2.2 Physical examination
Having taken the medical patient history, the physician conducts a thorough physical examination. If there is a suspicion of abdominal wall hernia, the respective area is examined for a protrusion, pressure pain and skin changes with the patient mainly standing upright. The doctor palpates the hernia opening, inguinal canal and hernial sac and checks whether it is possible to reposition the hernial sac. Depending on the location of the hernia, he pushes the skin of the respective site inwards with a finger. In the case of an inguinal hernia in males, he pushes the skin of the scrotum downwards with a finger like a glove into the inguinal canal; in females, he places a finger on the inguinal region, at the attachment of the labia majora. The doctor may ask the patient to cough or press so that an unnoticeable hernial sac can project, making it easier to feel. By listening with the stethoscope he can then determine whether the hernial sac contains intestinal loops and whether these are strangulated (intestinal noises!). To round off the examination, the physician palpates and taps on the entire abdomen to get an idea of the overall condition of the abdominal wall and ensure that any other hernias present are not overlooked.