Descending Perineum Syndrome (Perineal Descent): Symptoms, Causes & Pelvic Floor Treatment

What Is Descending Perineum Syndrome?

Descending perineum syndrome, also known as perineal descent or perineal bulging, is a pelvic floor disorder that occurs when the muscles and tissues supporting the perineum become weakened or stretched. The perineum is the area between the anus and the vulva or scrotum.

As the pelvic floor weakens, the perineum can begin to descend or bulge below its normal position, particularly during straining or bowel movements. Descending perineum syndrome may occur alongside other pelvic floor conditions, including pelvic organ prolapse, rectocele or bowel dysfunction.

What Are the Symptoms of Descending Perineum Syndrome?

Symptoms of perineal descent can vary depending on the severity of pelvic floor weakness and associated prolapse conditions. Common symptoms may include:

• A feeling of heaviness, pressure or dropping in the pelvis
• The need to press on or support the perineum during bowel movements
• Difficulty emptying the bowels completely
• Constipation or excessive straining
• Bowel leakage or faecal incontinence
• A visible bulge or swelling around the perineum
• Discomfort during standing, lifting or physical activity
• Symptoms of pelvic organ prolapse occurring alongside bowel symptoms

Because descending perineum syndrome is often linked to weakened pelvic floor muscles, pelvic floor rehabilitation and conservative pelvic health support may help improve symptoms and pelvic support over time.

What Causes Descending Perineum Syndrome?

Descending perineum syndrome is usually caused by long-term weakening or excessive strain on the pelvic floor muscles and connective tissues that support the bowel and pelvic organs. Over time, this pressure can cause the perineum to descend lower than its normal position, particularly during bowel movements or physical activity.

One of the most common causes is chronic constipation and repeated straining during bowel movements. Excessive straining places repeated pressure on the pelvic floor and rectum, which may weaken the muscles and supporting tissues over time. Many cases of descending perineum syndrome are associated with long-term bowel dysfunction and chronic straining.

Common Causes in Women

Women are more likely to develop perineal descent due to factors that place additional strain on the pelvic floor, including:

• Pregnancy and childbirth, particularly multiple or difficult vaginal deliveries
• Menopause and reduced oestrogen levels affecting pelvic tissues
• Pelvic organ prolapse
• Chronic constipation and straining
• Age-related pelvic floor weakness
• Obesity or increased abdominal pressure
• Chronic coughing
• Previous pelvic surgery or pelvic trauma

Pregnancy and childbirth can overstretch or damage the pelvic floor muscles, connective tissues and nerves, increasing the risk of pelvic floor disorders including prolapse and perineal descent.

Common Causes in Men

In men, descending perineum syndrome is more commonly linked to bowel strain and long-term pelvic floor pressure, including:

• Chronic constipation and repeated straining
• Heavy lifting or high-impact physical work
• Chronic coughing or smoking-related lung conditions
• Obesity
• Age-related muscle weakness
• Pelvic or colorectal surgery
• Nerve damage affecting pelvic floor function

Other Contributing Factors

Ageing, nerve changes and weakening of the pelvic floor muscles can affect both men and women. Over time, reduced muscle tone and connective tissue strength may make the pelvic floor less able to support the bowel and pelvic organs effectively.

Because descending perineum syndrome is often associated with pelvic floor weakness, pelvic floor rehabilitation and strengthening exercises may help improve pelvic support and bowel function over time.

How Can I Manage Perineal Descent or Perineal Bulging?

Managing perineal descent with Kegel8 can be an effective way to strengthen your pelvic floor muscles and support your overall pelvic health. Here's how you can manage perineal descent using Kegel8:

Pelvic Floor Exercises: Kegel8 devices are designed to help you strengthen your pelvic floor muscles, which is essential for managing perineal descent. Regular use of the Kegel8 Ultra 20, and the Kegel8 V For Men for example, can guide you through effective pelvic floor exercises that target the weakened muscles, helping to lift and support the pelvic organs.

Tailored Programs: Kegel8 offers specific programs for different pelvic health concerns, including prolapse, incontinence, and post-surgery rehabilitation. These programs can help you target perineal descent by strengthening and toning the muscles involved.

Consistent Use: Incorporating Kegel8 into your daily routine can help prevent the condition from worsening and support recovery. The device helps you perform your exercises correctly and consistently, which is key to managing perineal descent.

Improved Bowel Health: Strengthening your pelvic floor with Kegel8 can reduce straining during bowel movements, which is a major factor in perineal descent. By supporting your muscles, Kegel8 helps make bowel movements easier and less stressful. Use a squat toilet stool to reduce straining and constipation.

Prevent Further Complications: By using Kegel8 regularly to strengthen your pelvic floor, you can prevent the condition from progressing to more severe prolapse issues and avoid the need for invasive treatments or surgery.

Support Garments - supporting your perineum will help. See SRC Restore Shorts and SRC Restore Leggings. Medical garments designed to support perineum and strengthen the pelvic floor at the same time will help keep you active. 

With Kegel8, you have a reliable, clinically proven way to manage perineal descent, strengthen your pelvic floor, and improve your overall pelvic health.

In more severe cases of descending perineum syndrome, surgery may be considered when conservative treatments such as pelvic floor rehabilitation, bowel management and lifestyle changes have not provided enough symptom relief.

The type of surgery recommended will depend on the severity of the perineal descent, associated prolapse conditions and your individual symptoms.

Common Surgical Treatments for Perineal Descent

Sacrocolpoperineopexy (including robotic-assisted surgery)
This procedure helps restore pelvic support by lifting and supporting weakened pelvic tissues. In some cases, surgeons may use robotic-assisted techniques, such as the Da Vinci® surgical system, to improve precision during surgery.

Posterior vaginal wall repair or mesh-supported repair
Where significant pelvic floor weakness or prolapse is present, weakened tissues may be repaired and reinforced to improve pelvic support. The suitability of mesh procedures varies between individuals and should always be discussed carefully with your specialist.

Perineorrhaphy
Perineorrhaphy is a procedure used to repair and tighten weakened perineal muscles and tissues. It may help improve pelvic support, bowel symptoms and feelings of perineal laxity or weakness.

Associated Pelvic Floor Conditions

Descending perineum syndrome often occurs alongside other pelvic floor disorders, including:

• Rectocele
• Cystocele (bladder prolapse)
• Uterine prolapse
• Rectal prolapse

If rectal prolapse is also present, additional surgery such as rectopexy may be recommended to restore rectal support and bowel function.

Conservative Treatment Is Usually Recommended First

Before considering surgery, many specialists recommend conservative pelvic floor treatments to help manage symptoms and support pelvic health. This may include:

• Pelvic floor exercises
• Pelvic floor rehabilitation with Kegel8
• Managing constipation and reducing straining
• Improving fibre and fluid intake
• Using a toilet stool to improve bowel positioning
• Maintaining a healthy weight
• Lifestyle and bowel habit changes

Reducing constipation and excessive straining is especially important, as ongoing pressure on the pelvic floor can worsen symptoms over time. A diet rich in fibre, including fruits, vegetables and wholegrains, alongside good hydration, may help support healthier bowel movements and reduce strain on the pelvic floor.

Sources

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Descending perineum syndrome: new perspectives PubMed NIH - National Library of Medicine (2015) (DPS)  [viewed 22/10/2024]  F Pucciani    

Rectal prolapse and perineal repair April 2022 Delorme’s operation or Altemeier procedure NHS April 2022

Baek, H.N. et al. (2010) Clinical Significance of Perineal Descent in Pelvic Outlet Obstruction Diagnosed by using Defecography. Journal of the Korean Society of Coloproctology. 26(6): 395-401. [viewed 06/05/2026]

Broekhuis, S.R. et al. (2010) Perineal descent and patients' symptoms of anorectal dysfunction, pelvic organ prolapse, and urinary incontinence. International Urogynecology Journal. 21(6): 721-729. [viewed 06/05/2026]

ATM Annals of Translational medicine April 2024  [viewed 06/05/2026] - Descending perineal syndrome cure by deep transversus perinei ligament repair: surgical options

Descending Perineum Syndrome: A Fresh Look at an Interesting and Complex Pelvic Floor Disorder JMIG Journal of Minimally Invasive Gynaecology. 2014 [viewed 06/05/2026]