A careful history is necessary in all patients being considered for inguinal hernia repair. Symptoms which deserve investigation and appropriate treatment prior to proceeding with inguinal hernia repair include:

a. Chronic cough

b. Urinary hesitancy and straining

c. Change in bowel habit

The history and physical examination are almost exclusively the diagnostic modalities used for diagnosis and delineation of hernias. Chronic trauma in the form of overstretching of musculoaponeurotic structures is likely to be the significant factor in spontaneously occurring hernias. Failure to recognize underlying pathology contributing to symptoms of abdominal straining may both increase the risk of recurrent hernia as well as miss significant existing pathology. A chronic cough from chronic obstructive pulmonary disease should be investigated and attempts made to control symptoms. Significant obstructive uropathy may warrant urologic consultation and treatment prior to hernia repair. Such treatment is important both to prevent postoperative urinary retention, as well as persistent straining on the newly-completed repair. Change in bowel habits with constipation or the presence of blood associated with bowel movements may suggest a rectal or left-sided colon cancer. Patients frequently relate a specific episode of muscular straining during which a sudden discomfort occurs followed by hernia symptoms of discomfort or a bulge. There is little evidence to suggest that such a specific acute event can precipitate a hernia. A history of heavy lifting is important, however, in both planning of postoperative disability as well as consideration for long-term recurrence rates.