In general, the physical examination should be performed with the patient in both the supine and standing positions, with and without the Valsalva manoeuvre.
The examiner should attempt to identify the hernia sac, as well as the fascial defect through which it is protruding. This allows the proper direction of pressure for reduction of hernia contents. The examiner should also identify evidence of obstruction and strangulation.
The first step in attempting to identify a hernia is to look for swelling or mass in the area of the fascial defect. A fingertip is placed into the scrotal sac and advanced upward into the inguinal canal