A hernia is where an organ or part of the body bulges through a weak portion of the surrounding muscle into an area between tissues. A hernia can develop in any location in the body, whereas most of the time, it is inguinal—that is, in the abdomen and groin.
There are two types of inguinal hernias: direct and indirect hernias. Irrespective of the type, it involves the inguinal canal; however, it differs in how and where it develops.
What is a direct hernia?
Direct hernias occurs by the weakening of abdominal muscles with the increase in age. It pushes a part of the intestine or some other tissue to pass across the weak area in the rear wall of the inguinal canal. This type of hernia is most common in adult males and usually has reasons like too much straining, lifting something heavy, or stress on the muscles around the abdominals.
What is an indirect hernia?
An indirect hernia is normally congenital; most of them occur at birth. This occurs because the opening in an infant’s abdominal wall, typically referred to as the inguinal canal, fails to close normally during an infant’s fetal development. This gives an unlimited passageway for organs such as a part of the intestine to be able to move into an infant’s inguinal canal and starts creating hernia. An indirect hernia normally occurs more frequently in children and young adults.
Differences Between Direct and Indirect Hernia
| Factor | Direct Hernia | Indirect Hernia |
|---|---|---|
|
Causes |
Weak abdominal muscles, aging, straining, injury |
A congenital defect, incomplete closure of the inguinal canal |
|
Location |
Protrudes through the back wall of the inguinal canal |
Protrudes through the inguinal ring |
|
Common Age |
Mostly seen in older adults |
Often found in babies, children, and young adults |
|
Symptoms |
Bulge in the groin, no descent into scrotum, groin pain |
Bulge in the scrotum, elliptical swelling, discomfort during standing or coughing |
|
Risk Factors |
Age, chronic cough, smoking, heavy lifting, previous surgeries |
Men are at higher risk, family history, congenital factors |
|
Complications |
Bowel obstruction, severe pain, vomiting, inability to pass gas |
Strangulated hernia, pressure on tissues, pain, and swelling in the scrotum |
Symptoms
Both direct and indirect hernias result in swelling in the groin. This swelling enlarges with standing and coughing or straining at exercise. In men, it may extend into the scrotum if large enough.
Common symptoms are as follows:
- An obvious bulge in the groin or scrotum
- Pain or discomfort in the groin, especially with physical activity
- A burning sensation around the affected area
- Swelling or tenderness near the groin
- Difficulty standing or walking for long periods
If untreated, hernias can gradually grow to enlarge sizes and develop features such as nausea, vomiting, and failure to pass gas or stool. Men might feel pain or a sensation of dragging in the groin with the extension of herniated viscera into the scrotum.
Causes
Causes of both types of hernias may vary but there are some common factors which give rise to them:
Causes of a Direct Hernia
- Age: The risk of direct hernia increases mainly with age as muscles naturally weaken over time.
- Heavy lifting: The pressure that getting placed on the abdominal muscles due to lifting heavier objects gym or workplace that what the muscles can allow can lead to hernia.
- Straining: Continuous straining at stool, particularly due to constipation, may be the root cause of weakening in the abdominal muscles.
- Chronic cough: Long-term conditions resulting in a chronic cough, like smoking or lung diseases, are potentially significant risk-enhancing causes of hernias.
- Injury or surgery: Any abdominal surgery or injuries may weaken the muscle walls and thus, there lies a possibility of developing a hernia.
Indirect Hernia Causes
- Congenital defect: Indirect hernias are explained by a birth defect in a person where their inguinal canal does not ever quite seal off as other people’s do,.
- Strenuous activities: Less frequent in young adult, this activity increases pressure within the abdomen and causes an indirect hernia in those who are at risk due to a congenital defect.
Risk Factors
Some interrelated risk factors make some people more predisposed to developing hernias. These are slightly different between direct and indirect hernias; however, there is great overlapping between the two.
Risk Factors for Direct Hernia
- Age: The abdominal muscles of elderly people are weaker, and thus they are more prone to direct hernias.
- Gender: Direct hernias are more common among men when compared to women.
- Family history: There is an increased risk with a history of hernia in the family.
- Chronic coughing: disease that causes chronic coughing such as cystic fibrosis or smoking will increase the chances of direct hernia.
- Previous surgeries: Any previous surgery in the abdominal area may weaken the muscle, giving a chance to a hernia to occur.
Risk Factors of Indirect Hernia
- Congenital diseases: The major predisposing factor to indirect hernias is the condition of being born with a patent inguinal canal.
- Gender: Men present with indirect hernias nine times more than their female counterparts, more commonly in the onset of their lives like in childhood and early adulthood.
- Family history: People who have a family history of hernias are at a greater risk of acquiring an indirect hernia.
- Heavy lifting: The chances are slim, but that can escalate the risk especially among teens who often engage excess activities in abdominal pressure.
Diagnosis
Diagnosis of hernias typically begins with a physical examination. Most likely, a doctor would examine the groin area for obvious protrusions or swelling. A hernia will be much more prominent during either standing or coughing, so it is quite possible a doctor would like to see the hernia by watching the patient during these two actions.
Imaging tests may be recommended for further confirmation:
- Ultrasound: This is conducted to get a picture of the hernia and surrounding tissues.
- CT scan: It is useful in the objective identification of location and size, along with further evaluation for a possible complication of the hernia.
- MRI scan: Infrequently this is needed when added detailed imaging would help to make differentiation between a direct and an indirect hernia.
At times, it extends to even the scrotum. In such an occurrence, it is usually an indirect hernia because the direct hernias do not follow this path in their movement through the inguinal ring.
Treatment
Hernias do not heal or improve on their own and in fact will usually get worse with time. In general, surgery is necessary to repair hernias. How bad the hernia is and the overall health of the patient are some of the factors surgeons consider in determining which type of surgery best suits each case.
Surgical Options
Open surgery: This is where the surgeon would have to make an incision in the abdomen, put back the hernia, and thereafter fix the abdominal wall, usually reinforced with mesh for additional strength.
Laparoscopic surgery: It is a much less invasive procedure in which several minor incisions are made. Through the incision, the doctor puts in the camera, as well as the repair tools, and operates the hernia from inside the belly. It is conducted with less scarring and is relatively fast.
Prevention
While it is impossible to prevent an indirect hernia, which in most cases derives from a congenital cause, there are steps to take to reduce the risk of a direct hernia.
Tips to prevent direct hernias:
- Avoid heavy lifting: Use proper lifting techniques and avoid straining your abdominal muscles.
- Maintain a healthy weight: Being overweight puts extra strain on your abdominal muscles and can therefore increase the chances of a hernia.
- Treat chronic cough: If you have a persistent cough, seek treatment to avoid putting extra pressure on your abdomen.
- Prevent constipation: Straining during defecation can weaken the abdominal wall, so constipation needs to be managed.
People who are at risk of developing an indirect hernia due to genetic reasons are both infants and young children, the condition can’t be prevented. But diagnosis at an early stage and timely treatment can prevent complications.
Conclusion
Both direct and indirect hernias include the inguinal canal, but their causes, location of causation, and age varies. A direct hernia manifests basically because of age and muscle strain, while an indirect hernia is more often than not congenital. The treatment in both is surgery, and early detection is essential and mandatory so as to avert other further complications later on, such as bowel obstructions or strangulation.
