Understanding Perineal Hernia

A perineal hernia is a protrusion of organs and tissues into the abdominal cavity. It develops when the pelvic floor muscles become too weak to keep the organs and tissues in place. Typically, this type of hernia is caused by damage to the pelvic area muscles, which drives them to stretch and weaken over time.

The risk of developing a perineal hernia is higher after getting pelvic surgery, but other injuries and pregnancy can also drive its development. In some cases, a person can be born with a perineal hernia. The only treatment option available is surgery.

This article explains everything you should know about perineal hernias.

What Does Perineal Hernia Mean (and What Organs Does It Affect)?

Perineal hernias are rare types of hernias caused by weakness in the transverse perineal muscle. The word “perineal” is used to describe the perineum, which is the area between the anus and genitals. This can be either the scrotum or the vagina. When the muscle and skin in this area become weak, nearby organs and tissues can protrude through the muscle, leading to a visibly noticeable bulge in the pelvic region.

Types of Perineal Hernia

Perineal hernias are characterized by whether they occur in front of or behind the pelvic diaphragm. When they are in front, they are referred to as anterior, and when they are in the back, they are referred to as posterior.

How Common Are Perineal Hernias?

Perineal hernias are incredibly rare. According to research, the type that develops following injury, illness, pregnancy, or surgery occurs in between 0.6 and 7% of people.

What Causes Perineal Hernias?

Perineal hernias develop when the pelvic floor muscles and area become damaged. This damage can occur in various ways, including with pelvic surgeries, injuries, illnesses, or pregnancy.

Having open surgery (surgery that requires a large incision in the abdomen) is correlated with the development of perineal hernias. During this type of surgery, the pelvic floor muscles are stretched to the point of weakening.

During pregnancy, pressure on the pelvic region can also drive the weakening of the muscles and lead to a perineal hernia. Congenital perineal hernias are also rare but can occur if the development of the perineal cavity does not occur properly in the womb. In some cases, experiencing chronic constipation or straining while having a bowel movement can also drive the development of a perineal hernia.

Which Surgeries Increase the Risk of a Perineal Hernia?

There are several pelvic surgeries correlated with the heightened risk of developing a perineal hernia, including:

• Abdominal resection, which involves removing the anus, rectum, and part of the large intestine to treat rectal or anal cancer
• Low anterior resection to remove cancer from the rectum through an incision made in the lower abdomen
• Pelvic exenteration, which removes the rectum and nearby organs such as the uterus, bladder, or prostate to treat various types of pelvic cancers

What Are the Symptoms of a Perineal Hernia?

In some cases, a person with a perineal hernia won’t experience any symptoms. However, when they do develop, the hernia will present with:

• Bowel obstructions
• Difficulty urinating or having a bowel movement
• Feeling a pulling sensation or discomfort when in a standing position
• Pain in the area
• Swelling or bulging in the area, often in one butt cheek or near the anus
• Topical skin erosion

How Are Perineal Hernias Diagnosed?

Since perineal hernias are visible, the diagnostic process will start with a physical exam. A healthcare provider will also evaluate a person’s medical history to determine if they fall into any of the high-risk categories, such as those who have recently undergone major pelvic surgery.

Following that, more imaging tests, such as ultrasounds, magnetic resonance imaging (MRI) scans, or computed tomography (CT) scans, may take place to help confirm the diagnosis and rule out other conditions.

How Are Perineal Hernias Treated?

The only way to treat a perineal hernia is through surgical intervention. Once the organs protrude through the pelvic wall, they must be manually put back into place.

Several surgical options are available for perineal hernias. The option chosen will depend on the severity of the hernia and the individual’s health.

Possible surgeries include:

• Laparoscopic, which involves inserting a thin tube with a camera on the end into small incisions in the abdomen to repair and replace organs and the pelvic wall.
• Transabdominal surgery, which opens the abdomen at the site of the hernia to put the organs back where they should be.
• Transperineal, which involves making an incision in the perineum to help relocate the protruded organs.

During the procedure, a surgeon may also place synthetic mesh into the area to help keep things in place, strengthen the pelvic wall, and improve the overall outcome of surgery.

What Is Recovery Like?

Like any other type of surgery, there is a recovery process. During this time, people may experience various sensations, including:

• Pulling or discomfort in the hernia area
• Bruising near the genital area or repair site
• Swelling

You may be advised to rest and get enough sleep for the first few weeks to help the body recover. You can also walk daily, starting with short bouts and walking a bit more each day. People should avoid strenuous activities, lifting, and sexual activity until given the go-ahead by a healthcare provider.

You should also avoid bathing for the two weeks following surgery and practice good wound care, such as patting the wound dry following a shower and changing the wound dressing regularly. Prescription or over-the-counter (OTC) pain relievers recommended by your healthcare provider can help make you more comfortable during recovery.

Can You Prevent a Perineal Hernia?

While you can’t always prevent a perineal hernia from occurring, you can strengthen your pelvic floor muscles through muscle-strengthening Kegel exercises. This will help reduce the risk of the pelvic wall weakening and, in turn, the risk of developing a perineal hernia.

If you struggle with constipation, you should also avoid excessive straining and try other techniques to get your bowels moving, such as using stool softeners or laxatives or speaking to your healthcare provider about potential causes and therapy options.

What Is the Outlook for Someone With a Perineal Hernia?

After treating a perineal hernia, there should be no long-term complications as long as the wound is cared for adequately. However, there is a chance of recurrence after surgery for this type of hernia.

Talking to your healthcare provider about prevention techniques could help keep recurrence risk to a minimum. Getting synthetic mesh placed during surgery also reduces the risk of perineal hernia recurrence.

When to Contact a Healthcare Provider

You should contact your healthcare provider if you experience any changes in your bowel or urination habits alongside a bulge in your perineum. Additionally, you should contact them if you experience pain in the region while standing or sitting.

Summary

A perineal hernia develops when the pelvic wall muscles weaken and stretch, allowing nearby organs to push through. This type of hernia is most notably associated with pelvic surgeries that weaken the pelvic floor muscles but can also develop due to injury, pregnancy, or be present at birth.

The only way to treat a perineal hernia is through surgery, and several options are available. The surgery chosen will depend on factors such as preference, severity of the hernia, and a person’s level of overall health.

When experiencing symptoms of a perineal hernia, such as a bulge in the buttocks, pain while standing, or difficulties using the bathroom, it’s essential to contact a healthcare provider. These signs can indicate a hernia or something else and should be investigated so that proper treatment can be given.