Direct vs. Indirect Inguinal Hernia: What Are the Differences?

Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPreventionFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Prevention

Frequently Asked Questions

Aninguinal hernia, which occurs when organs push through weak areas of the abdominal muscles, can be direct or indirect.

The difference between indirect and direct inguinal hernias is in the anatomical location. Direct hernias protrude through the posterior (back) wall of the inguinal canal (passages that run down the lower abdomen on either side of the groin). Indirect hernias protrude through the inguinal ring (at the end of the inguinal canal).

Verywell / Michela Buttignol

Indirect hernias are often congenital (meaning present at birth), whereas direct hernias are due to heavy lifting or straining.

This article will discuss the symptoms, causes, diagnosis, and treatment of indirect and direct hernias.

Symptoms of Direct and Indirect Hernias

Direct hernias protrude through the back wall of the inguinal canal, while indirect hernias protrude through the inguinal ring.

The symptoms of indirect and direct hernias are similar. They include:

When You Notice SymptomsSymptoms may only be noticeable or be worse when coughing or straining. They improve when you rest or lie down.

When You Notice Symptoms

Symptoms may only be noticeable or be worse when coughing or straining. They improve when you rest or lie down.

Causes of Direct and Indirect Hernias

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, 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.

Pregnancy Hernia: Formation During Trimesters or After Delivery

Direct Inguinal Hernias

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.

Risk FactorsCertain people are more at risk of developing direct inguinal hernias. Risk factors include:Connective tissue disorders(tissues that support or protect the body’s other tissues and organs)Chronic coughChronic constipationDoing heavy liftingRegularly standing or walking for long periodsA family history of inguinal hernias

Risk Factors

Certain people are more at risk of developing direct inguinal hernias. Risk factors include:Connective tissue disorders(tissues that support or protect the body’s other tissues and organs)Chronic coughChronic constipationDoing heavy liftingRegularly standing or walking for long periodsA family history of inguinal hernias

Certain people are more at risk of developing direct inguinal hernias. Risk factors include:

Other Causes of an Abdominal Lump

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Diagnosing 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:

What to Do About a Groin Hernia

Treatment for Inguinal Hernias

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.

Watchful WaitingFor adults who do not have significant symptoms, a doctor may use watchful waiting, which is closely monitoring but not giving treatment. However, it’s important to note that watchful waiting is not an alternative to surgery but rather a delay in receiving surgical repair.Of those who delay surgery, 70% will require surgery within five years.

Watchful Waiting

For adults who do not have significant symptoms, a doctor may use watchful waiting, which is closely monitoring but not giving treatment. However, it’s important to note that watchful waiting is not an alternative to surgery but rather a delay in receiving surgical repair.Of those who delay surgery, 70% will require surgery within five years.

For adults who do not have significant symptoms, a doctor may use watchful waiting, which is closely monitoring but not giving treatment. However, it’s important to note that watchful waiting is not an alternative to surgery but rather a delay in receiving surgical repair.

Of those who delay surgery, 70% will require surgery within five years.

Indirect and direct inguinal hernia surgery involves two steps:

The type of surgery your doctor recommends depends on your age and overall health. Common surgical procedures are:

Strangulated HerniaInguinal hernias are usually not a cause for alarm. However, a strangulated hernia, in which blood flow to trapped tissue is cut off, can lead to life-threatening complications. The World Society of Emergency Surgery (WSES) recommends immediate emergency surgical hernia repair when strangulation is suspected.

Strangulated Hernia

Inguinal hernias are usually not a cause for alarm. However, a strangulated hernia, in which blood flow to trapped tissue is cut off, can lead to life-threatening complications. The World Society of Emergency Surgery (WSES) recommends immediate emergency surgical hernia repair when strangulation is suspected.

Preventing Inguinal Hernias

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:

Different Types of Hernia in Men

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.

Frequently Asked QuestionsIndirect inguinal hernias in babies are congenital. This means that during fetal development, something did not develop completely.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.Inguinal hernias are quite common. In fact, 27% of people with testicles and 3% of people with ovaries will develop an inguinal hernia in their lifetime.Indirect inguinal hernias are more common in babies with testicles. That’s because testicles begin developing inside the abdomen and must travel down through the inguinal canal to reach the scrotum.When this canal doesn’t close before birth, a hernia can develop.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.No. Inguinal hernias do not go away on their own. Therefore, surgery is the only solution for indirect and direct inguinal hernias.

Indirect inguinal hernias in babies are congenital. This means that during fetal development, something did not develop completely.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.

Indirect inguinal hernias in babies are congenital. This means that during fetal development, something did not develop completely.

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.

Inguinal hernias are quite common. In fact, 27% of people with testicles and 3% of people with ovaries will develop an inguinal hernia in their lifetime.

Indirect inguinal hernias are more common in babies with testicles. That’s because testicles begin developing inside the abdomen and must travel down through the inguinal canal to reach the scrotum.When this canal doesn’t close before birth, a hernia can develop.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.

Indirect inguinal hernias are more common in babies with testicles. That’s because testicles begin developing inside the abdomen and must travel down through the inguinal canal to reach the scrotum.When this canal doesn’t close before birth, a hernia can develop.

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.

No. Inguinal hernias do not go away on their own. Therefore, surgery is the only solution for indirect and direct inguinal hernias.

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Diabetes and Digestive and Kidney Diseases.Inguinal hernia.Johns Hopkins Medicine.Inguinal hernia.National Library of Medicine. Medline Plus.Lump in the abdomen.HerniaSurge Group.International guidelines for groin hernia management.Hernia. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-xBirindelli A, Sartelli M, Di Saverio S et al.2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.World Journal of Emergency Surgery. 2017;12(1). doi:10.1186/s13017-017-0149-yStanford Children’s Health.Inguinal hernia.

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Diabetes and Digestive and Kidney Diseases.Inguinal hernia.Johns Hopkins Medicine.Inguinal hernia.National Library of Medicine. Medline Plus.Lump in the abdomen.HerniaSurge Group.International guidelines for groin hernia management.Hernia. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-xBirindelli A, Sartelli M, Di Saverio S et al.2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.World Journal of Emergency Surgery. 2017;12(1). doi:10.1186/s13017-017-0149-yStanford Children’s Health.Inguinal hernia.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute of Diabetes and Digestive and Kidney Diseases.Inguinal hernia.Johns Hopkins Medicine.Inguinal hernia.National Library of Medicine. Medline Plus.Lump in the abdomen.HerniaSurge Group.International guidelines for groin hernia management.Hernia. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-xBirindelli A, Sartelli M, Di Saverio S et al.2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.World Journal of Emergency Surgery. 2017;12(1). doi:10.1186/s13017-017-0149-yStanford Children’s Health.Inguinal hernia.

National Institute of Diabetes and Digestive and Kidney Diseases.Inguinal hernia.

Johns Hopkins Medicine.Inguinal hernia.

National Library of Medicine. Medline Plus.Lump in the abdomen.

HerniaSurge Group.International guidelines for groin hernia management.Hernia. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-x

Birindelli A, Sartelli M, Di Saverio S et al.2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.World Journal of Emergency Surgery. 2017;12(1). doi:10.1186/s13017-017-0149-y

Stanford Children’s Health.Inguinal hernia.

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