The squat and cough test is a straightforward, non-invasive maneuver frequently used by medical professionals during a physical examination. This diagnostic tool provides immediate, observable evidence of underlying issues. By temporarily creating forceful stress on the body’s core structures, the maneuver helps clinicians assess the integrity of the abdominal wall and the pelvic floor. It is a quick method to screen for conditions where internal organs or tissues may be protruding or failing to contain internal pressure.
Defining the Squat and Cough Maneuver
The maneuver involves the patient performing a sharp, forceful cough while the clinician observes or palpates a specific area. While a full squat is sometimes used to increase abdominal engagement, the test is often performed standing or leaning over, depending on the area being examined.
For diagnosing hernias, the patient may stand while the physician places a finger over the suspected area, such as the groin. For pelvic floor assessment, the patient is typically asked to cough while the physician observes the pelvic area for signs of leakage or descent. The instruction must be clear, aiming for a single, explosive expulsion of air, as this intense muscular effort generates the necessary diagnostic information.
The Physiological Mechanism
The effectiveness of this test is rooted in its ability to rapidly and significantly elevate intra-abdominal pressure (IAP). A sharp cough is a reflex action involving the coordinated contraction of the abdominal, thoracic, and pelvic muscles. This simultaneous contraction compresses the abdominal and pelvic contents, increasing the pressure within the abdominal cavity.
This sudden pressure surge can be substantial, sometimes exceeding IAP values produced during heavy weightlifting. The pressure pushes outward against the surrounding muscular and fascial walls. If these containment structures are compromised, the sudden increase in pressure forces internal contents through the defect, making the issue visible or palpable to the clinician.
Conditions Assessed by the Test
Hernias
The most common application of the cough maneuver is in the assessment of hernias, particularly in the groin area. A hernia occurs when an organ, such as a loop of intestine, pushes through a weak spot in the surrounding muscle or tissue.
When the patient coughs, the spike in intra-abdominal pressure forces the herniated tissue further into the defect, creating a visible or palpable bulge known as a “cough impulse.” This impulse helps confirm the presence of inguinal, femoral, or umbilical hernias. For example, an inguinal hernia is felt in the groin as tissue passes through the inguinal canal, while an umbilical hernia appears near the navel.
Pelvic Floor Dysfunction
The maneuver is also a standard component of the urogynaecological examination to assess pelvic floor function, often referred to as a “cough stress test.” By increasing IAP, the maneuver stresses the muscles and ligaments supporting the bladder, uterus, and rectum.
If the urethral sphincter is weakened, the sudden pressure can overcome its resistance, resulting in involuntary urine loss, known as stress urinary incontinence (SUI). The physician observes for any immediate leakage of urine during the cough.
The action is also used to assess pelvic organ prolapse (POP), where pelvic organs descend from their normal position. The pressure from the cough can cause the bladder, uterus, or rectum to visibly descend or bulge into the vaginal canal. This observation allows the clinician to determine the severity and specific compartment of the prolapse.