A perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually, is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
These hernias present as easily reducible perineal bulges and usually are asymptomatic. Alternatively, there may be pain, dysuria, bowel obstruction or perineal exenteration.
Treatment is by operation. The hernia is exposed by making an incision directly over it. The sac is opened, its contents reduced, it is cleared from surrounding structures and the wound is then closed. With patients in the semi-Trendelenburg position, the abdomen is opened and the mouth of the sac exposed. The sac is inverted, and excised, and the pelvic floor repaired.
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