direct hernia vs. indirect: main differences and causes (2023)

ONEHerniaIt occurs when organs pierce weak areas of surrounding muscle. ONEherniaoccurs in the abdomen through the inguinal canal.These are passages that descend into the lower abdomen on either side of the groin. This type of hernia usually appears as a bulge in the groin area.

Inguinal hernias can be direct or indirect. The difference is in the anatomical location. Direct hernias protrude through the posterior (posterior) wall of the inguinal canal. Indirect hernias protrude through the inguinal ring.

direct hernia vs. indirect: main differences and causes (1)

Indirect hernias are usually congenital, while direct hernias result from heavy lifting or exertion.

Learn about the symptoms, causes and treatment of indirect and direct hernias. So make sure you see a doctor for a diagnosis so you can get the right treatment.


Indirect and direct inguinal hernias are similar in that they both appear as bulges in the groin area. Both are also caused by organs pushing through the inguinal canal. However, indirect and direct hernias occur in different locations.

Direct hernias project through the posterior wall of the inguinal canal, indirect hernias through the inguinal ring.

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

  • A lump in the groin
  • A lump in the scrotum
  • Pain or burning in or around the groin area

If you notice the symptoms

Symptoms may be felt or worsen with just coughing or straining. They get better when you rest or lie down.


Although the symptoms of direct and indirect hernias are similar, the underlying causes are different.

Indirect inguinal hernias

Indirect inguinal hernias are usually present at birth. They are more common in babies with testicles.These hernias occur when one or both of the inguinal canals fail to close during fetal development.

This incomplete closure can cause the organs in the abdomen to be pushed out. Certain genes can increase your risk of developing a hernia.

Although most indirect inguinal hernias are congenital (that is, present at birth), they do not always appear in infancy or even childhood. Therefore, an adult may be diagnosed with an indirect inguinal hernia that was not present at birth but occurs later in life. This can occur due to acquired weakness of the inguinal ring.

Direct inguinal hernias

Direct inguinal hernias occur along the posterior wall of the inguinal canal. They are the result of a weakened wall of the inguinal canal that occurs with age. They are usually caused by straining or lifting something heavy.

Like indirect hernias, direct hernias are more common in people with testicles. In fact, 27% of people with testicles will develop a hernia in their lifetime, while only 3% of people with ovaries will develop one.People over the age of 40 are at a higher risk of developing this type of hernia.

risk factors

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

  • connective tissue diseases(Tissues that support or protect other tissues and organs in the body)
  • chronic cough
  • chronic constipation
  • do heavy lifting
  • Standing or walking regularly for long periods of time
  • Family history of inguinal hernias


(Video) Introduction to Direct and Indirect Inguinal Hernia

Click play to learn all about hernias

This video has been clinically reviewed bydr. Kashif J. Piracha

To diagnose

Doctors diagnose indirect and direct inguinal hernias through a physical examination and sometimes x-ray tests. Your doctor will start by taking your medical history.

A physical exam involves visually looking at the area and palpating (touching and pressing) to try to detect a hernia. You will be asked to stand up for the exam, as the hernia may be more pronounced when you are standing up.

For people with testicles, your doctor will ask you to cough while examining your scrotum. This allows the doctor to feel the hernia moving in and out.

If your doctor needs more confirmation, he or she may order specific tests. Tests to diagnose hernias include:

  • ultrasonic
  • Computed tomography(CT-Scan
  • MRI image(MRI

What to do if you have a hernia


Hernias do not heal on their own and can get bigger over time. For this reason, surgical repair is the only treatment for inguinal hernias. More than 20 million people worldwide undergo inguinal hernia surgery every year.

watchful waiting

For adults who don't have significant symptoms, the doctor may use watchful waiting, which means they are closely monitored but not treated. However, it is important to note that watchful waiting is not an alternative to surgery, but rather a delay in surgical repair.

70% of those who postpone surgery will need surgery within five years.

Indirect and direct inguinal hernia surgery involves two steps:

  1. Move the prolapsed tissue back into place
  2. Repair of the fragile 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 sutures and a piece of mesh for extra support when closing the abdominal wall.
  • laparoscopic surgery: That is To do this, several small holes are drilled in the abdomen. Your doctor will use special tools that allow the surgeon to see the hernia and repair it. Mesh can also be used during this operation.

Both types of surgeries are performed by a general surgeon or under general anesthesia.Colorectal Surgeon🇧🇷 Groin surgeries are usually performed on an outpatient basis, so you can go home the same day.

strangulated hernia

Hernias are usually not a cause for alarm. However, a herniated hernia, which stops blood flow to the herniated tissue, can lead to life-threatening complications. The World Society for Emergency Surgery (WSES) recommends immediate emergency surgical hernia repair if strangulation is suspected.


As indirect hernias are usually congenital, they cannot be prevented. However, there are some steps you can take to reduce your risk of a direct inguinal hernia, including:

(Video) What are hernias? | Direct and Indirect | MedStudier

  • Be careful when lifting heavy things.
  • Don't strain yourself when evacuating.
  • TreatConstipation(difficulty passing stool).
  • treat apersistent cough.
  • Get treatment if necessarystraining to urinate.
  • Maintain a healthy weight for you.

Different types of hernias in men


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 usually congenital, meaning they are sometimes, but not always, diagnosed at birth.

Both types of inguinal hernia are more common in people with testicles. The main symptom is a lump in the groin or scrotum, and pain may occur. The diagnosis is made by physical examination and can be confirmed by imaging tests. Surgery is then required to correct the problem.

A Word from Verywell

Rest assured, hernias are quite common. Most of the time, they are not a cause for concern. However, if you notice a lump in your or your child's groin area, it is important to have it checked out by a doctor. The only treatment for indirect and direct inguinal hernias is surgery.

common questions

  • What causes indirect hernias in babies?

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

    In this case, the inguinal canal, which runs to the groin on both sides of the abdomen, was not closed. When this happens, part of the internal abdominal organs push through this channel, causing a bulge in the groin area.

  • How common are hernias?

    Hernias are quite common. In fact, 27% of people with testicles and 3% of people with ovaries will develop a hernia at some point in their lives.

  • What do testicles have to do with hernia symptoms in men?

    Indirect inguinal hernias are more common in babies with testicles. This is because the testes begin to develop in the abdomen and must travel through the inguinal canal to reach the scrotum.If this canal does not close before birth, a hernia can develop.

    Direct inguinal hernias are also more common in people with testicles. This is because they have a wider inguinal canal than those with ovaries. As a result, the channel is more likely to stretch and weaken over time.

    (Video) Hernias: Direct vs. Indirect vs. Femoral (SIMPLE Mnemonics)
  • Does the hernia go away on its own?

    no Hernias do not disappear on their own. Therefore, surgery is the only solution for both direct and indirect inguinal hernias.

6 gears

Verywell Health only uses quality sources, including peer-reviewed studies, to back up the facts in our articles. read ourpublishing processto learn more about how we review our content and keep it accurate, reliable, and reliable.

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

  2. Cleveland Clinic.hernia.

  3. Medicina Johns Hopkins.hernia.

  4. HerniaSurge Group.International guidelines for the treatment of inguinal hernias.Hernia. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-x

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

    (Video) Direct and Indirect Inguinal Hernias

  6. Stanford Child Health.hernia.

direct hernia vs. indirect: main differences and causes (2)

Forkathi valeii
As a freelance writer, Kathi has experience writing features and essays for national publications on health, advocacy and education issues. Most of her work focuses on parenting, education, health and social justice.

See Our Editorial Process

Meet our panel of medical experts

share comments

This page was helpful

Thank you for your comments!

what is your OPINION?

(Video) Inguinal Hernia Anatomy (1/2) | Direct and Indirect Inguinal Hernia | Abdomen | Anatomy


What are the differences between indirect and direct hernias? ›

A direct inguinal hernia shows a bulge from the posterior wall of the inguinal canal, whereas an indirect inguinal hernia passes through the inguinal canal or the groin. In the indirect inguinal canal, it is difficult to feel the defect as it occurs behind the external oblique muscle fibers.

What causes an indirect hernia? ›

Indirect inguinal hernia: An indirect inguinal hernia enters your inguinal canal through the top. This usually occurs because of a birth defect. In some fetuses, the opening to their canal doesn't close all the way during development in the uterus.

How to differentiate between direct and indirect hernia on examination? ›

The size of the external ring can be ascertained by palpating just lateral to the pubic tubercle. Again with the patient coughing, hernia bulges can be felt either against the side of the examining finger (direct hernia) or at the tip of the finger as it approaches the internal ring (indirect hernia).

What causes a direct hernia? ›

A direct hernia is usually caused when the wall of the abdominal muscles becomes weak. That allows a portion of the intestine to push through the abdominal wall. This weakening can develop over time, due to everyday activities and aging.

What is difference between direct and indirect inguinal hernia? ›

There are two types of inguinal hernias: Direct: Develops over time due to straining and is caused by weakness in the abdominal muscles. Most common in adult males and rare in children. Indirect: Caused by a defect in the abdominal wall that will typically have been present since birth.

What is the difference between a direct inguinal hernia and an indirect inguinal hernia quizlet? ›

Remember--direct inguinal hernias protrude through the weak fascia of the abdominal wall, medial to the inferior epigastric vessels. Indirect inguinal hernias (which can also be called congenital inguinal hernias) occur lateral to the inferior epigastric vessels--they protrude through the deep inguinal ring.

When do indirect hernias occur? ›

Indirect inguinal hernias occur when abdominal content such as fat or bowel pushes down along the inguinal canal. What is the inguinal canal? It is the tunnel through which a man's vas deferens and testicular vessels travel down into the scrotum.

What causes indirect inguinal hernia? ›

Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking. Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery.

Why are indirect hernias more common in males? ›

Indirect inguinal hernia.

Although it can occur in men and women, it is much more common in men. This is because the male testicle starts inside the abdomen and has to go down through an opening in the groin area to reach the scrotum (the sac that holds the testicles).

How do you remember direct and indirect hernias? ›

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.

How do you diagnose a direct hernia? ›

Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you'll likely be asked to stand and cough or strain. If the diagnosis isn't readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.

What are the complications of indirect inguinal hernia? ›

The most commonly reported complications are similar to those seen in other operations and include seroma, hematoma, urinary retention, and surgical site infection. Two serious complications directly related to an inguinal hernia are hernia recurrence and chronic pain.

What is the difference between direct and indirect hernia Hesselbach's triangle? ›

What is the difference between a direct and an indirect inguinal hernia? A direct inguinal hernia protrudes through the Hesselbach triangle, while an indirect inguinal hernia does not. However, both types of hernia will likely involve intestines or bowel.

What is the difference between a direct and indirect hernia quizlet? ›

Direct hernias lie medial to the inferior epigastric vessels. Indirect hernias lie lateral to the inferior epigastric vessels.

What is the key difference between direct and indirect techniques of influence quizlet? ›

What is the key difference between direct lobbying and indirect lobbying? Direct lobbying involves attempts to influence elected officials directly, whereas indirect lobbying attempts to rouse the public to influence elected officials.

What is the main difference between direct and indirect competitors quizlet? ›

What is the difference between direct competition and indirect competition? Direct competition: is the competition among products that are similar. Indirect competition: is the competition between products or services that are not directly related to each other.

Are direct or indirect hernias more common in adults? ›

These are indirect inguinal hernias which protrude through the internal inguinal ring lateral to the epigastric vessels. They are about twice as common as direct inguinal hernias. There is a recent debate that all indirect inguinal hernias result from a processus vaginalis that had never closed.

How do you get a direct inguinal hernia? ›

More so than the indirect inguinal hernias, any activity that places chronic stress on the lower abdominal wall is also a risk factor to develop a direct inguinal hernia.
Some examples are:
  1. Multiple childbirths.
  2. Chronic constipation.
  3. Straining to urinate (prostate problems)
  4. Chronic cough.
  5. Heavy lifting over time.
  6. Obesity.

Which hernia has highest risk of strangulation? ›

Strangulation risk is probably greatest with femoral hernias.

Is indirect hernia always congenital? ›

It is concluded that the etiology of indirect inguinal hernia in adults, as in infants, is congenital.

Is indirect hernia acquired? ›

Indirect inguinal hernias are usually congenital, forming a sac in the core of the spermatic cord covered by the internal spermatic, cremasteric, and external spermatic fasciae13. Direct inguinal hernias are acquired; the sac lies beside/behind the cord13.

What is the difference between indirect and direct hernia Medscape? ›

Types of hernia

An indirect hernia is defined as a defect protruding through the internal or deep inguinal ring, whereas a direct hernia is a defect protruding through the posterior wall of the inguinal canal.

Do direct hernias need surgery? ›

If a hernia is gentle and causes no side effects, you shouldn't do something besides take an “attentive waiting” approach. Hernias don't mend all alone so you may require a surgical procedure later whether it's a direct or indirect hernia.

Do direct hernias go through the deep ring? ›

Indirect inguinal hernias pass through the deep inguinal ring, down through the canal toward the superficial ring. Direct hernias are acquired and pass through a weakened abdominal wall medial and inferior to the deep ring.

What is the differential diagnosis for indirect inguinal hernia? ›

Inguinal hernia must be differentiated testicular torsion, epididymitis, hydrocele, varicocele, spermatocele, epididymal cyst and testicular tumor.

Can an indirect inguinal hernia be pushed back in? ›

Inguinal hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall. The operation is usually recommended if you have a hernia that causes pain, severe or persistent symptoms, or if any serious complications develop.

Is indirect hernia strangulated? ›

Indirect inguinal hernias have a higher risk of strangulation. The risk of strangulation and obstruction is lowest for direct inguinal hernias as they have a wide neck, which can often be monitored and managed conservatively.

What is the difference between direct and indirect hernia ultrasound? ›

Inguinal hernias can be classified into direct and indirect hernias. Direct hernia is derived from protrusion of the intra-abdominal contents through a weak abdominal wall, while indirect hernia results from protrusion toward the inguinal canal.

Whats an indirect hernia? ›

An indirect hernia is a protrusion of an organ through the "wall" located near the groin or abdomen. The bulge is painless but when strangulated, can cause symptoms.

What is the difference between incisional and ventral hernia? ›

A ventral hernia is a bulge of tissues through an opening of weakness within your abdominal wall muscles. It can occur at any location on your abdominal wall. Many are called incisional hernias because they form at the healed site of past surgical incisions.

What are the clinical features of direct inguinal hernia? ›

A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach's triangle. The borders of Hesselbach's triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

Which is worse direct or indirect hernia? ›

Indirect inguinal hernias are more likely to cause bowel obstruction than direct inguinal hernias. This is because that tunnel described above, the inguinal canal, can be narrow. The narrow area enlarges as the canal travels downward. The narrow area can strangulate the tissue which is further herniated down the canal.

What is the most common cause of incisional hernia? ›

An incisional hernia can occur for a number of specific reasons; individuals who participate in excessive or premature physical activity after surgery, gain considerable weight, become pregnant or increase abdominal pressure in any other way before the incision is fully healed are especially at risk for an incisional ...

What are the 3 types of hernias? ›

Common types of hernias include umbilical hernia, inguinal hernia and femoral hernia.
You may get a hernia:
  • In your lower chest through your diaphragm.
  • In your groin through your lower abdominal wall.
  • Along the front midline of your abdomen.
  • Through a former abdominal surgery incision.
Feb 7, 2023

Does a ventral hernia cause bloating? ›

A part of the intestines is trapped inside the hernia and has become blocked. The contents of the intestines can't move ahead. You can't pass gas or motions, and you may have severe pain, vomiting, and abdominal swelling. Strangulated hernia.


1. inguinal hernias |direct inguinal hernia|indirect inguinal hernia
2. Inguinal Hernias Explained
3. Surgery 856 Direct Hernia Difference Indirect between Inguinal Hesselbach Triangle Ogilvie Malgaigne
(Dr Fatima Medical guide)
6. USMLE Step 1 | Direct vs Indirect Inguinal Hernias
(Snake On A Stick)
Top Articles
Latest Posts
Article information

Author: Dr. Pierre Goyette

Last Updated: 12/07/2023

Views: 5868

Rating: 5 / 5 (50 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Dr. Pierre Goyette

Birthday: 1998-01-29

Address: Apt. 611 3357 Yong Plain, West Audra, IL 70053

Phone: +5819954278378

Job: Construction Director

Hobby: Embroidery, Creative writing, Shopping, Driving, Stand-up comedy, Coffee roasting, Scrapbooking

Introduction: My name is Dr. Pierre Goyette, I am a enchanting, powerful, jolly, rich, graceful, colorful, zany person who loves writing and wants to share my knowledge and understanding with you.