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Perineal Hernia in Dogs

By: Dr. David Diamond

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Diagnosis In-depth

  • A thorough physical examination is necessary for a dog that is straining to defecate. Your veterinarian will palpate the abdomen carefully to feel for abdominal masses or other abnormalities.

  • A digital rectal examination allows your veterinarian to feel for weakening of the muscles of the pelvic diaphragm and diagnose the condition. The hernia may occur on either side of the rectum or on both sides together. Palpation of the perineal swelling while performing digital rectal examination will help to rule out other problems with the anal sacs, tumors around the anus, or tumors in the rectum.

  • In some cases, if your veterinarian is unsure of the diagnosis, a contrast material like barium may be fed to the animal or given as an enema to delineate the rectum on X-rays and see the hernia.

    Treatment In-depth

  • In mild cases of perineal hernia or cases in which surgical correction is decided against, medical management may keep the animal comfortable for an extended period of time. The goal of medical management is to maintain a soft consistency of the stool so the dog has an easier time defecating. This is accomplished with stool softeners, such as lactulose, or high fiber diets. These treatments cause the stool to retain water and thus remain soft. Occasionally, some animals need periodic manual removal of the hardened stool by the veterinarian, or periodic enemas, often given at home by the owner.
    When medical management is pursued, the animal must be closely monitored for worsening of the problem. It is especially important that the animal be watched for some of the serious symptoms such as vomiting or straining to urinate. It is very common for the problem to progress over time; for example, animals that initially require monthly enemas may later require weekly or daily enemas to keep the stool moving. When the condition reaches this point, surgery may be unavoidable.

  • For animals that have progressed despite medical management or those that are in a crisis because of intestinal or bladder entrapment within the hernia, surgery is usually recommended. The surgery entails making an incision over the swelling next to the anus, replacing the abdominal contents back into the abdomen, and repairing the hole through the pelvic diaphragm muscles. In some cases the defect in the muscles can simply be sewed back together. The most common repair involves the use of a muscle flap, created from another pelvic muscle, to cover the defect. This surgery, called an internal obturator muscle flap, is technically difficult but may be less likely to have postoperative recurrence.

  • Intact male dogs are also neutered at the time of the hernia repair to help reduce recurrence and treat some forms of prostatic disease that might be causing the animal to strain.

  • For animals that have bilateral perineal hernias, surgery can be performed on both sides at the same time; however, many surgeons prefer to wait several weeks prior to doing the second surgery to minimize postoperative discomfort and straining by the animal.

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