I’m Having Trouble Defecating… Is It Perineal Descent?

A weakened pelvic floor can lead to a range of issues, most commonly pelvic organ prolapse. Any instance that strains the pelvic floor muscles can cause them to stretch and weaken to the point that organs like the uterus (uterine prolapse) ,bladder (cystocele) or rectum (rectocele) fall through the vagina. Similarly, a weakened pelvic floor can cause perineal descent. Difficult childbirth that results in tearing and stretching of the perineum contributes to perineal descent. Chronic constipation or straining can also be associated with perineal descent. It’s typical for women with pelvic organ prolapse to also experience some perineal descent. Rectal prolapse can also co-exist with perineal descent.

In order to better understand what perineal descent is, it might be helpful to have a quick anatomy refresher. The perineum is the muscular shelf at the base of the pelvic floor. This Includes the muscle between the anal canal and the opening of the vagina. The perineum provides the foundation for your pelvic floor, and it also helps with sexual arousal.

Perineal descent occurs when the muscle that comprises the perineum is compromised resulting in a bulge that is noticed outside the vaginal opening. Patients with perineal descent might experience symptoms like difficulty defecating, sometimes needing to press the perineum upward (splinting) to enable a bowel movement. Patients have also said that perineal descent feels like the pelvis is “dropping out” of their body whenever they’re in the middle of load-bearing activity such as running or climbing stairs.

Treating perineal descent requires a multi-prong approach, especially if you’re also experiencing constipation. It’s important to address the root cause for constipation and treat it as needed. Pelvic floor strengthening with activities such as pilates can help with symptoms, but surgery is performed in more severe cases.

The exact surgery you’ll receive is dependent on whether or not you have other conditions like cystocele, rectocele or uterine prolapse. At Austin Urogynecology, we offer da Vinci sacrocolpoperineopexy that results in elevation of the perineum. If you’re experiencing a bulge outside the anal opening, it might also mean you’re suffering from rectal prolapse which can be treated at the same time with rectopexy.

In order for us to come up with the best treatment plan for you, you’ll need to have an in person consultation where we can review your anatomy and symptoms. Contact us today if you suspect you may be dealing with perineal descent and we can help find the best treatment option for you.