Direct versus Indirect Hernia- What are the Differences?

Direct versus Indirect Hernia- What are the Differences?

A hernia occurs when a certain organ pushes through an opening in the tissue or the muscle that is holding it in place. For example, it is common for the intestines to break push through a weak area somewhere in the abdominal wall.

Hernias are most commonly seen in the abdomen but can be seen in the belly button, upper thigh, and groin. Most of the hernias are not life-threatening initially. However, they usually do not go away on their own and require medical attention. In some cases, surgery is required to avoid potential complications.

What are the Common Types of Hernia?

A hernia can be divided into several types which are explained below:

An inguinal hernia

An inguinal hernia is considered as the most common form of a hernia. It makes up for approximately 70 percent of all the hernias, as per the British Hernia Center. This type of hernia occurs when the intestines break through a weak spot in the lower abdominal wall. The inguinal canal is often involved.

The inguinal canal is located in the groin. In men, it refers to the area where the spermatic code enters the scrotum. This cord is used to hold up the testicles. In women, this canal consists of a ligament that helps to hold the uterus in its proper place.

Inguinal Hernia

An inguinal hernia is commonly seen in men as compared to women. This is because the testicles of a male descend through this canal shortly after the birth. The canal has too close almost completely after this. In some cases, the closing of canal does not occur leaving behind an area prone to a hernia.

A hiatal hernia

A hiatal hernia is a type of a hernia that occurs when a part of your stomach comes out into the chest cavity via the diaphragm. The diaphragm refers to a sheet of muscles that helps in breathing. It is also important for separating the contents of the chest from those in the abdomen.

A hiatal hernia is commonly seen in people over the age of 50. If a child suffers from this condition, it is probably because of a congenital birth defect. Hiatal hernias are always associated with gastroesophageal reflux, a condition in which the contents of the stomach leak back into the esophagus and cause a sensation of burning in the chest.

RELATED: What Are The Symptoms Of a Hiatal Hernia?

An umbilical hernia

Umbilical hernias can occur in children and infants under the age of 6 months. This usually happens when their intestines push through the abdominal wall causing the bulge to appear near the bellybutton.

An umbilical hernia can go away on its own as the strength of the abdominal wall muscles increases as the child ages. If it does not go away on its own, surgery might be indicated.

An incisional hernia

Incisional hernias occur usually after an abdominal surgery. The intestines push through the scar or the incision where the tissue has been weakened.

Direct versus an Indirect Hernia

An inguinal hernia, being the most common form of a hernia, can be divided into two subtypes; direct and indirect. This depends upon how and when a hernia occurs. The type of an inguinal hernia also depends upon the gender and the age group of the affected person.

Incisional hernia

What are the Symptoms?

Both direct and indirect inguinal hernia leads to a bulge on both sides of the groin, in case the hernia is large enough. The bulge can be noticed in a standing position. It also becomes more prominent during coughing or straining.

In many cases, hernias do not cause pain unless they increase in size. In men, pain is felt in the scrotum if a hernia reaches that region.

An indirect hernia most likely occurs during infancy. This is because an indirect hernia is mostly caused by a congenital condition. Such type of a hernia can be diagnosed when a baby is crying.

A direct hernia, on the other hand, develops in adulthood, unless the problem is due to an injury.

What can be the Causes?

A direct hernia usually occurs when there is a weakening of the abdominal muscles. This allows the portion of intestine to break through the abdominal wall. The weakening may develop over time, particularly because of aging and other daily life activities.

Sometimes, improper lifting or lifting something extremely heavy puts great pressure on the abdominal muscles, leading to a weakening or tearing.

Direct and indirect hernia

An indirect hernia, on the other hand, is not caused by weakening or injuring of the abdominal muscles. Instead, it usually occurs when a certain area of the abdominal tissues, known as the inguinal ring, fails to close while the baby is still in the womb of the mother.

In males, the ring permits the descent of testes into the scrotum after which it usually closes. When it remains open, there is always a possibility for a part of the intestine to protrude through it.


Hernias are usually diagnosed with the help of a physical examination. The doctor identifies a bulge in the groin area as a type of a hernia. It might be difficult to differentiate between a direct and an indirect hernia. Most of the people in 20s suffer from the indirect type of a hernia.

If you are a man and you a hernia has extended into the scrotum, chances are that it is an indirect hernia. An indirect hernia does not follow the path through the inguinal ring straight into the scrotum. This means that a hernia that a hernia that usually forms on either side of the groin is likely a direct hernia.

An indirect hernia can also lead to bowel obstruction, especially if it makes its way into the inguinal ring and swells. The condition can lead to “strangulation”, a phase in which the blood flow of intestines is affected.


If a hernia is causing no problems, the preferred treatment is not to do anything about it and just wait. Hernias usually do not go away without any treatment so you may need to go through a surgery in the future irrespective of the type of a hernia.

Surgical procedures in babies and children for indirect hernias are quite safe. The hernia sac is taken away from the scrotum and other delicate areas and closed with the help of sutures.

A small fraction of children having an indirect hernia on one side can develop it on the other side as well. A debate has been going on in the medical field in order to investigate a second hernia.


In adults, the direct hernia is treated with the help of an open surgery. A large incision is given and the hernia is placed back into its right position. Repairing of the abdominal wall occurs with the help of a small mesh device that provides strength to the weakened area.

Laparoscopic surgery is also a choice of treatment for a hernia as it involves less scarring of the abdominal muscles. It is especially suitable in the case of recurrent hernias.


If you have already suffered from a direct or an indirect form of a hernia, there is an increased risk of its recurrence.

Surgeries can repair hernias easily and have high success rates, so a full recovery is expected. It might take several weeks for you to fully recover and perform the normal activities of life.

You will also be advised not to lift heavy objects for some time. Do consult with a doctor, an occupational therapist, or a physical therapist regarding tips on lifting for the upcoming days.


Nancy Walker

Nancy holds a Medicine degree and a Masters of Science MS in Infectious Disease and Global Health (MS-IDGH) from Tufts University. She worked as a lecturer for three years before she turned towards medical writing. Her area of interest are infectious diseases; causes, mechanism, diagnosis, treatments and prevention strategies. Most of her writings ensure an easy understanding of uncommon diseases.

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