Medial inguinal fossae between the medial and the lateral umbilical folds, areas also commonly called inguinal triangles (Hesselbach triangles). These are potential sites for direct inguinal hernias.

- The course of a direct inguinal hernia is through the weak abdominal wall, into the inguinal triangle, medial to the inferior epigastric artery, through the external inguinal ring only.
- Older men usually get direct inguinal hernia.

- Direct inguinal herniae arise as a result of weakness in the posterior wall of the inguinal canal.  This hernia cannot be controlled by digital pressure over the deep ring and only rarely does the hernia pass into the scrotum.