Perineal Descent Meaning
A disorder known as perineal descent occurs when the perineum prolapses (bulges downward) or drops below the bony outlet of the pelvis. Patients suffering from chronic constipation often experience perineal descent as a result of persistent straining. Perineal descent can also be caused by other disorders that impair the pelvic floor muscles. Pelvic organ prolapse is frequently accompanied by a perineal descent of varying degrees.
The condition known as “descending perineum syndrome” also occurs when the perineum prolapses below the bony outlet of the pelvis and bulges downward. Perineal descent syndrome, which is characterized by perineal swelling, was defined by Parks et al. in 1966 as the clinical evaluation of the anal edge descending beneath the line across the ischial tuberosity.
Perineal Descent Symptoms
Patients who have a history of persistent straining and a feeling of incomplete defecation, which is occasionally accompanied by a sensation of obstruction, are at an increased risk of developing the perineal descending syndrome.
Externally, this syndrome manifests either in a lowered anus at rest or descending perineum in response to straining. The anal mucosa often shows discomfort during this time of straining.
Anal hemorrhage, mucous loss, discomfort, and itching in the perineum are other possible complaints. Digital movements are sometimes necessary to pass feces, and severe cases are frequently linked with anal incontinence. Several disorders can cause the pelvic floor muscles to become weakened, which can potentially result in symptomatic perineal descent. Pelvic organ prolapse frequently coexists with some degree of perineal descent.
Rectal prolapse often occurs alongside perineal descent and chronic constipation. Rectopexy is performed in conjunction with Sacrocolpopexy in cases where rectal prolapse is prevalent. When the perineal body is weak and the condition is treated by anal sphincteroplasty, bowel, and fecal incontinence are also sometimes linked with perineal descent.
To help with bowel movements, people with descending perineum syndrome often have to press up on their perineum. They may also experience a “dropping” sensation in their pelvis when they bear weight.
The symptoms of descending perineum syndrome can worsen over time, shifting from an isolated obstructive disease syndrome to fecal incontinence and triggering a vicious cycle in which the patient strains harder, stretching the levator ani muscle further, which in turn worsens the obstructive disease syndrome.
Physical treatment for the pelvic floor is the primary strategy for avoiding perineal descent. Strengthening the pelvic floor mostly reduces perineal descending symptoms.
Perineal Descent Causes
Parks et al. originally described this descending perineum syndrome in 1966. The syndrome is typically defined as a ballooning of the perineum several centimeters below the bone outlet of the pelvis while the individual is under strain; however, the descent can also take place when the individual is at rest.
Straining excessively and repeatedly is believed to be one of the leading causes. Because of this straining, the anterior rectal wall is forced to protrude into the anal canal, which results in a feeling of incomplete defecation as well as a weakening of the pelvic floor muscles. This, in turn, creates further straining, creating a vicious cycle.
Other factors that often contribute to the development of this problem include a weakened pelvic floor due to either the neuropathic degradation of muscle that comes with advancing age or trauma to the pelvic floor muscles or the nerve supply to those muscles that can occur during pregnancy and childbirth.
This syndrome is diagnosed through rectal examination. Perineum descent can be measured using a specialized instrument called a “Perineocaliper.” A retro anal ultrasound scan is mostly utilized to observe this condition. When performing a rectal examination while straining, the puborectalis drops sharply, and the anterior rectal wall presses against the examining finger.
Perineal Descent Treatment
Identifying the source of the pain is the first stage in treatment. Pelvic floor physical therapy, in which the pelvic floor is strengthened, can occasionally alleviate symptoms. If surgery is necessary, da Vinci Sacrocolpoperineopexy or posterior vaginal mesh installation with perineorrhaphy and perineal elevation are the procedures of choice.
The first step in conservative medical treatment for descending perineum syndrome is making changes to how the person acts. The patient’s quality of life can improve if they adopt a high-fiber diet and drink more water to alleviate their constipation and diarrhea. Every day, the patient needs to consume at least two to three liters of fluids that are free of alcohol and caffeine. Kegel exercises can be started under a pelvic floor physiotherapist’s guidance.