Diagnosing Ventral Hernia? What tests should a doctor preform?

A hernia is a true defect of the abdominal wall typically with very discreet edges often associated with an incision. The diastasis is more broad based.

In most cases, it is relatively straight forward to differentiate between a diastasis and a true hernia based on physical examination. Exceptions are patients who are significantly overweight or have had multiple prior surgeries. In those cases a CT scan is the best way to identify a ventral hernia.

Usually hernias can be diagnosed on physical exam.  In heavier patients, or those with prior abdominal surgeries I will often obtain a CT scan of the abdomen as a "roadmap" for surgery and also to define the extent of the defect and reveal any other areas of weakness that may also exist.

A rectus diastasis is simply separation of the rectus abdominis muscles away from the midline- the 'bridge' between the two muscle bundles is a thin band of connective tissue which can bulge. This is not a true hernia, since there is no 'hole' in the connective tissue of the abdominal wall. Such a hole can allow abdominal contents (fat, bowel etc) and  to enter- this is a hernia sac. The contents of a hernia sac can be entrapped, strangulated, or can just progressively enlarge over time. A rectus diastasis poses no risk of entrapment, and is therefore not considered a diagnosis covered by insurance companies.

Mr. Glass

The best way to diagnose a ventral hernia is through physical exam.  The surgeon can feel the edges of the ventral fascial defect.  Another way to make this diagnosis is through a CT or MRI scan of the abdomen - demonstrating a herniaton of abdominal contents through the ventral fascia.