Inguinal hernias may be direct or indirect. The difference is in the anatomical location. Direct hernias protrude through the posterior (back) wall of the inguinal canal. Indirect hernias protrude through the inguinal ring.
Indirect hernias are often congenital, whereas direct hernias are due to heavy lifting or straining.
Learn more about the symptoms, causes, and treatment of indirect and direct hernias. Then, make sure to see a healthcare professional for a diagnosis so that you can receive the proper treatment.
Symptoms
Indirect and direct inguinal hernias are similar in that they both present as bulges in the groin area. They also are both caused by organs pushing through the inguinal canal. However, indirect and direct hernias occur in different locations.
The symptoms of indirect and direct hernias are similar. They include:
A bulge in the groin areaA bulge in the scrotumPain or burning in or around the groin
Causes
Although the symptoms of indirect and direct inguinal hernias are similar, the underlying causes are different.
Indirect Inguinal Hernias
Indirect inguinal hernias are often present at birth. They are more common in babies with testicles. These hernias occur when one or both of the inguinal canals do not close during fetal development.
This failure to fully close can result in organs in the abdomen being pushed outward. Certain genes may increase the risk of developing inguinal hernias.
While most indirect inguinal hernias are congenital (meaning present at birth), they don’t always show up in infancy or even childhood. Therefore, an adult may be diagnosed with an indirect inguinal hernia that wasn’t present at birth but appears later in life. This might occur due to an acquired weakness of the inguinal ring.
Direct Inguinal Hernias
Direct inguinal hernias occur along the back wall of the inguinal canal. They are the result of a weakened inguinal canal wall that happens as a person ages. They often are caused by straining or lifting something heavy.
Like indirect hernias, direct hernias are also more common in people with testicles. In fact, 27% of people with testicles will develop an inguinal hernia in their lifetime, while only 3% of people with ovaries will. Those over 40 are most at risk of developing this type of hernia.
Diagnosis
Doctors diagnose indirect and direct inguinal hernias through a physical exam and sometimes through radiological tests. Your doctor will begin by taking a medical history.
Connective tissue disorders (tissues that support or protect the body’s other tissues and organs) Chronic cough Chronic constipation Doing heavy lifting Regularly standing or walking for long periods A family history of inguinal hernias
A physical exam involves visually observing the area and palpating (touching and pressing) to try to feel for a hernia. You will be asked to stand for the exam since the hernia may be more prominent when standing.
For those with testicles, your doctor will ask you to cough while they examine your scrotum. This will allow the doctor to feel the hernia move in and out.
If your doctor needs further confirmation, they may order certain tests. Tests used for diagnosing hernias include:
Ultrasound Computed tomography (CT) scan Magnetic resonance imaging (MRI) scan
Treatment
Inguinal hernias do not heal on their own and can grow larger over time. That’s why surgical repair is the only treatment for inguinal hernias. Worldwide, more than 20 million people undergo surgery for groin hernias every year.
Indirect and direct inguinal hernia surgery involves two steps:
Of those who delay surgery, 70% will require surgery within five years.
Moving the herniated tissue back into placeRepairing the weak area where the hernia occurred (in indirect cases, this involves closing the inguinal canal)
The type of surgery your doctor recommends depends on your age and overall health. Common surgical procedures are:
Open surgery: Your doctor will make an incision in your abdomen to locate and repair the hernia. The surgeon may use stitches and a piece of mesh for extra support when closing the abdominal wall. Laparoscopic surgery: This is done by making several tiny holes in the abdomen. Your doctor will then insert special tools that will allow the surgeon to see the hernia and repair it. Mesh may also be used during this surgery.
Both types of surgery are done under general anesthesia by a general surgeon or colorectal surgeon. Inguinal surgery repair is usually outpatient, meaning that you will be able to go home the same day.
Prevention
Since indirect inguinal hernias are often congenital, it is not possible to prevent them. However, there are some steps you can take to lower your risk of developing a direct inguinal hernia, including:
Be careful when lifting heavy things. Don’t strain when having a bowel movement. Treat constipation (difficulty moving your bowels). Treat a persistent cough. Get treatment if you must strain to urinate. Maintain a weight that is healthy for you.
Summary
Direct inguinal hernias occur through the posterior (back) wall of the inguinal canal, while indirect hernias protrude through the inguinal ring. Indirect inguinal hernias are often congenital, which means they are sometimes, though not always, diagnosed at birth.
Both types of inguinal hernias are more common in people with testicles. The chief symptom is a bulge in the groin or scrotum, and there may be associated pain. Diagnosis is by physical examination and may be confirmed with imaging. Then, surgery is needed to correct the problem.
A Word From Verywell
Rest assured that inguinal hernias are quite common. Most often, they are nothing to be alarmed about. That said, if you notice a bulge in your groin or your child’s groin, it is important to have it evaluated by a doctor. The only treatment for indirect and direct inguinal hernias is surgery.
In this case, the inguinal canal, which runs on either side of the abdomen to the groin, did not close. When that happens, part of the internal abdominal organs pushes through that canal, causing a bulge in the groin area.
Direct inguinal hernias are also more common in people with testicles. That’s because they have a wider inguinal canal than those with ovaries. As a result, over time, the canal is more likely to stretch out and become weak.
