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The muscles of the male perineum The muscles of the female perineum [ edit on Wikidata ] 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.
A common cause of perineal hernia is surgery involving the perineum. Perineal hernia can be caused also by excessive straining to defecate. Other causes include prostate or urinary disease, constipation , anal sac disease in dogs , and diarrhea [ citation needed ]. Atrophy of the levator ani muscle and disease of the pudendal nerve may also contribute to a perineal hernia. In humans[ edit ] 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,   but not in infants and children see coccygectomy. The standard surgical technique for repair of perineal hernia uses a prosthetic mesh,  but this technique has a high rate of failure due to insufficient anchoring.
Promising techniques to reduce the rate of failure include an orthopedic anchoring system,  a gluteus maximus muscle flap,   an acellular human dermis graft,  and an acellular pig collagen graft. The overlying skin is already blueish. In dogs, perineal hernia usually is found on the right side. Dogs with benign prostatic hyperplasia have been found to have increased relaxin levels and suspected subsequent weakening of the pelvic diaphragm.
Because only about 20 percent of cases treated medically are free of symptoms, surgery is often necessary. 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.
Pararectal and obturator hernias as incidental findings on gynecologic laparoscopy.