Merck Manual

Please confirm that you are a health care professional

Loading

Perineal Hernia

By

Stanley I. Rubin

, DVM, MS, DACVIM, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign

Last full review/revision Dec 2013 | Content last modified Dec 2013

Perineal hernia is a lateral protrusion of a peritoneally lined hernial sac between the levator ani and either the external anal sphincter muscle or the coccygeus muscle. Incidence in intact 6- to 8-yr-old male dogs is disproportionately high, and Welsh Corgis, Boston Terriers, Boxers, Collies, Kelpies and Kelpie crosses, Dachshunds and Dachshund crosses, Old English Sheepdogs, and Pekingese are at higher risk.

Etiology and Pathogenesis:

Many factors are involved, including breed predisposition, hormonal imbalance, prostatic disease, chronic constipation, and weakness of the pelvic diaphragm due to chronic straining. The higher incidence among sexually intact males is evidence that hormonal influences probably play a primary role. Prostatic hypertrophy attributed to sex-hormone imbalance has been strongly implicated. Both estrogens and androgens have been cited as causative agents.

Clinical Findings and Diagnosis:

Common signs include constipation and obstipation, tenesmus, and dyschezia. Stranguria and urinary obstruction may develop secondary to retroflexion of the bladder and prostate. Visceral strangulation may be seen. A perineal swelling ventrolateral to the anus is evident. Herniation may be bilateral, but two-thirds are unilateral and >80% of these are on the right side.

The mass is soft and fluctuant and may be reduced digitally. A firm, painful swelling may be compatible with retropulsion of the bladder and prostate. Determination of contents is often made by rectal examination and perineal centesis (to determine whether urine is present). More than 90% of perineal hernias contain a rectal deviation, which is a sacculation of the rectum into the hernial sac, where the layers of the rectal wall remain intact.

Treatment:

Perineal hernia is rarely an emergency, except when the bladder has strangulated and the animal is unable to urinate. If catheterization cannot be done, the urine should be removed by cystocentesis and an attempt made to reduce the hernia. An indwelling urinary catheter may be necessary to ensure urethral patency and prevent recurrence of obstruction.

Surgical correction is always indicated, and concurrent castration to reduce recurrence is recommended. The prognosis is guarded because of the high incidence of recurrence (10%–46%) and postoperative complications such as infection, rectocutaneous fistula, anal sac fistula, ischiatic and pudendal nerve entrapment, and rectal prolapse.

Others also read

Also of Interest

Videos

View All
Overview of Metabolic Acidosis
Video
Overview of Metabolic Acidosis
Cryptosporidiosis
Video
Cryptosporidiosis

SOCIAL MEDIA

TOP