I recall, many moons ago, we’d have physicals for sports that seemed to consist of solely stepping on a scale, maybe check our throats and eyes, drop trou and then the MD grabs the boys and asks you to “turn your head and cough”. That was about it, which seems a bit slack on the checking of fitness for summer football practices.
So what was the purpose of this manuever? Anyone know if they still do this?
Checking for hernias.
This thread reminds me of a cartoon seen many years ago (in Playboy, perhaps?): a Tree Surgeon has been called in to have a look at a family’s ailing christmas tree. He holds one of the ornaments, and says “Now cough” 
Ok, dumb follow up questions:
What, exactly, is a hernia? (I realise I can probably find out exactly what a hernia is by Googling, but as I’m a bit squeamish can someone humor me on this? Simple, not-to-over-the-top language appreciated).
How does it present so that coughing helps to diagnosis it? What are the symptoms? Can one grab their own balls and cough and check if a hernia is present, or does it require a more deft touch?
Is there any relation between hernias and “herniated disks”? I infer that hernia is a sort of generic term for “stuff out of place”.
How is a hernia repaired?
Are they that common or that important that they are only thing checked for in our annual physicals?
Someone with actual medical qualifications will be along soon to give useful answers no doubt. I only want to add that I asked my doctor once what benefit there is to having the patient turn their head during this procedure. I was expecting some answer about how it improves detection of the hernia in some way. He said it was just because the doctors didn’t like getting coughed on all day!
In general terms a hernia is when an internal organ juts out through whatever body part is supposed to contain it, such as a section of intestine squeezing out between the abdominal muscle groups. Weight lifters get these because of the intense amount of pressure placed on the groin muscles during a lifting routine.
The doctor is checking to see if a section of intestine has moved through the inguinal canal and into the scrotum. For the life of me I can not imagine how this could happen without me being aware of it.
Don’t google for hernia information at work because the resulting images are often NSFW.
A hernia is basically a bulge that should not be there. The classic Football Player /Weightlifter hernia is a section of bowel that, under exertion, extrudes through the abdominal wall - frequently through the opening where your testes descended. If the opening subsequently becomes constricted, the protruding bowel can have its circulation cut off and/or its contents isolated, which is a “strangulated” hernia, which is much more serious and may well require surgery.
A “simple” hernia can frequently be fixed by just pushing things back into place with your finger, but this will not, of course, prevent the same thing from happening again. A more permanent fix would involve closing the opening so that the hernia cannot re-occur. Surgery (minor, these days) would be indicated.
A herniated disk is a bulge in the disks that cushion your vertebrae. The disks are rubbery, and uneven compression on the spine (by lifting a weight incorrectly, for example) can cause the disk to bulge out on one side. Since the spinal column is a bundle of nerves that serve various parts of the body, the bulging disk frequently puts pressure on one of these nerves, and you feel pain - but not in your back. For example, if the lower vertebrae have a herniated disk, you typically feel pain in the back of the leg because the sciatic nerve is compressed. Massage on the leg won’t help, because the pain isn’t really coming from the leg. This is called “referred” pain, and requires a more sophisticated diagnosis (such as a CAT scan) to find the source of the problem.
A hernia, at least what they are checking for, is a rupture in the abdominal muscle wall. It is different from a herniated disc. I was born with a hernia, had it repaired when I reached the age of six months, and then went and developed another one before I was eight years old. Not a lot of heavy lifting at those ages, so it was more like I was born with some kind of weakness at those places. It is corrected by surgery - 40-some years later, still have scars from both operations. But I’m sure it’s less invasive these days.
IANAD, so I don’t know how grabbing and coughing tells some else you’ve got a hernia. But I can tell you that the medicos were very interested that I had bilateral hernia corrections when I enlisted. They had great fun showing the new corpsman trainees how my boys were hanging a little lower than normal because of the surgeries.
Apparently one of the frequent causes of a hernia is when the intestines protrude through the area where the testes descended and the abdominal muscles are thinner. (Thus, the cupping of the boys to feel for any bulges). The coughing increases the pressure on the abdomen, thus amplifying any bulge.
Because most sports require a lot of physical exertion and straining, you want to identify any potential hernias before starting out. (Because of the area where this might happen, you can imagine a young athlete being too shy or embarassed to complain about pain early on, leading to potentially serious complications.)
There it is again! I looked at the thread, saw that nobody had explained the cough, hit Reply, and there’s Finagle’s post!
As he says, the cough increases the pressure so the doc can feel any problems. I’m sure a sneeze would work even better than a cough; both are muscle spasms that go all the way down.
While I’m here, since my doc just told me I have a hernia and is referring me to a surgeon, I have questions I should have asked him. Just to save me searching, what does a typical repair involve? Do they scope or cut? Do they just suture the weak spot, or put in a patch? How long is a typical recovery? Will I be able to play the piano?
MrAru had his done laparascopically through his bellybutton [more or less]
They basically took a sheet of mesh of some hypoallergenic stuff [teflon?] and tacked it against the inside of the opening, sort of like when your mother used to use a 3 inch by 5 inch [or larger] cloth patch on the inside of the knees of your play pants to fix a small hole. IIRC they also took a couple stitches in the muscle tissue to hold the tear together to heal. I am sure that QtM or another medical person will be along with more info… FWIW, he had to take it easy for a week, then just avoid straining it for a few more weeks of ‘light duty’ then he was better than new=)
On the other hand, we learned exactly how far he could projectile puke water, fruit salad and ginger ale=) [no nausea, he was dressing to leave, bent over to pick up a shoe to put it on and whoosh - 9 feet of clear liquid with lightly chewed but undigested fruit salad…amazing :eek: ] Doctor said it was an involuntary muscle spasm from bending over and was harmless as it didnt do anything to the surgical site.
That depends - can you play it now?
I had a double hernia operation more than a year ago. The best way to get the procedure done is lapriscopically, that is with a scope. They make a small incision below your belly button, snake the utensils and camera down to the appropriate area, patch it up with a little mesh and then pull everything out and seal it up. In my case, they attempted to perform the surgery lapriscopically, but due to unforseen circumstances (they didn’t really explain it) they had to do it the old fashiond way, with two scars a few inches above the scrotum, performing everything open face if you will. The recovery for the lapriscopic procedure is supposedly much quicker than what I had done. My recovery consisted of an overnight stay in the hospital, followed by several days of lying down. Moving is an enormous pain, and you don’t want to know about attempting bowel movements. Let’s just say you’ll be very careful in everything you do for the next couple of weeks. The pain gradually subsides, although I still have recurring pain. The surgeon said it was the mesh pushing against nerves and that I’d have to deal with it the rest of my life. I’ve talked with my internist and a urologist about the pain, and they’ve indicated it isn’t another hernia and pretty much echoed my surgeon’s sentiments. I hope you have a better experience than I and can have the procedure done lapriscopically. 
I’d have made a lousy MD - I get woozy just reading about medical procedures.
So, since a couple of you have had experiences with this, what does it feel like to have a hernia? Surely it’s not the most comfortable thing in the world – did you notice all by yourself or did you have to wait until some guy in a white coat had you literally by the balls?
I just had an inguinal hernia repaired a little over a week ago. My regular doctor found it during my annual checkup last year, and actually had to check twice to confirm, that’s how (apparently) small mine was. But he told me to have it fixed in the next six months or so, before it unexpectedly got worse. I talked to a surgeon about it back in May, and he didn’t seem to think there was a big hurry to get it fixed. But by about mid-to-late September I actually started to notice a persistent “pulled muscle” sort of feeling in the groin area, and once my work schedule allowed, I went ahead and scheduled the surgery.
I had my operation on a Friday, was in pain pretty much all day Saturday, but was up and walking around pretty easily on Sunday. There was some bruising and swelling for a few days, but nothing more uncomfortable than a persistent low-grade “kicked in the nuts” sort of feeling. I was back at my desk job by the following Thursday. The doctor says no heavy lifting (more than 20 lbs) for at least another month.
A little nit-picking here. The spinal column is not a bundle of nerves, but nerves do travel through it, and those nerves are part of the central nervous system, as opposed to the peripheral nervous system. If you have a disc problem (herniated or bulging), you will feel pain not only at the nerve’s terminal but also along its path, including the back. The pain in the radicular distribution of the nerve is called radicular pain, not referred pain. Referred pain is felt in a body part other than that in which the cause that produced it is situated. Although the distal cause is the spine, the irritated nerve is also a cause. The part of the leg in which pain is felt depends upon the site of the herniation, herniations at the different levels affecting the outlets of different afferent nerves.
About 30 years ago Mr. S had one and didn’t know it. It was discovered when he had a physical before starting a new job. He says the hernia didn’t hurt at all, but the surgery sure did!
Technically, the doctor never holds your balls during a hernia check. He/she puts a finger above each testicle and pushes up and into the inguinal canal as far as it will go (inside the body). If there is an inguinal hernia present, a cough will push the peritoneal wall against the doctor’s finger.
Maybe you just didn’t tip your doctor enough.
Quite so; and when I had my herniated disk I felt no back pain, only pain in the legs. According to the orthopaedic surgeon who consulted on my case, this was “referred” pain.