Direct vs. Indirect Hernia

Medically Reviewed on 8/8/2023

What are inguinal hernias?

Direct and indirect hernias are types of inguinal hernias.
Direct and indirect hernias are types of inguinal hernias.

Inguinal hernias are the most common type of hernias. They occur when tissues protrude through a spot in the abdominal muscles. Frequently, this tissue will be part of the intestine.

Inguinal hernias are not dangerous itself but can lead to significant complications especially if the intestinal tissue loses its blood supply. Usually, the hernia can be pushed back in or even slides back when the patient lays down. If the hernia cannot be pushed back in, it is considered incarcerated (the contents of the hernia are trapped). This will usually lead to severe pain, as well as nausea and vomiting. If the blood supply is cut off, the hernia is considered strangulated. A strangulated hernia is life-threatening and requires immediate surgery.

Inguinal hernias are divided into direct and indirect hernias.

What is a direct and indirect hernias?

Direct hernia

These inguinal hernias are usually caused by weakness in the muscle of the abdominal wall. The weakness can be due to an acute event (heavy lifting) or slowly develop over time.

Most commonly, this hernia is found in adult males.

Indirect hernia

An indirect hernia is caused by a birth defect in the abdominal wall.

What are causes and risk factors of direct and indirect hernias?

The hernias usually appear after increased abdominal pressure, such as straining or lifting a heavy object. Often they are linked to a weak spot in the abdominal wall that can be present since birth or secondary to abdominal surgery, injuries, or develop over time.

In men, the weakness usually is found in the inguinal canal that leads down into the scrotum.

Risk factors for inguinal hernias are older age, obesity, being male, and having a family history of a hernia. Chronic cough and pregnancy are also risk factors.

What are signs and symptoms of direct and indirect hernias?

A bulge is usually visible in your inguinal area (groin). This bulge might become more obvious on standing or when lifting or coughing (straining). There might be pain or discomfort in the groin. If the hernia is pushed into your scrotum, pain and swelling around the testicle will be present.

In newborns, the hernia might be visible when the child cries or coughs.


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What is the diagnosis and treatment for direct and indirect hernias?

Your doctor can usually diagnose an inguinal hernia by physical examination alone. A bulge will be apparent in your groin while standing. Coughing will help show the bulge.

Should the hernia not be readily visible, your doctor might order a CT scan or MRI.

If the hernia is not painful and not too large, you can choose to watch it without any specific therapy. Depending on your lifestyle and the discomfort level, you might choose surgery to fix the hernia.

An enlarging hernia, or significant pain, will usually require surgery to alleviate the symptoms.

Any hernia that cannot be reduced (pushed back in) will require surgery.

Hernia repair can take place in two different ways: open hernia repair and laparoscopic repair.

The open procedure requires an incision, pushing the hernia back in, and then repairing the weak area.

During the laparoscopic procedure, the surgeon will repair the hernia via several small incisions and guidance by a small camera inserted through one of the incisions.

What is the prognosis for direct and indirect hernias?

The repairs of inguinal hernias are usually successful with minimal complications and reoccurrences.

Is it possible to prevent direct and indirect hernias?

In many cases, it is impossible to prevent inguinal hernias as the weakness in the abdominal wall is present since birth. Avoiding straining, heavy lifting, and treating chronic cough can be helpful preventive measures.

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Medically Reviewed on 8/8/2023
Bhandarkar, Deepraj S., Manu Shankar, and Tehemton E. Udwadia. "Laparoscopic surgery for inguinal hernia: Current status and controversies." J Minim Access Surg 2.3 September 2006: 178-186.