Direct inguinal hernias often happen to men age 40 and older. Your abdominal muscle wall can weaken as you age. Heavy lifting can cause it too. If you’ve had lower abdominal surgery in the past, it increases your risk of an inguinal hernia. Other risk factors for direct inguinal hernia include: Being white; Chronic cough or constipation. Dec 19, · It can cause symptoms such as: pain gastrointestinal upset constant feeling of stomach fullness.