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

Inguinal Hernia

There are different types of hernia – Inguinal, Femoral, Umbilical, Incisional and Hiatal. Inguinal hernias are the most occurring hernia out of all. This is the protrusion of tissues which is a part of 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 hernia back, the content of the hernia may be trapped in the abdominal wall, also known as incarceration.

Causes if inguinal hernia

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 bulging is either the body fat or a part of the small intestine. 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. Direct hernia is usually seen in adult males. It is caused by weakness in the abdominal wall that develops over time due to lifting heavyweight 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 Hernia Direct Inguinal Hernia
Usually seen in children and young adults Common in elder people mostly above 40 years of age
It may be congenital It comes along with age when straining or lifting heavy objects
Can descend into the scrotum Cannot descend into the scrotum
Pass through the inguinal canal Bulge from the posterior wall of the inguinal canal
It appears as an elliptical swelling It appears as a circular, symmetric swelling at the external ring
Reduces upward then laterally and then backward Reduces upward and then straight backward
It is not that noticeable as it is behind the fibers of the external muscle It may be felt in the abdominal wall
The reduction of the indirect hernia can be controlled by pressure over the internal ring Reduction cannot be controlled in case of the direct hernia
On standing, indirect hernia takes time to reach to its complete size Direct hernia appears immediately on standing
Similarly, on lying down, there is a delay before the indirect hernia retracts fully Similarly, direct hernia disappears immediately
After the reduction, the bulge appears in the middle of the inguinal region before turning to the scrotum After reduction, the protrusion appears exactly where it was before


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 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 a few small incisions are made instead of one large cut. A thin telescope-like instrument helps to see inside the abdomen and treat the hernia. Laparoscopic surgery is preferable 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.


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

After surgery precuations
  • 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: It may prevent constipation and strain during the 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 lower back or abdominal muscle. This will reduce the strain to your lower back.

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

Also Read: Role of Laparoscopy to Treat Hernia Effectively

Also Read: Difference between femoral and inguinal hernia

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