Facts you should know about direct vs. indirect hernias

- Approximately 800,000 hernia surgeries are performed every year in the U.S.
- Inguinal hernias are diagnosed by physical examination.
- Surgery (laparoscopic or open technique) is the standard treatment for a hernia.
- Hernia compilations can range from minor pain to a need for emergency surgery.
What are 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 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.
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 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.
How do health care professionals diagnose hernias, and what is the 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.

SLIDESHOW
Pelvic Pain: What's Causing Your Pelvic Pain? See SlideshowIs 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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Can You Heal a Hernia Without Surgery?
While non-surgical approaches such as wearing a corset, binder, or truss may exert gentle pressure on the hernia and keep it in place, a hernia usually does not go away without surgery. Conservative or non-surgical management should strictly be done under a doctor’s supervision because they may lead to complications such as bowel obstruction and strangulation.CT Scan (Computerized Tomography)
A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.Chronic Cough
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease.Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
Hernia (Abdominal Hernia)
A hernia occurs when an organ or piece of tissue protrudes from the space in which it is normally contained. Symptoms of a hernia include pain, nausea, vomiting, bowel obstruction, and fever. Hernias are diagnosed by a physical exam and imaging tests. Some hernias may be held in place with a supportive belt. Other hernias require surgical repair. The prognosis of people who undergo elective hernia repair tends to be good.Hernia Quiz: Test Your Medical IQ
Exactly what is a hernia and why do we get them? Take this quiz to learn causes, symptoms, treatments and home remedies for this common condition.Hernias: Causes, Types, and Treatments
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A laparoscopic inguinal hernia repair is a routine surgery to repair a weakness or perforation in the muscle or tissue in the abdominal cavity. Most people can return to normal activities in two weeks, but may need to avoid heavy lifting.MRI (Magnetic Resonance Imaging Scan)
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.Nausea and Vomiting
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