Examination of the groin and abdominal wall for hernias !

Exam technique

Checking the groin, umbilicus and scars, standing and while coughing, to find bulges pushing through weak spots in the wall.

Updated 2026-11-01

See it in 3D: Inguinal canal · Inguinal ligament · Spermatic cord · Epigastric vessels · Femoral vein · Linea alba · Pubic symphysis

What it is

A hernia is abdominal contents pushing through a weak spot in the wall. It is examined with the patient standing, because abdominal pressure makes the bulge obvious, and again while coughing or straining. You need to tell an inguinal hernia (above the inguinal ligament) from a femoral one (below it), and to recognize an incarcerated or strangulated hernia, which is a surgical emergency.

Landmark anatomy

The inguinal ligament runs from the anterior superior iliac spine to the pubic tubercle; the inguinal canal runs above and parallel to it.
The deep inguinal ring lies lateral to the inferior epigastric vessels; the superficial ring lies above and lateral to the pubic tubercle.
Hesselbach triangle: bounded by the inferior epigastric vessels, the lateral edge of the rectus and the inguinal ligament; direct hernias come through it.
The femoral canal lies below the inguinal ligament, medial to the femoral vein.

Technique, step by step

Explain the exam, ensure privacy and offer a chaperone; patient standing in front of the seated examiner.
Inspect both groins, the scrotum or labia majora, the umbilicus, the midline and any scars; ask the patient to cough and watch for bulges.
In men, invaginate the scrotal skin with the index finger along the cord up to the superficial inguinal ring, beside the pubic tubercle.
Ask the patient to cough or strain and feel whether an impulse strikes the finger.
Feel below the inguinal ligament, medial to the femoral artery, for a femoral hernia.
If there is a bulge, describe site, size, consistency, tenderness, whether it reduces and whether it has a cough impulse.
Repeat supine: many hernias reduce on lying down; never force reduction of a painful hernia.
Check the umbilicus and scars with the head raised to reveal umbilical, epigastric and incisional hernias.

Abnormal findings

A groin bulge that grows with coughing and reduces on lying down: uncomplicated inguinal hernia.
A bulge below the inguinal ligament in an older woman: suspect a femoral hernia.
A tense, painful, irreducible bulge with red skin, vomiting and distension: strangulated hernia with bowel obstruction.
A solid groin mass that neither reduces nor has a cough impulse: lymph node, lipoma or undescended testis.
A ridge along the midline on raising the head, with no ring: rectus diastasis, which is not a hernia.

Common errors

Examining only lying down: many hernias are missed.
Telling direct from indirect hernia by examination is unreliable; surgery defines it.
If the exam is unclear, ultrasound helps confirm.

Test yourself

Think of the answer, then tap the question to see it.

How do you tell an inguinal from a femoral hernia on examination?

An inguinal hernia appears above the inguinal ligament and medial to the pubic tubercle; a femoral hernia below the ligament and lateral to the pubic tubercle.

How does an indirect hernia relate to the inferior epigastric vessels?

It comes through the deep inguinal ring, lateral to those vessels; a direct hernia comes out medial to them, through Hesselbach triangle.

Which findings suggest a strangulated hernia?

A tense, very painful, irreducible bulge, red skin, nausea, vomiting and distension; it is a surgical emergency.

Why is the patient examined standing?

Standing pressure plus coughing brings out the hernia, which may reduce by itself on lying down.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Hernias of the Abdominal Wall - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025).

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