Since hernias are external or internal protrusions of body parts due to a combination of defected muscle tissue and increased internal body pressure, the two most common methods to test and diagnose hernias are physical exams and X-ray imaging. Depending on the anatomical region of the affected area, physicians may perform additional diagnostic testing to rule out other more serious medical conditions unrelated to hernias.
A physical exam is often the first line of testing to diagnose external hernias. The physician usually palpates the affected bulge for the texture, size and fullness of the protrusion. He or she will also visually evaluate the protrusion for discolorations, since inflammation or abnormally dark blotches may signify infection or gangrene, a life-threatening condition involving tissue necrosis. Questions regarding symptoms present in hernias may also be asked. Physical exams are commonly used in the diagnosis of external hernias such as the following:
- Inguinal and femoral hernias: Usually, the doctor will palpate the inguinal ring and scrotum areas of male patients to determine whether the protrusion is inguinal or femoral. He or she may also ask the patient to perform a cough test. Depending on the protrusion's reaction to pressure, the physician can confirm whether the inguinal hernia is direct or indirect. Afterward, an X-ray may be taken to determine if internal organs, such as the intestines, had further entered the protrusion.
- Umbilical hernias: Umbilical hernias can be diagnosed by a visual test, since the affected site is almost always at the location of the belly button. Since this happens more in infants and toddlers, the doctor may perform a cough or cry test on the child to verify whether the bulge reacts to internal body pressures inflicted from the coughing or crying.
- Incisional hernias: Since these hernias almost always appear at previous abdominal surgical sites, they can be diagnosed by a physician through visual tests and the patient's medical history.
X-Ray and Imaging
For hernias that occur internally or that cannot be determined from a physical exam, diagnostic X-ray and imaging would be performed to confirm the presence of a hernia. X-rays are also used for external protrusions when the doctor suspects the presence of a body organ in the hernia. Since internal hernias often share similar symptoms with other unrelated medical conditions, it is important to confirm the diagnosis before implementing any form of treatment. A common type of X-ray would be the multi detector CT (MDCT), which can clearly show the contents of the sac and its exact anatomical location. Common examples of internal hernias that require X-ray diagnosis include the following:
- Diaphragmatic and hiatal hernias: Chest X-rays may be performed to see if there are any "shadows" that may signify the presence of diaphragmatic or hiatal hernias.
- Spinal hernias: Magnetic resonance imaging (MRI), which provides high-quality contrast between the hard and soft tissue, is usually used to diagnose the condition. However, a physical test involving raising and lowering of limbs may also be performed to further help locate the site of protrusion.
Other Types of Testing
Depending on the anatomical site of the hernia and the seriousness of the case, doctors may choose to perform additional testing to further confirm the diagnosis. One example would be performing an endoscopy, which would involve directly inserting an endoscope into the suspected body cavity to examine the internal organs at the affected site.
Laboratory testing can also be used to eliminate other suspecting medical conditions, as well as to confirm the severity of the hernia. Blood tests that perform a white blood cell count can detect inflammation, infection and presence of tissue necrosis, while a complete red blood cell count can detect internal blood loss or circulation blockage. For diaphragmatic hernias, a pH test can identify the presence of stomach ulcers, which is one of the consequences of untreated internal abdominal hernias. A stool sample can also be taken to test for strangulation of abdominal organs in the hernia protrusion, since irregular bowel activity is often a symptom of intestinal incarceration. Biopsies, which involve tissue sampling at the hernia protrusion, can further help rule out other more serious conditions, such as tumors or cancer.
It is important to see a licensed physician to correctly diagnose the appearance of hernia, since some internal hernias share symptoms with other unrelated medical conditions that require completely different forms of treatment. Some of such conditions include but are not limited to the following:
- Appendicitis: an inflammation of the appendix, a small section of the large intestine
- Pancreatitis: an inflammation of the pancreas that can be characterized by acute pain
- Irritable bowel syndrome: a functional bowel disorder characterized by chronic pain, discomfort and abnormal bowel movements
- Gallstones: a crystalline condensation in the gallbladder that can be accompanied by pain
- Heartburns: an acid reflux disorder that may cause a burning sensation in the chest