What is Perineal Descent?
This is a condition in which the "perineum" (the skin and fibrous tissue between the vaginal and rectal openings) descends or prolapses below its normal position. This may result from a tear in the ligaments that support this structure or possibly a stretching of these ligaments. This condition may be associated with difficulty defecating. This condition often occurs with pelvic organ prolapse.
Diagnosing Perineal Descent
In some cases, this condition will be identified during a gynecologic examination. In other cases, a defecography X-ray study will be necessary to diagnose perineal descent.
Defecography is performed to identify the position of the pelvic organs and to determine whether the organs descend significantly during defecation or bearing down.
How to Prepare for a Defecography
- Preparation for this test includes laxatives and/or enemas to clean out the colon.
- Before the X-ray pictures are taken, a special fluid is instilled into the bladder through a catheter so that the bladder will show up on the x-ray pictures. A special gel is placed into the vagina for the same purpose. A paste is placed into the rectum, again to allow the position of the rectum to be visible on the x-ray pictures.
- The woman sits on a special chair or commode as X-ray pictures are taken. She is then asked to bear down or defecate (expel the paste from her rectum) as X-ray pictures are taken.
- The series of pictures allows the radiologist to measure any shift or descent in the pelvic organs and the perineum. In some circumstances, we recommend a similar test using Magnetic Resonance Imaging (MRI) instead of X-rays.
In some cases, physical therapy can alleviate the symptoms of perineal descent. However, in most cases, surgical correction is necessary. Surgery involves a repair of the weakened or torn ligaments that support the perineum and the back wall of the vagina.
At Johns Hopkins, our physicians are experienced at diagnosing perineal descent. Your physician will discuss different treatment options and refer you to an experienced surgeon if necessary.