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Perineal Descent

What is Perineal Descent?

Descending perineum syndrome is when the perineum (the area between the anus and the scrotum/vulva) bulges down and prolapses below the bony outlet of the pelvis. It’s a pelvic floor disorder, which can often occur alongside other types of prolapse. It’s also known as ‘perineal bulging’ or ‘perineal relaxation’.

What are the Symptoms of Perineal Descent?

Symptoms of descending perineum syndrome include:

The need to press up on the perineum to help with bowel movements
Bulging perineum can be due to weak pelvic floor muscles or a perineal hernia, or perineal swelling. (Perineal hernias are also known as levator or pudendal hernias)
The feeling of the pelvis dropping during weighted activity
Bowel and/or faecal incontinence, constipation.
Perineal descent is also often present in conjunction with pelvic organ prolapse.

What Causes Perineal Descent?

One of the main causes is thought to be excessive and repetitive straining. Straining forces the anterior rectal wall to protrude into the anal canal, this creates a sensation of incomplete defecation and weakness of the pelvic floor. This can happen if you suffer from chronic constipation; 90% of descending perineum cases are caused by chronic straining.

Childbirth: Vaginal deliveries, especially multiple or complicated ones, can overstretch and damage the pelvic floor muscles and nerves, leading to perineal descent. 9% of descending perineum syndrome cases are caused by childbirth or labour.

Aging: As we age, muscle tone and connective tissue strength naturally decrease, contributing to a weaker pelvic floor.

Chronic coughing: Conditions such as chronic bronchitis or smoking can lead to persistent coughing, which increases pressure on the pelvic area, causing the perineum to descend.

Obesity: Excess body weight adds pressure to the pelvic floor, increasing the risk of perineal descent.

Pelvic surgery or trauma: Surgical procedures or injuries in the pelvic area can disrupt or weaken the muscles and ligaments supporting the perineum.

Other possible causes related to weak pelvic floor muscles is neuropathic degeneration of muscles that comes with aging, or trauma to the pelvic floor muscles or the nerve supply during pregnancy and childbirth. 9% of descending perineum syndrome cases are caused by childbirth or labour.

How Can You Prevent Perineal Descent?

The main method of preventing perineal descent is pelvic floor physcial therapy. By strengthening the floor of the pelvis, symptoms of perineal descent can be reduced.

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, 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.
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.

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

What Else Can I Do To Manage Perineal Bulging?

In addition to using Kegel8 to manage your perineal descent and strengthen your pelvic floor, here are a few more things you can do to help prevent the need for surgery:

Avoid Straining During Bowel Movements: Chronic straining can worsen perineal descent. To help with this, try using a toilet squat stool to position your body in a way that eases bowel movements, reducing pressure on your pelvic floor. Increase your intake of fibre-rich foods and stay hydrated to prevent constipation. Use a Squatting stool such as Go Better for 90% less straining. Femmeze vaginal splint helps to make bowel movements easier and reducing straining by realiging the bulge.
Maintain a Healthy Weight: Extra body weight puts added pressure on your pelvic floor. Managing your weight through a balanced diet and regular exercise can help reduce strain on your pelvic area.
Stay Active: Low-impact exercises like walking, swimming, or yoga can help maintain overall pelvic health without putting excessive strain on the area. These activities also support weight management and overall fitness.
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.
Posture and Lifting Technique: Avoid heavy lifting, but if you need to lift something, use proper posture—bend at your knees, not your waist, and engage your pelvic floor to avoid straining.
Pelvic Floor Physiotherapy: Consider seeing a pelvic floor specialist or physiotherapist. They can guide you through personalized exercises and techniques to strengthen your pelvic muscles, helping you manage perineal descent effectively.
Quit Smoking: If you smoke, quitting can reduce chronic coughing, which can put extra pressure on your pelvic floor.

By combining the use of your Kegel8 device with these lifestyle adjustments, you can manage perineal descent more effectively, reduce your symptoms, and lower the chances of needing surgery. Keep focusing on strengthening and supporting your pelvic floor to prevent the condition from worsening.

What Surgical Treatments are Available for Perineal Descent?

In terms of surgery, there are three main types of operations used to correct perineal descent, these include:

Da Vinci Sacrocolpoperineopexy - A surgeon uses a robotic platform to assist in surgery.
Posterior vaginal mesh placement - Tissue that is weakened is brought together and supported with the use of transvaginal mesh.
Perineorrhaphy - Perineal relaxation can occur when the opening to the vagina is stretched and relaxed; this can weaken the perineal muscles and decrease sensation. Perineorrhaphy is a procedure whereby the weakened perineal muscles are brought together for reinforcement.

The method of surgical treatment will also depend on the prevalence of other conditions, such as rectocele, cystocele, or uterine prolapse, and their severity.

Constipation and perineal descent may also be found along with rectal prolapse. If this is the case, rectopexy (rectal prolapse surgery) will be performed alongside sacrocolpoperineopexy.

You can also avoid straining by improving fibre intake in your diet by eating foods such as wholegrains, fruit and vegetables.

Sources

Austin Urogynecology Perineal Descent [online]. Austin Urogynecology [viewed 22/10/2024]. Available from: https://austinurogynecology.com/perineal-descent/

Descending perineum syndrome: (2015) (DPS) happens when the muscles in the pelvic area weaken, leads to trouble going to the toilet, straining, and even bowel leakage. It can cause rectal pain or discomfort. The focus now is on how different factors, like straining during bowel movements or difficulty coordinating muscles, can make DPS worse. Treatment options are designed to help manage symptoms at different stages, improving your comfort and bowel function. [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.

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.