The diagnosis of a perineal hernia is made during an examination by your veterinarian. External palpation and a rectal examination will generally confirm the suspected hernia. Additional diagnostic procedures may include X-rays and an ultrasound of the abdomen and hernia to make sure that the bladder is not displaced into the hernial sac.
Lab work, like a complete blood count, chemistry profile, and urine testing are performed before surgery to allow your veterinarian to determine if there are other medical conditions present and to choose the best anesthetic protocol for your companion.
Treatment requires surgery to repair and stabilize the weakened pelvic diaphragm musculature and neutering (castration) to remove the hormonal influence testosterone has on muscle weakness and prostate enlargement. Prior to surgery, the surgeon will determine if the bladder is trapped within the hernial sac. If this is the case, a catheter is placed into the urethra and bladder to relieve the build up of urine and to allow the bladder to be replaced into the abdomen.
If there is no organ entrapment, surgical correction can be performed at a scheduled time, as opposed to on an emergency basis. Surgery involves replacement of the hernia contents back into the abdomen and reconstruction of the muscles of the pelvic diaphragm using suture. This reconstruction generally uses the surrounding musculature, but may include use of a synthetic mesh (SIS or polypropylene) in some cases. In some patients with bladder retroflexion and severe herniation, the surgeon may also choose to operate inside the abdomen to permanently affix the bladder and the colon to the interior of the abdominal wall (cystopexy and colopexy). This can help to prevent recurrent displacement of these organs into the repaired hernia.
Complications can occur with any surgical procedure in the perineal area. Infection is uncommon with careful attention to sterile techniques and use of broad spectrum antibiotics during and after surgery. Other complications may include fecal incontinence, rectal prolapse (where the stretched rectal lining everts through the anal opening), and recurrence of the hernia. In cases where the hernia is only on one side, the opposite side may also weaken and develop a hernia in the future. The recurrence rate after surgical repair is about 10 to 15%.
After surgery, your pet will receive pain medications and be placed on a special diet and/or stool softeners to decrease straining and make defecation easier. It is important to not allow any strenuous activity for at least 30 days to prevent undue stress on the repaired muscles in the hernia. Call your veterinarian immediately if your pet has excessive swelling and redness around the incision area, if there is drainage from the incision or develops a fever, as all of these could be signs of infection and should be addressed immediately.