Saturday, June 7, 2014
Why Doctors Have Men “Turn Their Heads and Cough” During Physicals
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Pretty much all guys have been there at some point or another. The
doctor asks you to drop your drawers. They slap on their latex gloves,
grab your junk, and ask you to turn your head and cough. One imagines
this can’t exactly be the highlight of the doctor’s day, probably
ranking up there with the lovely process involved in probing prostates
for potential problems. So what exactly are they looking for when they
ask you to turn your head and cough? In a word: hernias.
More specifically, they are checking for something called an inguinal (inner groin) hernia, which accounts for about 70%-80% of all hernia cases and is surprisingly common in men and not nearly so much in women (lifetime risk of 27% for men vs. just 3% for women, due to the much smaller opening in women’s superficial inguinal ring than men’s). In fact, inguinal hernia surgery is one of the most common surgeries performed on kids and teenagers. Inguinal hernias happen when certain soft tissue, particularly lower intestines, starts to come through the lower abdominal wall through a small hole or tear in the wall.
So how does grabbing a guy’s balls help the doctor’s check for this? It turns out, they aren’t actually grabbing your balls, as is often eluded to in many a comedic skit. What they are doing is poking their fingers up around the inguinal canal, above the testicles. The inguinal canal runs down about where your leg and torso meet and is also the canal the spermatic cord passes through, attached to the testicles. For women, ligaments pass through this canal to help hold the uterus in place. For both sexes, the ilioinguinal nerve also passes through the inguinal canal.
The inguinal canal has some common weak spots, so doctors are feeling around these weak spots and particularly looking to see if they can feel a bulge or other indications that something is poking through that shouldn’t be, often falling into the scrotum. Besides something in a guy’s scrotum that shouldn’t be, a slight bulge might also be visible around where the upper thigh meets the groin. If either of these things happens, congratulations, you have an inguinal hernia.
As to why the doctor will then have you stand and turn your head and cough, the first part is because the hernia may well disappear when you lay down, with the tissue receding back into your abdominal cavity. The second “turn your head” part is simply for sanitary reasons; it’s bad enough the doctors are having to get eye level with and grab around your scrotum, but they don’t want to also be coughed on (some doctors also may ask you to cover your mouth in addition to or instead of turning your head). As to why they ask you to cough, this creates internal pressure in your abdomen. So if some of your intestines or other soft tissue is protruding through your abdominal wall into your scrotum or if there is an opening that tissue may exploit momentarily when pressure is added, coughing will help the doctor observe these things.
Once found, it used to be common for doctors to immediately recommend that the inguinal hernia be fixed via surgery, in order to avoid potentially life threatening complications, such as if the intestines become strangled, cutting off blood supply and potentially resulting in gangrenous tissue or an infection. However, this has very recently started to change to more of a “let’s keep a close eye on it” approach for many minimal cases, such as very small bulges that don’t cause pain and are “reducible” in that the tissue can be pushed back into the abdomen when pressure is applied or when the person lays down (so here the tissue isn’t being “incarcerated” or “obstructed” and chance of strangulation is minimal).
This recent switch from recommending surgery for everyone who has this to the “keep a close eye on it” approach is because there is only about .2% chance of the inguinal hernia becoming trapped, while 10%-12% of people who have this particularly hernia surgery end up having post-surgery “herniorraphy pain syndrome”, also known as “inguinodynia”, which is basically just chronic groin pain that lasts more than a few months after the surgery was performed. So if the hernia isn’t already causing pain or isn’t too severe in its size, the doctor may well simply recommend a treatment plan, which won’t actually fix it, but will help manage it.
More specifically, they are checking for something called an inguinal (inner groin) hernia, which accounts for about 70%-80% of all hernia cases and is surprisingly common in men and not nearly so much in women (lifetime risk of 27% for men vs. just 3% for women, due to the much smaller opening in women’s superficial inguinal ring than men’s). In fact, inguinal hernia surgery is one of the most common surgeries performed on kids and teenagers. Inguinal hernias happen when certain soft tissue, particularly lower intestines, starts to come through the lower abdominal wall through a small hole or tear in the wall.
So how does grabbing a guy’s balls help the doctor’s check for this? It turns out, they aren’t actually grabbing your balls, as is often eluded to in many a comedic skit. What they are doing is poking their fingers up around the inguinal canal, above the testicles. The inguinal canal runs down about where your leg and torso meet and is also the canal the spermatic cord passes through, attached to the testicles. For women, ligaments pass through this canal to help hold the uterus in place. For both sexes, the ilioinguinal nerve also passes through the inguinal canal.
The inguinal canal has some common weak spots, so doctors are feeling around these weak spots and particularly looking to see if they can feel a bulge or other indications that something is poking through that shouldn’t be, often falling into the scrotum. Besides something in a guy’s scrotum that shouldn’t be, a slight bulge might also be visible around where the upper thigh meets the groin. If either of these things happens, congratulations, you have an inguinal hernia.
As to why the doctor will then have you stand and turn your head and cough, the first part is because the hernia may well disappear when you lay down, with the tissue receding back into your abdominal cavity. The second “turn your head” part is simply for sanitary reasons; it’s bad enough the doctors are having to get eye level with and grab around your scrotum, but they don’t want to also be coughed on (some doctors also may ask you to cover your mouth in addition to or instead of turning your head). As to why they ask you to cough, this creates internal pressure in your abdomen. So if some of your intestines or other soft tissue is protruding through your abdominal wall into your scrotum or if there is an opening that tissue may exploit momentarily when pressure is added, coughing will help the doctor observe these things.
Once found, it used to be common for doctors to immediately recommend that the inguinal hernia be fixed via surgery, in order to avoid potentially life threatening complications, such as if the intestines become strangled, cutting off blood supply and potentially resulting in gangrenous tissue or an infection. However, this has very recently started to change to more of a “let’s keep a close eye on it” approach for many minimal cases, such as very small bulges that don’t cause pain and are “reducible” in that the tissue can be pushed back into the abdomen when pressure is applied or when the person lays down (so here the tissue isn’t being “incarcerated” or “obstructed” and chance of strangulation is minimal).
This recent switch from recommending surgery for everyone who has this to the “keep a close eye on it” approach is because there is only about .2% chance of the inguinal hernia becoming trapped, while 10%-12% of people who have this particularly hernia surgery end up having post-surgery “herniorraphy pain syndrome”, also known as “inguinodynia”, which is basically just chronic groin pain that lasts more than a few months after the surgery was performed. So if the hernia isn’t already causing pain or isn’t too severe in its size, the doctor may well simply recommend a treatment plan, which won’t actually fix it, but will help manage it.
This post was written by: Admin
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