Difference Between Direct And Indirect Hernia

Hernia is a protrusion of an internal organ through the weak tissues that surround it. It has some clinical features such as:

  • Lump at the abdominal site
  • Increases in size on coughing or straining
  • Size reduces when in a relaxing position

A hernia can be categorized into two types-

  • Direct hernia
  • Indirect hernia

What is Direct Hernia?

This is a type of hernia that develops over time due to the weakening of the abdominal muscles. This is the most common type of hernias that develop in males.

As the inguinal canal is smaller in women, this type of hernia is less likely to occur in females. Moreover, there is an additional barrier along the inguinal canal in women. This also prevents from developing a direct hernia.

Causes of Direct Hernia

The most common causes of developing direct hernia are- aging and stress. Excessive straining can also weaken the inguinal canal. 

What is an Indirect Hernia?

This is a type of hernia that commonly develops in children. It is more common amongst children because it is a defect in the abdominal wall that is present since birth. 

Causes of Indirect Hernia

When the fetus is growing inside a mother’s womb, there is an opening on the inguinal canal that closes before birth. 

Sometimes when the opening doesn’t get closed, there are chances that a part of the intestine or other developing organs can slip through, causing a hernia. 

Other causes of Direct and Indirect Hernia

  • Lifting heavyweights
  • chronic constipation
  • Smoking
  • Being overweight

Inguinal Hernia

There are different types of hernia – Inguinal, Femoral, Umbilical, Incisional and Hiatal. Inguinal hernias are the most common type of hernia that can occur. In this type of hernia, there is the protrusion of a part of the intestine in the groin area through the weak spot.

They occur in the inguinal canals and may extend to the scrotum in males. If you are not able to push back the hernia, the content of the hernia can get trapped in the abdominal wall. This is also known as incarceration.

Inguinal hernias are not dangerous in itself but may lead to significant complications when the blood flow stops to the intestine. It is known as strangulation. The symptoms of strangulation may be nausea, vomiting, fever, sudden pain, inability to bowels and/or hernia bulge turning red or dark.


To make you understand, the area between the hip and the chest is known as the abdomen. The lower abdominal wall is the inguinal region, also known as the groin. The hernia may get back to its place when the person lays down. The risk of hernia increases if you are overweight or you smoke or have a family history of hernias.

Inguinal hernia can be of two types:

  • Indirect inguinal hernia
  • Direct inguinal hernia
Direct-indirect hernia

Indirect hernia is caused by the birth defect in the abdominal wall. A direct hernia is usually seen in adult males. It is caused by weakness in the abdominal wall that develops over time due to lifting heavy weight or straining. Direct hernia is common at later stages of life as the abdominal wall weakens with age.

Difference between Indirect and Direct Inguinal hernia

Indirect Inguinal HerniaDirect Inguinal Hernia
Usually seen in children and young adultsCommon in elder people mostly above 40 years of age
It may be congenitalIt comes along with age when straining or lifting heavy objects
Can descend into the scrotumCannot descend into the scrotum
Pass through the inguinal canalBulge from the posterior wall of the inguinal canal
It appears as an elliptical swellingIt appears as a circular, symmetric swelling at the external ring
Reduces upward then laterally and then backwardsReduces upward and then straight backward
It is not that noticeable as it is behind the fibers of the external muscleIt may be felt in the abdominal wall
The reduction of the indirect hernia can be controlled by pressure over the internal ringReduction cannot be controlled in case of the direct hernia
On standing, indirect hernia takes time to reach to its complete sizeDirect hernia appears immediately on standing
Similarly, on lying down, there is a delay before the indirect hernia retracts fullySimilarly, direct hernia disappears immediately
After the reduction, the bulge appears in the middle of the inguinal region before turning to the scrotumAfter reduction, the protrusion appears exactly where it was before

How do doctors Diagnose Direct and Indirect Hernia?

To diagnose a hernia-whether direct or indirect- the doctor simply performs a physical examination. He can ask the patient to stand and then cough or strain. 

For further diagnosis, the doctors also recommend some imaging tests to check where the hernia is located

  • Ultrasound
  • Abdominal x-ray
  • CT scan

Treatment of Direct and Indirect Hernia

Hernias do not go away on their own, they need surgery in the future whether it is a direct or indirect hernia. Surgery for indirect hernia is usually safe in infants and children. The hernia sac moves away from the scrotum and closes with sutures. In adults, there are two approaches to repair a direct hernia, open surgery and laparoscopic surgery.

In open surgery, the surgeon makes a large incision and places hernia back to its place. The repairing of the abdominal wall takes place and sometimes he places a mesh to strengthen the abdominal wall.

 Laparoscopic surgery is a growing option for abdominal surgeries including hernia operation where doctors make few small incisions instead of one large cut. A thin telescope-like instrument helps to see inside the abdomen and treat the hernia. Laparoscopic surgery is preferred over open surgery to treat the hernia as it is a less invasive procedure. It involves less scarring and a short hospital stay. Even the recovery time after the surgery is less in comparison to open surgery. Learn more about the benefits of laparoscopic hernia surgery.

After surgery precuations

Prevention of Direct and Indirect Hernia

Therefore, now you may be able to prevent a congenital problem such as indirect hernia, but there are some instructions that you must follow to prevent the symptoms of a direct hernia.

  • Maintain a healthy weight

If you are obese, then lose weight. It will prevent you from straining on your abdominal muscles.

  • Increase liquid intake and fiber-rich foods

When you increase liquid and fiber-rich foods in your diet, it may prevent constipation and straining during bowel movements.

  • Stop smoking

Smoking causes lung problems and increases coughing which raises the risk of developing a direct hernia.

  • Be careful while lifting heavy objects

Whenever you lift heavy objects, use your legs and knees instead of the lower back or abdominal muscle. This will reduce the strain to your lower back.

Also Read: How To Prevent Hernia From Developing


Inguinal hernia may not show any symptom or may cause pain, especially when they appear first. Seek immediate medical help from Pristyn Care in case of any of the above problems as delay in the treatment may be life-threatening.

Also Read:

Pristyn Care Provides Best Hernia Treatment in:


Which is more common-direct or indirect hernia?

In children, indirect inguinal hernias are more common whereas direct inguinal hernias are very common in males over 40 years of age.

Where does a direct hernia occur?

A direct hernia is more likely to occur in adults, especially an inguinal hernia. A direct inguinal hernia is more likely to occur in the groin area of adults.

How do you diagnose a direct inguinal hernia?

A direct hernia's diagnosis simply includes a physical examination followed by imaging tests to confirm the diagnosis.