Bearing Down on Hernia Exams

When you palpate for inguinal hernias, ask the patient to take a deep breath and then bear down in a moderately strenuous Valsalva maneuver-rather than cough-after you have placed your finger in the inguinal ring. While coughing typically produces positive intra-abdominal pressure for less than a second, this maneuver creates pressure that lasts for several seconds. The probability of successfully palpating an inguinal hernia is thus increased.

---- David E. Bright, MD
       Boulder, Colo

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