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Perineal hernia is a hernia involving the perineum (pelvic floor). The hernia may contain fluid, 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 .
They unanimously agreed that surgery should be discouraged for pelvic floor dyssynergia, and instead that biofeedback/pelvic floor retraining was the first line treatment. When dyssynergia is present with major abnormalities like rectocele or rectal intussusception, biofeedback/pelvic floor retraining should be conducted before attempting surgery.
Descending perineum syndrome (also known as levator plate sagging) [1] refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. [2]
When operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence. [13] Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. [14] According to the FDA, serious complications are "not rare ...
Mechanistically, the causes of pelvic floor dysfunction are two-fold: widening of the pelvic floor hiatus and descent of pelvic floor below the pubococcygeal line, with specific organ prolapse, graded relative to the hiatus. [10] People with an inherited deficiency in their collagen type may be more likely to develop pelvic floor dysfunction.
Other causes of pelvic floor prolapse can be advanced age, multiple vaginal deliveries, and birthing trauma. Birthing trauma includes vacuum delivery, forceps delivery , and perineal tear . In addition, a history of chronic constipation and excessive straining with bowel movements are thought to play a role in rectocele.
After pelvic exenteration, many patients will have perineal hernia, often without symptoms, but only 3–10% will have perineal hernia requiring surgical repair. [4] Many problems can occur with the stoma. [1] Bowel obstruction may occur, or the anastomosis created by the surgery may leak. [1] The stoma may retract, or may prolapse. [1]
This is a shortened version of the seventeenth chapter of the ICD-9: Diseases of the Digestive System. It covers ICD codes 800 to 999. The full chapter can be found on pages 473 to 546 of Volume 1, which contains all (sub)categories of the ICD-9. Volume 2 is an alphabetical index of Volume 1.