Suggested Pre-Referral Evaluation and Management Guidelines
Inguinal hernia is a common condition in which there is a bulge, usually visible, in the region of the inguinal canal, which runs between the anterior superior iliac spine and the pubic bone. A bulge is usually visible as an asymmetry in this region, in the tissues adjacent to the pubic bone or in the upper labia in women. It is likely to be present when the patient is standing and go away when supine.
Most inguinal hernias do not cause pain, but rather a feeling of dull pressure, sometimes a burning discomfort, particularly when the hernia is expanding or stretching. Inguinal hernias do not cause continuous pain. Rather, symptoms are present primarily when the hernia is bulging and go away when the hernia reduces. Most patients with continuous groin pain do not have hernias (See "Groin Pain").
The presence of a small, reducible, minimally or asymptomatic hernia is not cause for alarm or urgent referral. The risk of complication, such as incarceration, in a prospective randomized trial of watchful waiting was 1 in 1300 person-years.
There is no reason for patients to alter their normal work or exercise habits because a hernia is found, unless what they do is causing pain.
Occult, asymptomatic inguinal hernias seen incidentally on CT do not require consultation unless they can be seen to contain bowel loops.
Hernias that are large, painful, difficult to reduce, or which have been associated with an episode of incarceration or bowel obstruction should be seen promptly. Otherwise, there is no urgency.
Suggested Additional Test/Management Prior to Specialty Visit
No additional testing is necessary. Ultrasound, in particular, is not needed and is frequently misleading, because it identifies small amounts of normal fat in the inguinal canal as hernias.
Patient Education/Information (includes preps)
4-8 weeks (see exception above)
How to Get Results to Consultant
UMHS Patients: See CareWeb
External Patients: Hand carry Non-UM records to visit