Perineal Hernia

What is a perineal hernia?

A perineal hernia occurs when weak pelvic floor muscles allow part of an organ or tissue to push into your abdominal cavity. This type of pelvic floor hernia can be a rare complication of pelvic surgery. It can also develop after an illness or injury. Less commonly, the condition is present at birth (congenital).

What does “perineal hernia” mean?

You may better understand this condition when you break down the meaning of each word:

• Perineal refers to your perineum, the area of skin between your anus and the outer part of your genitals. In the male reproductive system, this is the scrotum. In the female reproductive system, it’s the vagina.
• Hernias occur when part of an organ or fatty tissue pushes through a weak area in muscle or fascia. Fascia is a fibrous connective tissue that holds muscles, organs, nerves, bones and blood vessels in place. Your muscles and fascia are part of your musculoskeletal system.

What are the types of perineal hernias?

Healthcare providers classify perineal hernias as:

• Acquired: Occurring after an injury, illness or pregnancy.
• Congenital: Present at birth (this type is very rare).
• Secondary: Occurring after surgery (postoperative).

How common are perineal hernias?

Hernias are common. They can affect all ages. Inguinal hernias, which allow part of your small intestine to push into your groin area, are the most common. Approximately 1 in 3 Americans (mostly men) will develop an inguinal hernia at some point in their lives.

In comparison, perineal hernias are very rare. They occur in about 0.34% to 7% of people who undergo pelvic surgical procedures. Women are more likely to develop this type of hernia.

What causes perineal hernias?

Perineal hernias occur when damage to muscle or fascia in your pelvic floor causes the tissue to stretch or weaken. Injuries, illnesses, pregnancy and major pelvic surgeries can cause this damage. Your pelvic floor is a group of muscles that support organs in your pelvis, including your bladder and rectum. It also supports the prostate (in men) or the uterus and vagina (in women).

You’re most likely to develop a perineal hernia after pelvic surgery that takes place through a large incision in your abdomen. This type of open procedure often involves cutting or stretching a large amount of muscle and tissue in your pelvic floor. After surgery, your muscles and tissue are weaker. This can increase the risk of an organ pushing through your pelvic floor. Perineal hernias tend to occur within six months to five years of pelvic surgery.

What surgeries increase the risk of a perineal hernia?

You’re most likely to develop a secondary perineal hernia after undergoing certain surgeries, such as:

• Abdominoperineal resection: This is a procedure to treat rectal cancer or anal cancer. It involves removing your anus, rectum and a part of your large intestine called the sigmoid colon. You may have a laparoscopic abdominoperineal resection. This surgery takes place through several small incisions. An open abdominoperineal resection involves one large abdominal incision. Both procedures increase your risk of a perineal hernia.
• Low anterior resection (proctectomy): This surgery removes all or part of a cancerous rectum through an incision in your lower abdomen. This surgery is also a treatment for inflammatory bowel disease (IBD).
• Pelvic exenteration: This surgery removes your rectum, as well as nearby organs like your bladder, prostate or uterus. In addition to rectal cancer, this surgery treats prostate cancer in males. In females, pelvic exenteration also treats cervical cancer, uterine cancer, vaginal cancer and vulvar cancer.
• Prostatectomy: This surgery for prostate cancer removes your prostate gland. Surgical treatments include open radical prostatectomy and laparoscopic prostatectomy.

Who is at risk for a perineal hernia?

These factors increase your risk of perineal hernias:

• Being a woman.
• Cancer treatments like chemotherapy and radiation therapy.
• History of smoking.
• Hysterectomy.
• Rectal tumors or cancer.
• Use of immunosuppressants.

What organs does a perineal hernia affect?

After a trauma or surgery, one or more parts of these organs may push through your pelvic floor into your abdominal cavity:

• Bladder.
• Large intestine.
• Omentum (layer of fat that covers your intestines, liver and stomach).
• Small intestine.
• Uterus.

What are the symptoms of a perineal hernia?

Some people with perineal hernias don’t have symptoms. Others have pain or discomfort when sitting. Additional symptoms of a perineal hernia include:

• Difficulty peeing or pooping.
• Pulling sensation or discomfort when standing.
• Small bowel obstruction or large bowel (intestinal) obstruction.
• Swelling in one butt cheek.

How are perineal hernias diagnosed?

Your healthcare provider may be able to feel or see the bulging hernia sac. You may also get a CT scan or MRI to confirm the diagnosis.

How do providers treat perineal hernias?

You’ll need surgery to put the protruding organ or tissue back into place. Your surgeon will stitch together the weakened muscle or fascia. They may also sew a synthetic mesh material or a muscle flap into your pelvic floor to better support your organs.

Surgical options for hernias include:

• Laparoscopy, using a thin scope device with a camera (laparoscope) and several small incisions.
• Robotic surgery, using a laparoscope and a robotic device.
• Transabdominal, through an abdominal incision at the site of the hernia.
• Transperineal, through a small incision in your perineum.

What is the outlook for someone with a perineal hernia?

Surgery to treat perineal hernias is often successful. You shouldn’t have additional problems or complications.

Can you prevent a perineal hernia?

Doing Kegel exercises (pelvic floor exercises) can help strengthen your pelvic floor muscles. The surgeries that can cause a secondary perineal hernia are medically necessary and often lifesaving. After surgery, it’s important to follow your healthcare provider’s recommendations about resuming activities and lifting heavy objects. These steps may lower your chances of developing a hernia.

When should I call the doctor?

Call your healthcare provider if you have:

• Bulge in your perineum area or butt.
• Changes in urination or bowel movements.
• Pain or discomfort when sitting or standing.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the perineal hernia?
• What surgical treatment do you recommend?
• What steps can I take to prevent future hernias?
• Should I look for signs of complications?