What Is Perineal Descent?

When the perineum (the area between the anus and the vagina) begins to bulge and descend below the bony outlet of the pelvis, it can cause discomfort and difficulty in daily life. This condition, known as perineal descent, is commonly a result of chronic straining in patients experiencing constipation, however there are several other conditions that can weaken the pelvic floor musculature and contribute to issues caused by perineal descent. For example, perineal descent is often found in conjunction with pelvic organ prolapse, and it may coexist with rectal prolapse as well.

Patients with perineal descent may experience perineal heaviness, fecal incontinence, and have the feeling that the pelvis is “dropping” during weight bearing activity. Treatment begins with identifying and addressing the underlying cause, in mild cases pelvic floor physical therapy can help to strengthen the floor of the pelvis. Depending on the severity of the condition and the symptoms experienced, surgery may be performed.

The focus of surgeries that repair perineal descent is on elevating the perineum and pelvic floor. This can be achieved with either a da Vinci Sacrocolpoperineopexy or a posterior vaginal mesh placement with perineorrhaphy and elevation of the perineum. The choice of surgery depends on the presence of other conditions such as cystocele, rectocele, or uterine prolapse and on the severity of symptoms.If rectal prolapse is present, a rectopexy will be performed with the da Vinci sacrocolpoperineopexy. If the patient is suffereing from fecal incontinence, this is addressed by anal sphincteroplasty.

If you believe that you may be dealing with issues related to perineal descent, we encourage you to contact Austin Urogynecology today and schedule a free consultation.

Video Transcription (English):
“Hey everyone, my name is Dana, and I’m here with Dr. Shashoua’s office here at Austin Urogynecology. And today I’ll be talking to you about Perineal descent. Now the perineum is the structure most easily identified and described as the area between the vagina and the anus, and it functions as an important support to the vagina and other pelvic structures. Now sometimes when there is a weakening of the pelvic floor muscles, the perineum may bulge below the bony outlet of the pelvis. And this is what we know as Perineal descent. One of the main risk factors of this condition is chronic constipation with straining and common symptoms include a dropping sensation of the pelvic floor. Perineal descent can vary in severity and often co-exist with the presence of a rectocele, which is what we describe as a bulging of the rectum into the vagina. Now, diagnosis can often be made after a thorough history and physical exam. Treatment options vary and can utilize both conservative approaches and surgical management. Conservative therapies may include aggressive constipation management and pelvic floor physical therapy. Whereas surgical management focuses on rebuilding and elevating the perineum, which is often combined with pelvic floor prolapse repair. Thank you so much for listening. And if you’re still interested, you can reach out to our office or feel free to browse our website.”

Video Transcription (Spanish):
“Hola a todos, mi nombre es Dana y estoy en la oficina del Dr. Shashoua aquí en Austin Urogynecology. Y hoy voy a estar hablando con ustedes acerca de descenso perineal. Ahora, el perineo es la estructura más fácilmente identificada y descrita como el área entre la vagina y el ano, y funciona como un importante soporte para la vagina y otras estructuras pélvicas. Ahora bien, a veces cuando hay un debilitamiento de los músculos del suelo pélvico, el perineo puede sobresalir por debajo de la salida ósea de la pelvis. Y esto es lo que conocemos como descenso perineal. Uno de los principales factores de riesgo de esta condición es el estreñimiento crónico con tensión y los síntomas comunes incluyen una sensación de caída del suelo pélvico. El descenso perineal puede variar en gravedad y a menudo coexiste con la presencia de un rectocele, que es lo que describimos como un abultamiento del recto en la vagina. Ahora, el diagnóstico a menudo se puede hacer después de una historia clínica y un examen físico completo. Las opciones de tratamiento varían y pueden utilizar tanto enfoques conservadores como el manejo quirúrgico. Las terapias conservadoras pueden incluir un tratamiento agresivo del estreñimiento y la fisioterapia del suelo pélvico. Mientras que el tratamiento quirúrgico se centra en reconstruir y elevar el perineo, que a menudo se combina con la reparación del prolapso del suelo pélvico. Muchas gracias por escuchar. Y si todavía están interesados, pueden ponerse en contacto con nuestra oficina o siéntanse libres de navegar por nuestro sitio web.”