Assalam Aleikum Yahya,
Several classification schemes for groin hernias exist. The simplest and most common system separates them into direct and indirect inguinal hernias and femoral hernias.
Indirect inguinal hernias are the most common groin hernias in men and women. The hernia develops at the internal ring, which is the site where the spermatic cord in males (the round ligament in females) exits the abdomen. The origin is lateral to the inferior epigastric artery, in contrast to direct hernias which arise medially to the inferior epigastric vessels.
Most indirect inguinal hernias are congenital, even though they may not become obvious until later in life. They are most commonly thought to arise due to defective obliteration of the fetal processus vaginalis, which follows the path of the gubernaculums though the inferior anterior abdominal wall, preceding the testicle which then passes through the inguinal canal and into the scrotum at birth. Increased abdominal pressure in association with reduced muscular tone in the groin area may ultimately lead to protrusion of intraabdominal contents into the sac, resulting in a clinically detectable hernia.
Indirect hernias develop more frequently on the right, the side that descends last. The internal ring normally closes following the migration of the testicle into the canal and thus into the scrotum. The failure of this coaptation to occur, combined with failure of obliteration of the processus vaginalis, provides the necessary defect through which the hernia can develop, either in the neonatal, adolescent, post-pubescent, or adult periods. This is also the site through which the round ligament exits the pelvis and is affixed in the female.
Direct inguinal hernias — Direct inguinal hernias occur through Hesselbach's triangle, formed by the inguinal ligament (Poupart's) inferiorly, the inferior epigastric vessels laterally, and the rectus abdominus muscle superiorly. They occur as a result of a weakness in the floor of the canal. This weakness appears to be an inborn flaw in many cases, although some may occur due to "acquired" deficiencies in the abdominal musculature. The relationship between direct inguinal hernias and straining or heavy lifting is not clear; some studies suggest that the incidence of hernia is no higher in professions performing heavy manual labor than in sedentary professions, while others have come to the opposite conclusion [Am J Ind Med 1999 Dec;36(6):638-44].
Femoral hernias — Femoral hernias account for <10 percent of all groin hernias, but 40 percent present with emergencies such as incarceration or strangulation . Femoral hernias develop in the empty space at the medial aspect of the femoral canal, an area that can widen and become patulous over time and after trauma. The femoral nerve, femoral artery, and femoral vein are all lateral to the empty space in the femoral canal where femoral hernias develop.
femoral hernias are more common in women than in men, particularly older women. The reason for the higher incidence in women may relate to comparatively less bulky musculature at baseline, and/or weakness of the pelvic floor muscles from previous childbirth. Pectineus muscle atrophy with age may contribute to femoral hernia formation. Prior inguinal hernia repair also appears to be a risk factor for femoral hernia formation.
I hope that this information will be a benefit to you insha Allah,
wa salam aleikum