Hernia checks: Why are they no longer deemed necessary beyond a certain age

"Turn your head for me and cough."

"Again."

Many of us men have experienced this since the days of our youth, perhaps years before we even knew why we were being asked to cough, why the doc was sticking his/her finger up our inguinal canal via our scrotum, what they were looking for, why we even had to turn our head (as if that the head turn triggered some kind of muscular reaction vs merely coughing in the doc's face. Hell, I turned my head while supine, when the doc wasn't even near my face. )

And then, at some point, it all STOPS.

Is it all the accusations of sexual harassment, the increasing modesty toward males to insist they wear gowns, when Gen X and older were all tighty whitey prone ? The "don't do any more than absolutely necessary mentality", driven by a combo of modesty concern, potentially sexual harassment lawsuit concern, or maybe the health insurance companies say it's not worth it beyond a certain age.

AND I BRING THIS UP BECAUSE

I visited a friend earlier this evening at a bar he owns to wish him a "happy 55th". He has been living with a hernia that has gone undetected for a while now. He has had beyond annual physicals, due to other health issues, and a recent accident in which his vehicle was struck by a drunk driver from an oncoming lane. Yet, not too long ago did they discover the hernia. And nothing he did ever triggered him to know he had one.

When I visited him to wish him a happy 55th, I noticed a fuckin weird triangle projecting from his shirt, like a pool rack had gathered the fat of his stomach together to start a game. Afraid to even go there, he eventually told me of that health complication and even alluded to it.

BUT HERE IT IS

IF you can have a hernia AND NOT EVEN KNOW IT, why isn't that something regularly checked among male patients regardless of age. I have a physical coming up soon, and I know I plan to ask my primary care about it. Whether I get an honest and/or accurate answer, based on whatever is another story.

But you folks, and this is one topic where I actually invite medical care professionals to weigh in (whereas I normally tend to discourage them, because they tend to get too fuckin obnoxious at times), why does what seems to be an all important hernia check in our youth, tend not to be important at all, enough to give that quick "turn your head and cough for me"........

I'm also wondering if there is any correlation between male and female docs, if males are more apt to perform them, while female docs not, etc.

That sounds highly irregular. There is no reason not to check for or treat hernias in older patients. The frequency of hernias increases with age and some can become very severe and life threatening problems. Some hernias like hiatal may make breathing difficult or uncomfortable in some positions, but many patients do fine without hiatal repairs. Inguinal hernias are a different story. The morbidity and mortality of herniorrhaphy is very low in adults 55 and under and the same for 80 and older in articles I have read. Repairs should be performed. Age is no bar to repairing hernias.

I am afraid I must agree.

I went to a female provider who I had been too many years ago for a physical a couple years ago, and even though I git a digital exam, there was no hernia check.

I then went to a different clinic, entirely, and was never even checked, with referrals to the Urology and Gastro services at the local teaching hospitals. I went for the urology and had everything else, testicles and rectal, but of course, no hernia since that's a general surgery section.

I am about to turn 65, and it seems that this is something that is, indeed, going on.

There is no reason not to treat hernias in older patients.

The issue here is not about "treating hernias". My friend's hernia issue is on delay due to some chemo and other complications he's dealing with.

The issue is that during physicals of older men, the hernia check is no longer being performed. When i sought a primary care when I turned 50, and for the 1st time since back when I had plant physicians who seemed to perform them automatically, i have never been checked for hernia. My friend had no idea he had a hernia. So the issue is, if patients can't tell when they in fact have a hernia, shouldn't docs be checking for them during annual physicals. And if not, why not.

And how many older men on here can say whether or not they are still being checked for a hernia.....

And how many older men on here can say whether or not they are still being checked for a hernia.....

My sub has not had any hernia checks in the last few years of yearly physical check ups. I hadn't really thought about that not being done.

I agree too, 50 now and I've not been asked to 'cough' for a number of years.

I had annual hernia checks up until about age 50, then they dropped off to every other year or so from my PCP. Around 60, my PSA jumped a bit and she referred me to a urologist who did a hernia check every year. First time he said he felt a slight bulge and said I should avoid heavy lifting and see a surgeon if I felt any pain. The next year he checked again and said everything was fine - which made me wonder(?). When I retired and got on medicare annual wellness checks didn't mandate EKGs, hernia checks, DREs, etc. but my doc said if I was concerned I could ask for any of those. I didn't see a urologist for several years after I retired, but recently saw one and he did a hernia and DRE check and advocated a yearly check.

The first urologist I saw said my testosterone was on the low side of normal and put me on Androgel. I didn't feel any change nor did my numbers increase significantly over two years. He wanted to do the pellet injections in my butt so I didn't have to use the gel on a daily basis. I opted out and eventually quit using Androgel as well. My numbers remain steady in the normal range - albeit on the low side. Has anyone out there used the pellets, and if so are they more effective or just a convenience - or a pain in the ass(!)?

I haven't had a hernia exam in over a decade- but a recent CT scan revealed 3. Primary care provider didn't even mention them in the follow up appointment. If I hadn't asked for a copy of the CT findings, I wouldn't know.

Going to a new primary care provider in 3 weeks.

The primary care doctor I was seeing for the past 20+ years always did a hernia check for my yearly physical. She retired and I saw a new doctor this year which also coincided with me starting on Medicare. As I have written about on another post, my physical this year consisted of a bunch of questions by the nurse and then the doctor came in, listened to my heart and lungs and I didn't have to take off any cloths or get any other parts of my body checked. I have been going to a urologist for about 10 years and he has never done a hernia check. I guess when you hit Medicare age, doctors figure you already have one foot in the grave and the other on the edge so there is no need to be thorough when checking our health.

The alarming thing to me is that you can actually have a hernia and not know it. Previously, I had always thought you'd be carrying something or trying to lift something, and something would happen, and you'd know right away that you must have "overdone it."

Which would be consistent with a doctor not bothering to check, as if, if you had a hernia, oh you'd know it. But then after chatting with my buddy last night on his birthday, I learned (if i didn't already know it) that you could very well have a hernia and not even know it. With no triggers or symptoms.

Which, if that being the case, why WOULDN'T docs check a patient for that, since they may not know if they had one. Unless it's something you can live with, and if it's not bothering you, then fuck it. Do people sometimes opt for that?

Ok, so let's respond to some responses.

I had annual hernia checks up until about age 50, then they dropped off to every other year or so from my PCP. Around 60, my PSA jumped a bit and she referred me to a urologist who did a hernia check every year. First time he said he felt a slight bulge and said I should avoid heavy lifting and see a surgeon if I felt any pain. The next year he checked again and said everything was fine - which made me wonder(?). When I retired and got on medicare annual wellness checks didn't mandate EKGs, hernia checks, DREs, etc. but my doc said if I was concerned I could ask for any of those. I didn't see a urologist for several years after I retired, but recently saw one and he did a hernia and DRE check and advocated a yearly check.

The first urologist I saw said my testosterone was on the low side of normal and put me on Androgel. I didn't feel any change nor did my numbers increase significantly over two years. He wanted to do the pellet injections in my butt so I didn't have to use the gel on a daily basis. I opted out and eventually quit using Androgel as well. My numbers remain steady in the normal range - albeit on the low side. Has anyone out there used the pellets, and if so are they more effective or just a convenience - or a pain in the ass(!)?

Okay, so at least in your case, checks were every other year, vs not at all. And then despite actually feeling a bulge, there was advice "to see a surgeon" - meaning someone else - IF you felt any pain. Meaning, with no pain, like fuck it, you could just leave it there and live with it.

The Androgel prescription, as you've shared with us, sounds like a pre-disposition to prescribe meds that may or may not actually even be required. As you've indicated about opting out, it hasn't really seemed to be an issue, calling into question the actual need to be on meds and for how long. Which I would expect a doc to know enough to tell you - NO, actually i expect a pharmacist to know better to give you a clue as to how long you actually need them (past history with meds, pharmacists vs docs)

I haven't had a hernia exam in over a decade- but a recent CT scan revealed 3. Primary care provider didn't even mention them in the follow up appointment. If I hadn't asked for a copy of the CT findings, I wouldn't know.

Going to a new primary care provider in 3 weeks.

Not A hernia, but THREE ? Making non medical professional me wonder, if you have them and are not even aware, is it really a problem, and maybe I may be making too much out of this.

The "going to a new primary care". Again, red flags during routine check ups, like a fixation on smoking cessation thatt occurred almost a half century ago (in my case), yet still being revisited EACH time, all these years later. And then not even checking for hernias or anything genital related for that matter. Relying solely on patient input, but as this discussion suggests, the patient may very well not know if s/he has something. And to me, why don't docs consider that (or are hernias insignificant and then is it me making them out to be more than they really are)

I guess when you hit Medicare age, doctors figure you already have one foot in the grave and the other on the edge so there is no need to be thorough when checking our health.

When you stop and think about it, that is a SCARY disposition for medical professionals to have, especially that as we age, we "perhaps" feel more reliant on them, especially as most of us want to prolong that other foot in the grave, so to speak.

listened to my heart and lungs and I didn't have to take off any clothes or get any other parts of my body checked. I have been going to a urologist for about 10 years and he has never done a hernia check.

This whole "didn't have to take off any clothes" for a physical, reeks of cutting corners for me. Or do you want to suggest an overly concern with (male) modesty, and concerns about potential sexual harassment lawsuits (how many of you have to take online sexual awareness training in your jobs >= to once a year?)

Now that being said, devil's advocate me may be able to see why a primary care would pass the buck onto a urologist, but you're saying that not even your urologist bothers with a hernia check.

Am I making too much of this ?

I totally agree and that has been my experience as well. Doctors appear to be obsessed with hernia checks for boys and teens, but not older adults. And I don't think there is a valid medical reason. I understand testicular cancer is more common 18-35 but hernias can happen at any age.

I honestly wonder if doctors enjoy their power over younger patients or enjoy embarrassing them. But don't feel the same way about older adults and just skip genital exams.

I understand testicular cancer is more common 18-35 but hernias can happen at any age. I honestly wonder if doctors enjoy their power over younger patients or enjoy embarrassing them. But don't feel the same way about older adults and just skip genital exams.

With testicular cancer, male patients are taught and encouraged to do self checks on their own. So i could understand if that is skipped during routine physicals, once the doctor and patient have had an understanding that the patient knows to check periodically.

But I would think the hernia situation is a little more complex. And it's not like docs teach their patients to do self checks for that.

Not even sure docs still do hernia checks on their younger patients. I am usually in the room during my son's physicals with his pediatrician, and he's never been asked to cough. I do know the doc reaches in and feels around, though what she's doing at that point is never acknowledged, as she usually is talking about something unrelated.

My primary care internist (female) does a hernia exam on me each and every year during my annual physical. That may be partly due to the fact that I had bilateral inguinal surgery decades ago to repair my hernia. She may simply feel that it needs to be monitored. Or she is just particularly thorough.

I still get a hernia exam at every physical exam. Not sure why you aren't getting checked for that. Maybe you need a new doctor.

I've only had one doctor years ago who skipped the hernia exam and did that twice. But I got a rectal exam both times from the same doctor. My current doc who I've seen for several years always checks me for a hernia. I assume that a hernia can develop at any age and that they might even be more common as men get older.

Never had the "pleasure" of having the "hernia exam". I was six months old in 1962 when I was operated on to repair a hernia issue. As it was in my medical records as a youth, my pediatrician never needed to check. At a military physical, I was skipped as well as I noted the surgery on the form I had filled out prior.

Never ever have had it done in any medical exam.

I haven't had a hernia exam in years - but a recent CT scan revealed 3. Primary care provider didn't even mention them in the follow up appointment. If I hadn't asked for a copy of the CT findings, I wouldn't know.

Going to a new primary care provider in 3 weeks.

Not A hernia, but THREE ? Making non medical professional me wonder, if you have them and are not even aware, is it really a problem, and maybe I may be making too much out of this.

The "going to a new primary care". Again, red flags during routine check ups, like a fixation on smoking cessation thatt occurred almost a half century ago (in my case), yet still being revisited EACH time, all these years later. And then not even checking for hernias or anything genital related for that matter. Relying solely on patient input, but as this discussion suggests, the patient may very well not know if s/he has something. And to me, why don't docs consider that (or are hernias insignificant and then is it me making them out to be more than they really are)

-- -- -- -- --

I should add, that the hernias (umbilical and bilateral inguinal) are believed to be the result of robotic abdominal surgery 3 years ago - I guess the small incisions never completely healed. No real symptoms except occasional discomfort that I associated with kidney stones passing. No ripping pain, no lumps or "pop-outs" when lifting something. Surgeon said that he could fix them, but deferred to me - said, if they're not bothering you...

My doc did a few in the early years but as we both got older they seemed to stop. He assumed I knew what one was so he just asked me if I had one and when I said no he went on to other things. The exams never really bothered me. I can still chuckle about the first time I had one done with another boy for the scouts and he forgot to turn his head and coughed right in the doctors face. He wasn't pleased.

Never had one here, and I’ve never heard any of my friends talking about that either, seems it’s not the norm here..

I’ve never had the “turn your head and cough” in an exam. I’m almost 30 so i must’ve been just past when that was the case as it seems like many PCPs are switching to more interview and history based physicals. I even had a doctor ask if I’d had a hernia and I responded “I don’t think so” in an attempt to see if they’d check and they never did. Very interesting how things change and advance.

It's been long enough so I don't remember when my last cough test was. Apparently it's a youthful thing.

I think it’s more of a cultural difference than age. I had the first one at 19 during military recruitment. When I go to my GP, he does not examine my genitals.

I had it again during a full check-up at 56, it was a doctor specializing in sports medicine, I think with him it was a habit. Sometimes also at the urologist, but this is not systematic.

My little mind surmised that younger - athletic and active males - were more susceptible to hernias and that's why doctors tended to not check as we aged. WRONG AGAIN DIPSHIT!!

"Among adults, the chance of having an inguinal hernia increases with age, and inguinal hernias are most common in people ages of 75 to 80.2"

https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia#tests

It seems irresponsible for a doctor to NOT check for older males!

"Among adults, the chance of having an inguinal hernia increases with age, and inguinal hernias are most common in people ages of 75 to 80.2"

Maybe, if you're 75 to 80, the doctor IS checking you for a hernia. It's just that you're so old, you're forgetting it!

My little mind surmised that younger - athletic and active males - were more susceptible to hernias and that's why doctors tended to not check as we aged. WRONG AGAIN DIPSHIT!

It seems irresponsible for a doctor to NOT check for older males!

I think I would know if I had one and not sure how critical or dangerous they are anyway, especially over 70. I had a friend that knew he had one and joined the Marines and they didn't catch it. He told them a couple years later so he could get out of a 10 mile run so it obviously didn't bother him much.

Maybe, if you're 75 to 80, the doctor IS checking you for a hernia. It's just that you're so old, you're forgetting it!

That's why we should all get the new high-tech watch that tells you not only WHERE you are but WHY you are there! 😄

That's why we should all get the new high-tech watch that tells you not only WHERE you are but WHY you are there! 😄

I want one of those.

No, I NEED one of those.

I want one of those.

No, I NEED one of those.

@Roscoe - One of what?? I forgot what we were talking about! 😄

I believe the reason some doctors don't check for inguinal hernias anymore is because they don't treat them unless the patient is symptomatic, in which case the patient would bring the symptoms to the doctor's attention. None the less, the doctor should still be examining the testicles for signs of testicular cancer.

Mine still checks for them