Perineal hernia

Infobox Anatomy
Name = Perineum in humans
Latin =
GraySubject = 120
GrayPage = 424


Caption = The muscles of the male perineum


Caption2 = The muscles of the female perineum

Perineal hernia is a hernia involving the perineum (pelvic floor). The hernia may contain fat, any part of the intestine, the rectum, or the bladder. It is known to occur in humans, dogs, and other mammals, and often appears as a sudden swelling to one side (sometimes both sides) of the anus.

A common cause of perineal hernia is surgery involving the perineum. Perineal hernia can be caused also by excessive straining to defecate (tenesmus). Other causes include prostate or urinary disease, constipation, anal sac disease (in dogs), and diarrheaFact|date=April 2008. Atrophy of the levator ani muscle and disease of the pudendal nerve may also contribute to a perineal hernia.

In humans

In humans, a major cause of perineal hernia is perineal surgery without adequate reconstruction. In some cases, particularly surgeries to remove the coccyx and distal sacrum, adequate reconstruction is very difficult to achieve. The posterior perineum is a preferred point of access for surgery in the pelvic cavity, particularly in the presacral space. Surgeries here include repair of rectal prolapse and anterior meningocele, radical perineal prostatectomy, removal of tumors including sacrococcygeal teratoma, and coccygectomy. Perineal hernia is a common complication of coccygectomy in adults,cite journal
author = Zook NL, Zook EG
title = Repair of a long-standing coccygeal hernia and open wound.
journal = Plast. Reconstr. Surg.
volume = 100
issue = 1
pages = 96–9
year = 1997
pmid = 9207665
doi =
issn =
] cite journal
author = García FJ, Franco JD, Márquez R, Martínez JA, Medina J
title = Posterior hernia of the rectum after coccygectomy.
journal = Eur J Surg
volume = 164
issue = 10
pages = 793–4
year = 1998
pmid = 9840311
doi = 10.1080/110241598750005462
issn =
] but not in infants and children (see coccygectomy).

The standard surgical technique for repair of perineal hernia uses a prosthetic mesh,cite journal
author = Kumar A, Reynolds JR
title = Mesh repair of a coccygeal hernia via an abdominal approach.
journal = Ann R Coll Surg Engl
volume = 82
issue = 2
pages = 113–5
year = 2000
pmid = 10743431
doi =
issn =
] but this technique has a high rate of failure due to insufficient anchoring. Promising new techniques to reduce the rate of failure include an orthopedic anchoring system,cite journal
author = Berrevoet F, Pattyn P
title = Use of bone anchors in perineal hernia repair: a practical note.
journal = Langenbecks Arch Surg
volume = 390
issue = 3
pages = 255–8
year = 2005
pmid = 15580523
doi = 10.1007/s00423-004-0523-6
issn =
] a gluteus maximus muscle flap,cite journal
author = Brizendine JB, LeFaivre JF, Yost MJ, Fann SA
title = Reconstruction of parasacral hernia with acellular human dermis graft.
journal = Hernia
volume = 10
issue = 4
pages = 360–3
year = 2006
pmid = 16705361
doi = 10.1007/s10029-006-0092-4
issn =
] an acellular human dermis graft,, and an acellular pig collagen graft.cite journal
author = Abhinav K, Shaaban M, Raymond T, Oke T, Gullan R, Montgomery AC
title = Primary reconstruction of pelvic floor defects following sacrectomy using Permacoltrade mark graft
journal = Eur J Surg Oncol
volume =
issue =
pages =
year = 2008
month = April
pmid = 18439796
doi = 10.1016/j.ejso.2008.03.007
url =
issn =
]

In dogs and cats

In dogs, perineal hernia usually is found on the right side. [cite journal |author=Head L, Francis D |title=Mineralized paraprostatic cyst as a potential contributing factor in the development of perineal hernias in a dog |journal=J Am Vet Med Assoc |volume=221 |issue=4 |pages=533–5, 500 |year=2002 |pmid=12184704 |doi=10.2460/javma.2002.221.533] Most cases are in older intact (not neutered) male dogs (93 percent in one study). [cite web | last = Seim | first = Howard B., III | title = Perineal Hernia Repair | work = Proceedings of the 29th World Congress of the World Small Animal Veterinary Association |date=2004 | url = http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2004&PID=8772&O=Generic | accessdate = 2007-03-25 ] Breeds that may be at risk include Welsh Corgis, Boxers, Australian Kelpies, Boston Terriers, Collies, Dachshunds, Old English Sheepdogs, and Pekingese. [cite web | title = Perineal Hernia | work = The Merck Veterinary Manual |date=2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/20605.htm | accessdate = 2007-03-25 ] Perineal hernias are rare in female dogs and uncommon in cats.

Dogs with benign prostatic hyperplasia have been found to have increased relaxin levels and suspected subsequent weakening of the pelvic diaphragm. [cite journal |author=Niebauer G, Shibly S, Seltenhammer M, Pirker A, Brandt S |title=Relaxin of prostatic origin might be linked to perineal hernia formation in dogs |journal=Ann N Y Acad Sci |volume=1041 |issue= |pages=415–22 |year=2005 |pmid=15956739 |doi=10.1196/annals.1282.062] In cats, perineal hernias are seen most commonly following perineal urethrostomy surgery or secondary to megacolon.cite journal | last = Hoskins | first = Johnny D. | coauthors = | title = Anorectal Disease | journal = DVM | pages = 8S–10S | publisher = Advanstar Communications |date=September 2006 ] Medical treatment consists of treatment of the underlying disease, enemas, and stool softeners. Because only about 20 percent of cases treated medically are free of symptoms, surgery is often necessary. Recurrence is common with or without surgery.

Several surgeries have been described for perineal hernias in dogs. The current standard involves transposition of the internal obturator muscle. This technique has a lower recurrence and complication rate than traditional hernia repair. A new technique uses porcine small intestinal submucosa as a biomaterial to help repair the defect. This is can also be done in combination with internal obturator muscle transposition, especially when that muscle is weak.cite book|author=Ettinger, Stephen J.;Feldman, Edward C.|title=Textbook of Veterinary Internal Medicine|edition=6th ed.|publisher=W.B. Saunders Company|year=2005|id=ISBN 1-4160-0110-7]

References


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