Hernia is a medical condition found mostly in men than among women. As high as 1/4th of adult males face the risk of experiencing hernia. But, how does it occur and most importantly, what differentiates an indirect hernia from a direct counterpart? Getting to know the answers for these questions becomes quite essential.
Hernia is a condition wherein a tissue (or at times, an organ) protrudes or comes out of its normal position. The tissue often makes it way out through a weak or feeble spot surrounding it. Different types of hernia are observed; these are hiatal (top part of stomach), umbilical (in your belly button), femoral (outer side of your groin), incisional (caused by a surgery in your abdominal area) or inguinal (inner part of the groin).
Hiatus is an aperture (opening) in your diaphragm. Your food pipe goes through this slot. When your stomach (especially the upper part) pushes itself through this aperture, it is called hiatal hernia. Umbilical hernia is seen among overweight women as well as newly born infants. This condition occurs when your intestine (small) pushes out of the tissue seen closer to your navel. Femoral hernia – like umbilical hernias – may occur among women who are obese. Here, the slot holding your femoral blood vessel (artery) gets intercepted by your intestine. Incisional hernias occur when people lead a sedentary lifestyle after a surgery in the abdomen. A part of your intestine gets pushed across the wall of your abdomen; especially at the spot where a surgery was performed.
Almost all hernias (as huge as 95%) that occur in the groin region are inguinal hernias. Men are more susceptible to this condition; main reason is the presence of inherent weak spots in the inner part of your groin.
What triggers hernia?
As mentioned, a weakness in the tissue or muscular area may be a natural occurrence at birth. But, it may show as a medical condition as a person ages. In sum, hernia is caused by a weak spot in your tissue or muscle along with an undue pressure onto an organ. This undue pressure may be due to chronic sneezing or coughs, lifting heavy weights or frequent constipation or diarrhea. Medical studies observe that lifestyle habits such as excessive smoking, being overweight due to lack of activity or an unbalanced diet may also cause hernias.
Direct and indirect hernia
Inguinal hernia is the most common among all types of hernia. It is a protrusion of a tissue or an organ from a weak zone found on the walls of your abdomen. It can take either a direct or an indirect form. These two categories of inguinal hernias are based on the way the condition takes shape. The shape and form of these hernias are influenced by one’s gender, age and a few other factors.
The two types show up as a bulged protrusion on the groin; the bulge gets bigger if the hernia is huge. In the initial stages, you may observe pains in the region. However, pains may be experienced only when hernia grows bigger. Among men, a distinctive sign is acute pain in your scrotal bags; this is experienced when your intestine makes an effort to push out.
The key difference between indirect and direct hernias is direct form of hernia gets formed as you become an adult. Direct hernia is common during the later stages of one’s life. However, if you have met with an injury, it may show up at a fairly early stage of your life. In general, direct hernia develops when a part of your abdominal wall becomes weak. Medical studies indicate that the weakening of the abdominal wall may occur due to aging or due to performance of daily chores. Studies also show that poor planning of posture before carrying very heavy objects can lead to direct hernia.
The indirect hernia occurs congenitally – i.e., it occurs while one is born. It can be seen while your baby cries. Indirect hernias do not develop due to an injury or a surgery. This condition occurs when a part of the baby’s abdominal tissue (known as the inguinal circle or ring) stands ill-developed. The ring or circle remains unclosed while the baby is in the womb of the mother.
Risks triggering incidence of direct hernia are smoking, presence of a medical history of hernias, unhealthy body mass index (BMI) and above all, being a man (however, in some rare cases women also may suffer from this condition). The risk factors that trigger indirect hernia are not known. The only risk for this type is being a male. Medical research shows men are more likely to be affected (the odds are at least 8 times more) than women.
Diagnosis and treatment of direct and indirect hernias
It may be a tough thing to differentiate the type of hernia when your doctor spots a bulge in your lower abdomen. In most cases when the person is less than 21 years of age, the bulge may be attributed to indirect hernia. Also, if the protrusion has come till your scrotal bag, it is often inferred as an indirect form of hernia. This is because the direct form of hernia usually may not push down to reach your scrotal area. As an extension of this observation, if the bulge is seen on the side of the groin (one or the other side) it is very likely to be a direct form of hernia.
Also, direct hernia almost never constricts or strangles your bowels. But, indirect hernia may often constrict the bowel. This action may also have an impact on the flow of blood to your intestine. It may be noted that bowel gets constricted when it gets into the inguinal ring. As a result, a bulge may be spotted in your abdomen.
Be it indirect or direct hernia, they do not go away on their own. The condition needs a surgery.
An open surgical procedure is done for the repair of the direct form of hernia. This is done by making a large surgical cut. Through the cut, access is created to the walls of the abdomen. The weakened spots of the walls are fortified with a mesh. The surgery aims to place the hernia back to its original position.
Surgical procedure to treat indirect hernias is done as an outpatient protocol. The protrusion is taken from the scrotal area; once taken way, the area is cleaned and sutured. It is treated as a minor procedure and is usually considered safe for children as well as for infants.
Modern technologies to treat hernia
Operations through laparoscopy are fast gaining popularity, especially for performing abdominal procedures such as hernia surgeries. Using a tiny equipment set, your doctor gains access into the abdominal area with ease; it takes minimal surgical cuts or incisions to perform this procedure. The surgeon often uses a small camera which lets the medical team to have a closer view of the hernia and to subsequently operate on it. As the surgical cuts are far and few between, for people with repeated spells of hernia, laparoscopic surgeries are the most preferred option. But are people exposed to risks of recurrent episodes of hernia? Yes. Those who have a direct or an indirect hernia are more likely to have one or more hernias.
As these modern techniques are minimally invasive, you can get back to normalcy within a matter of a few weeks. You may however be advised not to lift or carry very heavy items. It is recommended to consult experts of physical therapy (physiotherapists) or occupational therapy and seek needful inputs about lifting heavy objects.
Prevention of hernia
The indirect form of inguinal hernia is a congenital condition; hence there are no known ways to prevent it. However, the direct form of hernia can be prevented. Your doctor may advise you to stop smoking (smoking causes coughing; excessive coughing may weaken tissues in your body which only increases the risks associated to hernias), avoid lifting heavy items (never lift from your lower back; bending at your knees to pick items as well as maintaining an erect posture while standing can also help) and avoid putting on excessive body weight (being overweight enhances the risks of hernias).
In essence, inguinal hernia is the most common form of hernia. It can assume either an indirect or direct form. The major difference between these two forms of hernias is direct hernia develops during your adulthood. But, if you have had an injury, the odds of it showing up earlier in your life are high. Indirect form of hernia is a congenital medical condition. It develops when a part of your baby’s abdominal muscle or tissue is underdeveloped and incomplete.
Open surgery is one proven way to treat direct hernia. A surgical cut is made and needful access is opened to the walls of your abdomen. Weakened zone of the abdominal walls are strengthened with a mesh. On the other hand, surgeries done to treat indirect hernias are done at an outpatient level. It is often considered as a minor procedure.
Procedures done through laparoscopy are gaining overall acceptance. As surgical cuts are minimal, minimally invasive surgeries are becoming a preferred option among people with hernia.
Education: Doctor of Physical Therapy (DPT) from New York University. Experience: 5 years of experience writing for physiotherapy and sports medicine blogs, providing expert insights on injury prevention and rehabilitation.
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