Direct inguinal hernia (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia:
 * sudden twists, pulls, or muscle strains
 * lifting heavy objects
 * straining on the toilet because of constipation
 * weight gain
 * chronic coughing

What are the symptoms of a Direct inguinal hernia?
Symptoms of inguinal hernia include:
 * a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum
 * discomfort or sharp pain—especially when straining, lifting, or exercising—that improves when resting
 * a feeling of weakness or pressure in the groin
 * a burning, gurgling, or aching feeling at the bulge

What are the causes of a Direct inguinal hernia?
Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years.

Who is at risk for a Direct inguinal hernia?
An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females.

How to know you have a Direct inguinal hernia (Diagnosis)?
To diagnose inguinal hernia, the doctor takes a thorough medical history and conducts a physical examination. The person may be asked to stand and cough so the doctor can feel the hernia as it moves into the groin or scrotum. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen.

When to seek urgent medical care
See your health care provider immediately if you develop any of the symptoms associated with a direct inguinal hernia.

Treatment options
In adults, inguinal hernias that enlarge, cause symptoms, or become incarcerated are treated surgically. In infants and children, inguinal hernias are always operated on to prevent incarceration from occurring. Surgery is usually done on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. The two main types of surgery for hernias are as follows:
 * “Open” hernia repair. In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia to sedate or help the person sleep, or a combination of the two. Then the surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support—an operation called hernioplasty.
 * Laparoscopy. Laparoscopic surgery is performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.

Diseases with similar symptoms

 * Epididymitis

Where to find medical care for a Direct inguinal hernia
Directions to Hospitals Treating a Direct inguinal hernia

What to expect (Outlook/Prognosis)

 * Surgery for inguinal hernia is usually done on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient.
 * Complications from inguinal hernia surgery are rare and can include general anesthesia complications, hernia recurrence, bleeding, wound infection, painful scar, and injury to internal organs.