Clinical differences between direct and indirect inguinal hernia are:
| Direct | Indirect | |
| Extend to scrotum | Does not go down to the scrotum | Can descend into the scrotum |
| Direction of reduction | Reduce upwards and then straight backwards | Reduce upwards, then laterally and backwards |
| Controlled by pressure over the internal ring | Not controlled after reduction, by pressure over the internal inguinal ring | Controlled, after reduction by pressure over the internal inguinal ring |
| Direction of reappearance after reduction | The bulge reappears outwards to original position | The bulge reappears in the middle of the inguinal region and then flows medially before turning down to the neck of the scrotum |
| Palpable defect | Defect may be felt in the abdominal wall above the pubic tubercle | No palpable defect as it is behind the fibers of the external oblique muscle |
| Relationship of cord to sac | Sac appears medial to the inferior epigastric artery and is outside the spermatic cord (posterior to the cord) | The sac is inside the spermatic cord |