Coughing as part of the abdominal exam

I went to the (real) doctors last week, and while pressing on my belly, the doctor pulled my knickers down at the front and asked me to cough.

Why did he do that?

is this normal? and why would they ask this? what would it show?

No Maddie, I think that you are the first person to ask that one here!

No idea what the answer is - I hope that someone else can come up with one.

I would just like to throw in with DrJ, yes it is to check for hernias. I don't hear ladies who get checked for that much. Don't know if it's because I just don't get to hear of it, or if they don't check woman as much? Not that, that conversation would come up much 😁

"Hey baby, Doctor check ya for that hernia?" You just don't get those conversations???? 😁

Well, anyway that's what he was checking for Maddie.

Anytime I have had a physical or seen the doctor, and he has palpated my abdomen, he has never had me cough. I know when my husband has had a physical, the doctor has held his scrotum, had him turn his head and cough. I know that the doctor is checking my husband for a hernia. I am not sure, but I think they only have women cough during an abdominal exam if they suspect a hernia.

Coughing refers to examination for hernias. I find this strange. I haven't heard before that women should do that as well during an examination. It's not a typical exam.

OK you "docs". The reason for the cough in the woman is to check for the femoral hernia, which is the most common one in women. Checking for an Umbilical hernia is also possible. The best I can describe it is if you are lying down, and you sight down your leg, the position of the femoral hernia would be above the crease in the skin where your leg joins the torso and about 1/3 to 1/2 of the way from the inside to the outside of the leg. (closer to the inside)

When you cough, there is an increase in abdominal pressure that can make a hernia visible or palpable. The doctor asks patients to turn their heads to avoid being coughed on.

Good information regarding femoral hernias SwSusie. Thanks for adding that for us "docs".

It is important for an examiner to listen to the patient carefully to avoid misunderstanding. In the start of the thread Maddie said "while pressing on my belly, the doctor pulled my knickers down at the front and asked me to cough."

From this comment I can only interpret that the physician was not palpating for a femoral hernia but rather an abdominal one. They may have also been compressing the ovaries to determine if coughing elicited pain which may be a hint of a tubal pregnancy or ovarian cyst.

While it's certainly helpful to have all this information about femoral hernias, it's clear that the test about which Maddie originally asked was the one for abdominal rather than for femoral hernia.

Thanks to everyone who answered my question...i feel a llittle better about it now!

I'm no expert but don't some women suffer from slight incontance when they cough?

I've never been asked to cough whilst my knickers are down.

Susie

Have any other females been asked to cough? At this point or any other point during the exam?

Yes, at a smear a few years ago. Nurse had speculum in and obviously could not see the cervix and asked could I give a cough please which she had to repeat as I just glanced down and said sorry, it surprised me at the time as had no clue why it was needed. Only found out later after looking it up online.

Lisa

Coughing was always a part during my abdominal exams, always when the doctors did the exam and deep thorough palpation of my (outie) navel because of my umbilical hernia. So I was ordered to cough several times when I was standing in front of the doctor while he was concentrately looking on my stomach and navel and then pressing with his finger on my navel, later when I was lying on the table, he did the same again. And of course he checked me for other hernias then, too.

I think the doctor asking you to cough while doing abdominal exam is to check for hernia- either at the umblical region or the groin

I think the doctor asking you to cough while doing abdominal exam is to check for hernia- either at the umblical region or the groin

Exactly.

Asking a patient to cough can be used in the diagnosis of Peritonitis.Peritonitis s an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness and abdominal guarding.

Which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place).

Asking a patient to cough can be used in the diagnosis of Peritonitis.Peritonitis s an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness and abdominal guarding.

Which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place).

Yes, but that is more likely to be confirmative rather than diagnostic during a routine exam.

It depends on what they are looking for I think. I know when I was rushed to the ER for abdominal pain the first thing the doctor did was check for rebound tenderness, the Blumburg sign. After they pulled me off the ceiling the doctor told me I was suffering from an appendicitis. I asked him if he was going to do other tests and he said yes, but it was only going to prove what he already knew. And he was exactly right. I really didn't need the other expensive tests after all. So he basically used rebound tenderness to form his initial diagnosis, then more invasive tests to prove his diagnosis.

Mashie

It's amazing that for decades, the doctor could diagnose appendicitis with a physical exam. Later, they would confirm it with a blood count. Somehow, the same diagnosis now needs all of the above plus a $1500 MRI and $500 ultrasound. The surgery could be over before the expensive tests are done and read by the appropriate specialist.

As Monty Python said "Get the most expensive machine in the hospital!"

Jd, you are exactly right. I think they are too afraid of being sued. Grrrrrr.

Mashie

Not to get too political, but when medicine is subsidized (yes, insurance is a subsidy), it gets increasingly expensive. Now add different layers of non-medical expenses - insurance company stock dividends, lawyers, corporations, advertising, big pharma, etc and the prices become unreachable for the average person. Now, to compete in a market that shouldn't have competition, everybody needs expensive machines - and bodies to put in them.

Insurance is not a subsidy, however both individuals and insurance companies partaking in the market place are being subsidized by the government. Competition drives prices down. The death spiral is being caused by the pre existing conditions clause of the ACA. Imagine if auto insurance companies couldn't deny coverage or charge higher premiums based on an individual's driving history. The driver with multiple at fault accidents and citations would be assessed at the same rate as the driver with no blemishes on his record. Which driver is more likely to be involved in an accident requiring a payout from his insurance company? The individual mandate was included in the legislation in an attempt to offset the costs incurred by the change in the covered population. Economics is to politics as gravity is to jumping.

Imagine if auto insurance companies couldn't deny coverage or charge higher premiums based on an individual's driving history.

Or worse yet, a driver that waits until they're in a terrible accident and THEN purchases auto insurance -- just because they can.