What’s the difference between direct hernia and in-direct hernia?

difference between direct and indirect hernia

A hernia usually occurs in the abdomen when organs push through weak areas of the surrounding muscle. There are passages called inguinal canal that run down the lower abdomen on either side of the groin.

An inguinal hernia that develops through the inguinal canal may be direct or indirect depending on the difference in anatomical location. Diagnosis to distinguish between direct hernia Vs indirect hernia may be difficult but with physical exam and sometimes through radiological tests such as ultrasound, CT scan or MRI, at the best hernia hospital, it can be rightly repaired.

Cause of direct hernia Vs indirect hernia

Direct hernia is caused by weakened or injured abdominal muscles. A direct hernia develops when a portion of the intestine pushes through the abdominal wall that has become weak.

The abdominal wall usually becomes weak over time, due to everyday activities and aging. Improper lifting of heavy objects can put extra pressure on the muscles, making them to weaken and tear. Direct hernias are found to protrude through the posterior (back) wall of the inguinal canal. Risk factors for direct hernias include:

  • family history of hernias
  • smoking
  • chronic cough due to conditions such as cystic fibrosis
  • chronic constipation
  • activities like heavy lifting, prolonged standing/sitting
  • lack of muscular build in case of low BMI
  • conditions like collagen vascular disease

Indirect inguinal hernias are often present at birth. Indirect hernia occurs when the inguinal ring, an area of abdominal muscle tissues fails to close up during foetal development. In cases where the ring may remain open, it allows a part of the intestine also to push through it.

However, indirect hernias don’t always present in infancy or even childhood. An indirect inguinal hernia that wasn’t present at birth but appears later in life due to an acquired weakness of the inguinal ring and that can be diagnosed during adulthood.

There are no real risk factors for developing an indirect hernia, other than being a man. Indirect hernia in men is 9 times more likely than in women.

Also read: Different symptoms of Hernia in Men & Women

Symptoms of direct hernia Vs indirect hernia

Symptoms of indirect and direct hernias are similar as they are both caused by organs pushing through the inguinal canal. The chief symptom is a bulge in the groin or scrotum, and there may be associated pain. Both present as bulges in the groin area, however, indirect and direct hernias occur in different locations. While direct hernias protrude through the back wall of the inguinal canal, indirect hernias push through the inguinal ring.

The protruding bulge may be noticeable or be worse only when coughing or straining and usually improve while resting or lying down. Symptoms may only be noticeable or be worse when coughing or straining. They improve when you rest or lie down. Similar symptoms of direct and indirect hernias include:

  • Hernia in women is seen as a protrusion in the groin area
  • A bulge in the scrotum in men
  • Pain or burning sensation in or around the groin

Treatment for direct hernia Vs indirect hernia

Hernia with no significant symptoms may require only watchful waiting to closely monitor the condition without any treatment.

However, surgical repair is the only permanent treatment for inguinal hernias as they do not heal on their own. It is important to note that watchful waiting is not an alternative to surgery but only a way to delay time for surgical repair.

Hernias can become larger over a period of time and get complicated. For this reason, of people who delay surgery, 70% get the surgery within 5 years. Every year, over 20 million people worldwide, undergo surgery for hernia at hernia treatment hospital.

Surgery for either indirect or direct hernia involves two main steps that include:

  • Herniated tissues have to be moved back into place
  • The weak area involving the hernia has to be repaired

The only difference in procedure for repair of indirect hernia, involves closing the inguinal canal. Surgery for hernia is done under general anaesthesia by an expert in colorectal surgeries. The type of surgery recommended may depend on the age and overall health of the patient. Common surgical procedures are:

  • Open surgery that involves an incision in the abdomen to locate and repair the hernia. Stitches and a piece of mesh may be used for additional support when closing the abdominal wall.
  • Laparoscopic surgery is done through several tiny holes in the abdomen. Special tools inserted through these holes allows the surgeon to view the hernia and repair it, even using a mesh is possible through this surgery. Laparoscopic surgical repair of inguinal hernia is usually outpatient, allowing the patient to be able to go home the same day.

Inguinal hernias do not raise an alarm, unless it progresses to become a strangulated hernia, where blood flow to trapped tissue is cut off, resulting in life-threatening complications. Emergency surgical repair of hernia is recommended by The World Society of Emergency Surgery (WSES) when strangulation of hernia is suspected.

Laser hernia operation through laparoscopic surgery is a growing option for inguinal hernias as the procedure involves less scarring of the larger abdominal muscles, giving an advantage over open surgery. In case of an indirect or direct hernia, there is an increased risk for developing another hernia.

Hence, least invasive surgeries to repair hernias are now increasingly common with high success rates and maximum recovery.

Dr. Karthik Gunasekaran