Understanding Perineal Descent

Perineal descent is a condition in which the perineum – the area between the genitals and the anus – begins to bulge and descends below the bony outlet of the pelvis. Perineal descent is also commonly referred to as “descending perineum syndrome”, “perineal bulging”, “perineal relaxation”, or a “bulging perineum”. One of the primary causes of perineal descent is chronic straining during defecation, however aging and childbirth can contribute to the gradual weakening of pelvic floor musculature and over time compounding issues can develop. Perineal descent often occurs alongside pelvic organ prolapse, and it may coexist with rectal prolapse as well.

Patients experiencing perineal descent may have the following symptoms: constipation/straining, fecal incontinence, and the sensation that the pelvis is “dropping” during weight bearing activities. Treatment begins with identifying and addressing the underlying cause of the symptoms, and in mild cases physical therapy targeting the pelvic floor muscles can be sufficient for strengthening the perineum. In more severe cases, milder treatments are not effective as the condition can be self-reinforcing due to repeated straining during defecation. When perineal descent has progressed to this point, surgery is usually necessary to restore the functionality of the pelvic floor muscles.

Surgeries that address perineal descent focus on elevating the perineum and the pelvic floor. There are two procedures we use to achieve this at Austin Urogynecology: either a da Vinci Sacrocolpoperineopexy, which addresses pelvic organ prolapse in addition to vaginal reconstruction, or a posterior vaginal allograft placement with perineorrhaphy and elevation of the perineum. The type of surgery recommended is based on the severity of symptoms and presence of other conditions, such as cystocele, rectocele, or uterine prolapse. In cases where a rectal prolapse is also present, a “rectopexy” will be performed alongside the da Vinci sacrocolpoperineopexy. If the patient is experiencing fecal incontinence, this can be addressed with a procedure called anal sphincteroplasty.

If you believe that you are suffering from symptoms related to perineal descent, contact Austin Urogynecology today and schedule a free consultation.