What is a Direct Inguinal Hernia?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 15 October 2019
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A direct inguinal hernia occurs when a weakened part of the inguinal Hesselbach triangle is further compromised by excess physical strain that forces intestinal tissue to breach the abdominal wall and enter the inguinal canal. In some cases, a direct inguinal hernia can place one’s life in jeopardy if the herniated tissue creates a bowel obstruction or necrotizes. Direct inguinal hernias usually necessitate surgery to restore the intestinal tissue to its anatomical position.

Generally, an inguinal hernia develops when excessive exertion is placed on weakened tissue within the abdominal wall. Whether the abdominal wall's physiology is compromised due to a congenital condition or age, physical strain can cause the weakened tissue to tear or break. In the case of a direct inguinal hernia, intestinal tissue breaks through a compromised area of the Hesselbach triangle, which includes a portion of the peritoneum, allowing it to enter directly into the inguinal canal. Individuals who do a lot of heavy lifting or straining often develop a direct inguinal hernia. Other conditions that may contribute to the development of this serious condition include pregnancy, obesity and chronic constipation.

The onset of painful hernial symptoms generally necessitates a visit to a physician. Diagnosing a direct inguinal hernia involves a comprehensive physical and palpatory examination. Due to the obvious presentation a hernial bulge creates, no additional testing is generally required.


In some cases, individuals may have an inguinal hernia but remain asymptomatic, meaning they experience no discernible signs or symptoms, for quite some time. As the herniated tissue becomes more pronounced in the groin area, the individual may notice not only a tell-tale bulge, but experience feelings of pressure, burning and discomfort in the affected area. It is not uncommon for the discomfort to intensify when one bends, coughs or strains when defecating. If signs and symptoms of a direct inguinal hernia are ignored, the individual places him or herself at risk for complications, including hernial necrosis, a life-threatening condition that necessitates emergency surgery.

There is no way for a direct inguinal hernia to go away or heal independently. Generally, if an individual remains asymptomatic, a wait and watch approach is taken. When symptoms cause significant discomfort, surgery is used to restore the herniated intestinal tissue to its anatomical position. Depending on the severity of one’s condition either a laparoscopic or open surgery may be performed; the only difference between the two procedures is whether several small incisions or a single, large incision are used to access the hernia.

During surgery to repair a direct inguinal hernia, the compromised intestinal tissue is restored to its normal position. Sutures mend the torn or ruptured abdominal tissue and close the hole. Generally, a supplemental mesh, made of either synthetic or natural material, is positioned over the weakened abdominal tissue as reinforcement to prevent future hernia development.


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