A hernia happens when an organ pushes through weak spots in the muscle or tissue around it. Out of the four main types of hernias, an inguinal hernia is the most common. It is further divided into two types. So, let’s discuss direct vs indirect hernia to know how each of them impacts one’s health.
Symptoms of Direct and Indirect Hernia
Indirect and direct inguinal hernias are alike because both cause bulges in the groin area, resulting from organs pushing through the inguinal canal. However, they occur in different places.
Direct hernias push through the back wall of the inguinal canal, while indirect hernias push through the inguinal ring. The symptoms of both types of hernias are similar and include:
- A bulge in the groin area
- A bulge in the scrotum
- Pain or a burning feeling in or around the groin.
Direct Vs. Indirect Hernia Anatomy
A direct inguinal hernia happens when part of the abdomen pushes through a weak spot in the back wall of the inguinal canal in a specific area called Hesselbach’s triangle. This triangle is bordered by the rectus abdominis muscle on one side, the inferior epigastric vessels on another, and the inguinal ligament on the bottom.
An indirect inguinal hernia happens when part of the abdomen enters the inguinal canal through the deep inguinal ring, which is the entrance to the canal. The hernia then moves along the canal and exits through the superficial inguinal ring.
Classifying Direct Vs. Indirect Hernia
Indirect Hernia:
- Passes through the inguinal canal.
- Can descend into the scrotum.
- The defect can’t be felt because it’s behind the fibers of the external oblique muscles of the abdomen.
- Commonly seen in children and young adults.
Direct Hernia:
- Bulges from the back wall of the inguinal canal.
- Does not descend into the scrotum.
- The defect can be felt as it lies in the abdominal wall, just above the pubic bone.
- Mostly occurs in older adults.
Diagnosis of Direct and Indirect Hernia
A hernia is usually diagnosed through a physical exam. Your doctor can notice a bulge in your groin that indicates a hernia. It can be hard to tell the difference between an indirect and a direct hernia. Most people in their 20s or younger with a hernia usually have an indirect inguinal hernia.
If you are a man and your doctor finds the hernia has reached your scrotum, it is likely an indirect hernia. A direct hernia does not follow this path through the inguinal ring into the scrotum. So, a hernia that stays on one side of the groin is more likely to be a direct hernia.
An indirect hernia can also cause a bowel obstruction if it gets stuck in the inguinal ring and swells inside the abdomen. This can get worse and lead to “strangulation,” where blood flow to the intestines is affected. A direct hernia is less likely to cause this kind of strangulation.
Treatment Options
Inguinal hernias don’t heal themselves and can get bigger over time. This is why surgery is the only way to treat them. Each year, over 20 million people around the world have surgery for groin hernias.
Watchful Waiting
For adults without serious symptoms, doctors may recommend watchful waiting, where the hernia is closely monitored but not immediately treated. However, this is not a substitute for surgery, just a delay in getting it.
Surgery for Indirect and Direct Inguinal Hernias
Surgery involves two main steps:
- Moving the herniated tissue back in place.
- Repairing the weak area where the hernia occurred (for indirect hernias, this includes closing the inguinal canal).
The type of surgery recommended depends on your age and health. Common options include:
- Open Surgery: The surgeon makes an incision in the groin to repair the hernia, often using stitches and mesh for support.
- Laparoscopic Surgery: The surgeon makes small incisions and uses special tools to repair the hernia from inside the abdomen, with mesh possibly used for support.
Wrapping Up
Both types of inguinal hernias are more common in people with testicles. The main symptom of direct vs indirect hernia is a bulge in the groin or scrotum, often with pain. Diagnosis is usually made through a physical exam and may be confirmed with imaging.
Visit Dr. Rick Q. Ngo at Texas Hernia & Surgical Specialists. Our doctor is one of those 25% general surgeons who perform minimally invasive hernia surgery. Call us at (888) 365-1544 for an appointment.