Hernia Ultrasound in Ajax: What to Expect

A hernia happens when part of the contents of the abdomen, often a small piece of fatty tissue or a loop of bowel, pushes through a weak spot in the muscle wall that normally holds it in. The result is usually a bulge, sometimes with an ache or a dragging feeling, that may be more obvious when you stand, cough or lift something heavy and may disappear when you lie down.

Many hernias can be recognized by a health-care provider during a physical examination. Even so, ultrasound is frequently requested to confirm what is there, to look at a lump that is hard to feel, or to check the other side. It is also an unusual ultrasound in one respect: you will be asked to take part. Coughing, straining and standing are often part of the exam, because a hernia that hides when you relax may only show itself when the pressure inside your abdomen rises.

This article walks through the exam from booking to follow-up, so patients from Ajax and across Durham Region know what is coming.

Know the warning signs first

Most hernias are not emergencies, but occasionally the tissue that has pushed through becomes trapped and its blood supply can be affected.

Call 911 or go to the nearest emergency department if a hernia bulge becomes suddenly very painful, turns firm and cannot be pushed back in when it previously could, changes colour to red, purple or dark, or comes with nausea, vomiting, a swollen belly, or an inability to pass gas or have a bowel movement.

A booked ultrasound at a community clinic is meant for planned investigation. If those symptoms appear, even on the morning of your appointment, go to emergency care instead.

Types of hernia an ultrasound may look for

Hernias are named for where they occur. Your requisition will usually name the area of concern.

Groin hernias

• Inguinal hernias occur in the groin, along a natural channel in the lower abdominal wall. They are the most common type and are more frequent in men, though anyone can have one.
• Femoral hernias sit slightly lower, near the top of the thigh. They are less common and are seen more often in women.

Hernias of the front of the abdomen

• Umbilical hernias appear at or near the belly button.
• Epigastric hernias appear in the midline between the belly button and the breastbone.
• Incisional hernias develop at or near the scar from a previous operation.

Other bulges

Not every lump in these areas is a hernia. Swollen lymph nodes in the groin, fatty lumps and fluid collections can feel similar. One of the useful things ultrasound does is tell these apart. If your lump turns out not to be a hernia, our article on lumps and bumps and soft tissue ultrasound explains how other kinds of lumps are described.

Why ultrasound suits this question

A few features make ultrasound a practical choice for hernias:

• It is live. The sonographer watches the abdominal wall in real time, which means they can see tissue move through a gap when you strain and slide back when you relax.
• It can be done in different positions. Lying, sitting and standing can all be used, which matters for hernias that only appear upright.
• It compares both sides easily. Groin hernias can be present on both sides, sometimes without symptoms on one of them.
• It uses no radiation.

Ultrasound does have limits. In some people, especially where there is a lot of tissue over the area or scarring from previous surgery, a small hernia can be hard to see. Your provider may then rely on their examination or arrange a different test. You can read more about how imaging tests are chosen in our article on ultrasound versus X-ray.

Before your appointment

Preparation

Hernia ultrasound usually needs little or no special preparation, but instructions can vary depending on what else your provider has asked to be examined. Follow the instructions you receive at booking, and call the clinic if anything is unclear. If the scan is combined with an abdominal ultrasound that needs fasting, the abdominal preparation guide explains that part.

What to wear

A two-piece outfit is the most practical. For a groin scan you will need to lower your trousers and underwear to below the area, so a gown or sheet will be provided to keep you covered. For a belly button or midline scan, you may only need to lift your top. Avoid belts with large buckles and tight waistbands if you can.

What to bring

• Your health card
• Your requisition
• Notes on when the bulge appears, for example only after standing for a while, or when lifting

A tip that helps

If your bulge tends to show up later in the day or after activity, mention this when you book. Some people find their hernia is easier to demonstrate when they have been up and about rather than first thing after getting out of bed. The clinic can tell you whether a different time slot is available.

During the scan, step by step

1. You start lying down. The sonographer applies warm gel over the area and scans with a handheld transducer while you rest.
2. You are asked to strain. This is often described as bearing down, as though you are having a bowel movement, or taking a breath and pushing your belly out. This is sometimes called a Valsalva manoeuvre. It raises the pressure inside your abdomen.
3. You may be asked to cough. A cough does the same thing in a short burst.
4. You may be asked to stand. If nothing shows lying down, or if you only notice the bulge upright, the sonographer may scan you standing.
5. The other side is checked. For groin scans, both sides are often examined for comparison.
6. You relax and dress. Tissues or a towel are provided to remove the gel.

The pressure from the transducer is usually gentle. If the area is tender, tell the sonographer, and they will adjust. If straining is uncomfortable for you, perhaps because of back problems or recent surgery, say so before the exam begins.

Pointing it out

The single most helpful thing you can do is show the sonographer exactly where you feel the bulge. If you can make it appear by standing or coughing, demonstrate it. Hernias can be small, and a precise starting point makes the search much faster.

After the scan

As with all imaging at Rossland Diagnostic Clinic, the report is sent to the provider who ordered the exam, and they will discuss it with you. The report may describe a hernia, including its location, roughly what it contains and whether it slid back in easily, or it may say that no hernia was seen.

A report that does not show a hernia does not necessarily mean you were imagining things. Small hernias can come and go, and some only appear under conditions that are hard to reproduce on the exam bed. Your provider will weigh the scan alongside your symptoms and examination. Decisions about whether a hernia needs repair, monitoring or nothing at all are made with your provider and, if needed, a surgeon.

Questions to bring to your provider

When you go over the report together, it can help to ask:

• Where exactly is the hernia, and what type is it?
• Did it slide back in on its own during the scan?
• Is there anything I should avoid in daily life, such as certain kinds of lifting, while we decide on next steps?
• Which symptoms would mean I should go to the emergency department?
• If no hernia was seen, what else could explain the bulge or the discomfort?

Writing the answers down, or bringing a family member along, makes it easier to remember the details once you are home.

Frequently asked questions

Will the scan make my hernia worse?

Straining briefly during the exam is similar to coughing or lifting in daily life. If you are worried, mention it to the sonographer before you begin.

Can I have the scan if I have already had hernia surgery?

Yes, ultrasound is sometimes used to look at an area after a repair. Tell the sonographer about any previous operations and where the scars are.

Do I need someone to drive me?

There is no sedation, so most people drive themselves. Bring someone along if it makes you feel more comfortable.

What if the bulge is not there on the day?

Tell the sonographer where and when you usually notice it. They will use positions and manoeuvres to try to bring it out. If it still does not appear, your provider will decide on the next steps.

Booking a hernia ultrasound in Ajax

Rossland Diagnostic Clinic offers ultrasound at Unit 102, 300 Rossland Road East in Ajax, with free parking and step-free ground-floor access. We are open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm, and we welcome patients from Ajax, Pickering, Whitby and beyond.

With your requisition ready, call us at 905-426-3111 or request an appointment, and we will confirm how to prepare.