For inguinal hernias, most patients notice a feeling of fullness or a lump in the groin area with pain and burning. Physical examination can usually confirm the diagnosis. Femoral or obturator hernias are more difficult to appreciate and symptoms of recurrent inguinal or pelvic pain without obvious physical findings may require a CT scan to reveal the diagnosis. Umbilical hernias are much easier to locate with the bulging of the belly button.

Hernias that are incarcerated or strangulated present a greater challenge since the potential complication of dead bowel increases the urgency. The health care professional seeks clues of obstruction, including a history of pain, nausea, vomiting, or fever. During a physical examination, a doctor may often discover that a patient has a markedly tender abdomen. These hernias are often exquisitely tender and firm. The exam may be enough to suspect incarceration or strangulation and require immediate consultation with a surgeon. Doctors may use X-rays or CT scans to confirm the diagnosis, depending upon the clinical situation.

Doctors may be able to diagnose hiatal hernias associated with GERD by learning a patient's medical history during his or her physical exam. A chest X-ray can reveal part of the stomach within the chest. If there is concern about complications including esophageal inflammation (esophagitis), ulcers, or bleeding, a gastroenterologist may need to perform an endoscopy.