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
• The feeling of the pelvis dropping during weighted activity
• Bowel and/or faecal incontinence
• 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.

Other possible causes related to weak pelvic floor muscles is neuropathic degeneration of muscles that comes with old age, 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 exercises. By strengthening the floor of the pelvis, symptoms of perineal descent can be reduced.

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

What 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 rectal prolapse, 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.

Sources

Austin Urogynecology (2014) Perineal Descent [online]. Austin Urogynecology [viewed 06/12/2018]. Available from: https://austinurogynecology.com/perineal-descent/

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.

University of Tennessee Medical Center. Descending-Perineum Syndrome [online]. University Colon & Rectal Surgery