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The Difference Between a Direct & Indirect Hernia

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

In this lesson, we will learn what a hernia is and specifically what an inguinal hernia is. We will learn about two types of inguinal hernias- direct and indirect.

What is a Hernia?

Your body contains different cavities that are protected and separated from each other to some degree. For example, your chest cavity contains your heart and lungs and is separated from your abdominal cavity by your diaphragm. Your abdominal cavity contains many of your internal organs such as your liver, stomach, and intestines and they are surrounded by your abdominal muscles.


The Different Cavities of the Body
abdominal cavity


A hernia is when body tissue protrudes through a weakened spot in the muscle that normally contains and protects it. This may be the intestines poking through the abdominal wall, but it can also be an entire organ that migrates into another body cavity through an abnormal hole in the muscle. Another example is fat pushing through the weakened muscle. There are all different types of hernias.

Let's learn more about the most common type of hernia next!

Understanding What an Inguinal Hernia Is

The type of hernia with the highest occurrence is the inguinal hernia. The abdominal muscles that protect the abdominal cavity have an opening in the lower, front part of the abdominal wall called the inguinal canal. This type of hernia allows body structures to exit the abdominal cavity into the genitals. This is where the inguinal hernia is located, right above the leg crease near the groin and can occur on either side of the abdomen.


This illustration portrays the opening in the abdominal muscle that is called the inguinal canal.
inguinal canal


An inguinal hernia is when part of your intestines protrude through this opening in your abdominal muscle. If you have an inguinal hernia, you will notice a bulging right above your groin area. It may become more prominent if you strain or cough. You may feel some pain and pressure in your groin.

Inguinal hernias can occur in both men and women but are much more common in men. There are two different types of inguinal hernias that we will learn about now.

Direct Inguinal Hernia

Bob is a 50-year-old male that is overweight and smokes cigarettes. He has felt some pressure and discomfort in his groin and noticed a bulging area in the left side of his groin. The area was soft and if he pushed on it, it would go away but then when he coughed it would return. He saw his doctor, and he told him he had a direct inguinal hernia.

A direct inguinal hernia is an inguinal hernia that usually occurs in men over the age of 40. It is due to weakened abdominal muscles, straining, and weight gain. This can occur in women, but men are eight to ten times more likely to be affected by an inguinal hernia than women.

Other risk factors include aging, frequent coughing such as from smoking, straining from constipation or heavy lifting, and family history.

The doctor instructs Bob on how to reduce the hernia, by gently pushing the area back into his abdominal cavity. He says getting a special hernia belt can also help to keep the hernia in place. At this time, he wants to monitor the hernia. He instructs Bob that if he has severe pain and discoloration of the hernia, he needs to seek immediate medical attention. These are signs of an incarcerated hernia which means blood supply has been cut off and this can be life-threatening.

Indirect Inguinal Hernia

Jimmy is a 25-year-old male that has also discovered a soft lump on the right side of his groin, right above the leg crease. He visits his doctor, and he is told that he has an indirect inguinal hernia.

An indirect inguinal hernia is a congenital defect which means Jimmy was born with this problem. When a fetus is forming, the inguinal canal allows the baby's testicles to descend. This creates a deficiency called the internal inguinal ring that normally will close during development. If the ring doesn't seal, it can become an inguinal hernia.

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