What Is a Hernia? Direct vs Indirect Inguinal Hernias

An inguinal hernia happens when part of your intestines or intestinal fat pushes through a weak area of muscle and forms a lump outside your abdomen. Direct and indirect inguinal hernias occur differently, but the symptoms and the treatment are the same.

direct vs indirect inguinal hernia symptoms

Inguinal hernias occur in about 25% of men. It may begin as a painless bulge, but it must be treated before it becomes strangulated. 

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Abdominal hernias are caused by an internal organ pushing through the muscular wall of the abdomen. If the hernia is near your belly button, it is called an umbilical hernia. If the hernia is in your groin area – also called the inguinal area – the hernia is called an inguinal hernia.

An inguinal hernia pushes through the weak or partially open area of muscle at the bottom of your abdominal wall, called the inguinal canal. The abdominal organs that push through the inguinal canal can be a loop of the small intestine, intestinal fat, or sometimes part of a woman’s reproductive system, like an ovary. There are two types of inguinal hernia:

  • An indirect inguinal hernia is caused by an opening in the inguinal canal that is there when you are born because the inguinal canal never closed properly. Contents of the abdomen may push through at birth or in childhood, but often the hernia does not occur until adult years.
  • A direct inguinal hernia is not caused by an opening at birth. The opening has closed but may be weak. Over time, the stress of lifting and straining pushes abdominal contents through the weak area to cause the hernia. This type of hernia usually occurs in older men.

Hernias usually occur on one side, more commonly the right side. It is also possible to have inguinal hernias on both sides. The contents of the hernia may push through and slip back into the abdomen on their own. Sometimes a hernia can be pushed back into the abdomen.

A hernia that gets stuck outside the abdomen and can’t be pushed back is called an incarcerated hernia. An incarcerated hernia may twist or compress the blood vessels that supply it with blood. This is the most dangerous type of hernia, called a strangulated hernia. Contents of the hernia will quickly start to die without a blood supply and the intestine will become blocked. This can be a life-threatening situation that requires emergency surgery.

Who Is Affected by Inguinal Hernias?

Inguinal hernias are common. They occur in about 25 percent of men. They are less common in women, but inguinal hernias in women are possible. Only between 2 to 3 percent of women will get an inguinal hernia. In babies and children, indirect inguinal hernias are common up to age five. Direct inguinal hernias are more common with increasing age and are most common in men between ages 75 and 80. People with a family history of inguinal hernia are at higher risk. Other risk factors include smoking and previous abdominal surgery.

Inguinal Hernia Symptoms

Indirect and direct inguinal hernias have the same signs and symptoms. They include:

  • A bulge may be felt or seen in the groin area, or in the scrotum in males. The bulge may be painless and it may go away when you lie down.
  • There may be a feeling of pain, heaviness, or burning in the groin, that gets worse with lifting, straining, coughing, or standing for a long time.
  • A strangulated hernia may cause sudden and severe pain, fever, nausea, and vomiting. The hernia lump may become larger, red, and very painful to touch.

Inguinal Hernia Repair

The only treatment for an inguinal hernia is surgery. If you have an inguinal hernia that comes and goes and does not cause any symptoms, you may be able to delay surgery for a while, called watchful waiting. However, inguinal hernias do not heal by themselves. Because of the danger of a strangulated hernia, surgery is almost always the best treatment. Two types of surgery are available.

Open hernia surgery is done by making an incision in the groin area. The hernia is placed back into the abdomen and the opening is closed with sutures. In some cases, a synthetic mesh is sutured into the repair to strengthen it.

Laparoscopic hernia surgery does the same repair through a few tiny incisions using a thin operating scope with a camera and surgical instruments that operate through the incisions. Mesh can also be used during laparoscopic surgery.

Both types of hernia surgery are usually safe and effective. Possible complications include bleeding or infection. Complete recovery from hernia surgery takes a few weeks. You may need to take pain medication during that time and avoid heavy lifting and strenuous activity. Most people can return to their usual activity in three to five days.

Inguinal hernia is a common condition, especially for men. If you have any symptoms of inguinal hernia, let your doctor know. In almost all cases, the best treatment is surgery. A strangulated inguinal hernia is a surgical emergency. If you have symptoms of a strangulated hernia you need to get help right away.

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Chris Iliades, MD

Dr. Chris Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery from the American Board of Otolaryngology and Head and Neck Surgery. He holds a medical … Read More

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