Perineal Hernia

Overview

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:

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 and sexes. 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 and people assigned male at birth/AMAB) 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 and people assigned female at birth (AFAB) are more likely than men and people AMAB to develop this type of hernia.

Symptoms and Causes

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 and people AMAB) or the uterus and vagina (in women and people AFAB).

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:

Who is at risk for a perineal hernia?

These factors increase your risk of perineal hernias:

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:

Diagnosis and Tests

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.

Management and Treatment

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.

Prevention

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.

Outlook / Prognosis

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.

Living With

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?

A note from Cleveland Clinic

If you’ve recently had pelvic surgery and find it uncomfortable to sit or stand, you should see your healthcare provider. You may have a perineal hernia. This pelvic floor hernia is a rare complication of certain pelvic surgeries. It can also occur after an illness, injury or pregnancy. Organs or fatty tissue protrude through weakened pelvic floor muscles to enter your abdominal space. Your provider can perform surgery to treat the hernia and strengthen your pelvic floor muscles.

Last reviewed by a Cleveland Clinic medical professional on 07/11/2022.

References

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  • Dahan M., Krief D, Pouget N, Rouzier R. Laparoscopic perineal hernia repair following pelvic exenteration: a case report. (https://doi.org/10.1186/s12893-021-01237-9) BMC Surg. 2021 May 18;245. Accessed 7/11/2022.
  • Méndez-Ibarra JU, Mora-Sevilla JM, Evaristo-Méndez G. Primary posterior perineal hernia associated with dolichocolon. (https://www.sciencedirect.com/science/article/pii/S2444050717300165) Cirujia y Cirujanos (English Edition). 2017 Mar-Apr; 85(2):181-185. Accessed 7/11/2022.
  • Rayhanabad J, Sassani P, Abbas MA. Laparoscopic Repair of Perineal Hernia. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015944/) JSLS. 2009 Apr-Jun;13(2):237-241. Accessed 7/11/2022.
  • Ryan S, Kavanagh DO, Neary PC. Laparoscopic Repair of Postoperative Perineal Hernia. (https://www.hindawi.com/journals/crim/2010/126483/) Case Reports in Medicine. 2010 Aug:Article ID 126483. Accessed 7/11/2022.
  • Ýmisson B, Hamad A, Govindarajah N, Khan A. Symptomatic Perineal Hernias: A Rare but Challenging Problem after Laparoscopic Abdominoperineal Resection for Rectal Cancers. Combined Abdominoperineal Approach and Biological Mesh Repair. (https://clinmedjournals.org/articles/ijsrp/international-journal-of-surgery-research-and-practice-ijsrp-5-077.php) Int J Surg Res Pract. 2018 Jun;5(2):077. Accessed 7/11/2022.

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