 4. If the test reveals pH levels that remain below 4 for an extended period, this indicates a medical condition.