Perineal Hernia
Unblocking Patients
What is a Perineal Urethrostomy?
Feline Lower Urinary Tract Disease is commonly diagnosed in young to middle aged, overweight, cats. The diameter of the urinary tract at the level of the penis is very small and is prone to blockage with urinary crystals, sediment and also due to spasm of the muscles of the lower urinary tract. In male cats there are several factors thought to be responsible, such as urinary crystals or stones, infection (cystitis), or behavioral and stress. Urinary tract blockage can also occur in male dogs due to bladder stones, trauma or tumors, and is less commonly seen in females. Obstruction will prevent the patient from urinating and cause excess accumulation of urine in the bladder, making the patient very ill due to a build-up of toxins and electrolyte imbalances.
What are some clinical signs of Perineal Hernia?
Clinical signs can include:
Perineal swelling – this can fluctuate in size
Perineal bruising
Pain/discomfort associated with the swelling
Pain or discomfort when defecating
Constipation
Urinary Incontinence – the inability to empty the bladder properly
Acute illness due to obstruction of urine flow from the bladder (if the bladder is located in the hernia)
What are the causes?
There is a strong association between perineal hernia and the male hormone levels in middle aged to older entire male dogs. Any disease process that affects the levels of male hormones can therefore predispose to perineal rupture. In addition, any condition that results in straining or increased intra-abdominal pressure can result in failure of the pelvic diaphragm muscles.
Risk factors for perineal hernia include:
Male pets that are not neutered
Disease of the testicles
Disease of the prostate gland
Straining due to abdominal disease
Pregnancy (due to increased abdominal pressure)
What are my treatment options?
Surgical repair of the hernia and stabilization of the pelvic muscles along with neuter is recommended, especially if more than just a swelling and rectum are herniated. The main goal of castration is to shrink the prostate by removal of testosterone and to hopefully prevent recurrence. Non-castrated males have almost a 3 times greater recurrence rate. Dr. Pedraza always recommends to complete a neuter with hernia repair. Surgical options include a surgical reduction of the empty space and the position of the muscles with specific suture pattern and surgical mesh around the hernia.
What happens after the surgery is complete?
Prevention of postoperative straining is critical. Often, because the rectum has been so stretched out by the hernia, a rectal prolapse can occur and should be gently and manually reduced until it contracts. This can take a few days. The surgical site needs to be cleaned daily. An e-collar is normally needed to prevent licking and no scooting should be allowed. Antibiotics and pain relief is given for the first 14 days after surgery.