My ten-year old small breed male dog was diagnosed with a perineal hernia about a month ago. I was told that stool softeners would make him more comfortable, but that surgery was the only permanent solution. Our veterinarian gave my dog an enema and then gave us lactulose as a stool softener. My dog is now actually dripping feces. Is that too soft and should I contact my veterinarian about it? What is a perineal hernia and what does the surgery entail? Aside from the usual risks of surgery, are there any side effects and/or risks? Is there any chance of a relapse?
It sounds like your veterinarian is covering the bases. Perineal hernia is common in older male dogs. It is relatively rare in cats. Any breed of dog may be affected, but these hernias develop most commonly in Boxers, Boston terriers, collies and Pekingese breeds. Perineal hernia involves a breakdown of the muscles that make up the pelvic diaphragm, which supports the rectum. This can happen on one side (unilateral) or both sides (bilateral) of the anus. When an animal strains to defecate against these muscles, an outpocketing (sacculation) of the rectum occurs. This becomes impacted with feces, making it difficult for the dog to defecate. Frequent straining, constipation, and/or accidents in the house may occur. Occasionally other organs such as the prostate or bladder can become entrapped in the hernia. This can make it a much more serious situation, especially if it causes an inability to urinate.
Based on your description, the fecal consistency may be too soft. Contact your veterinarian with regard to reducing the dose of lactulose.
As for the surgery, there are several types of procedures. The one favored by most surgeons is the internal obturator muscle flap technique. This involves elevating the internal obturator muscle, which is near the defect, and using it to reform the diaphragm. Following the surgery, the difficulty with defecation usually resolves over two to six weeks, depending on the size of the sacculation. It is strongly recommended that the dog be neutered at the time of surgery if it is intact, as the risk of recurrence of the hernia is increased in intact male dogs.
The potential complications include fecal incontinence. This is rare when an experienced surgeon performs the procedure. If it occurs, it is usually temporary. Breakdown of the repair can occur in about 10 to 15 percent of the cases repaired with the internal obturator muscle flap technique (this is in contrast to a 20 to 30 percent recurrence rate with some of the older procedures). Infection is uncommon, but can be troublesome, as this is a highly contaminated region of the body. Most veterinary surgeons administer antibiotics at surgery, and may continue them for several days following surgery to reduce the risk of infection.
If your dog is affected on only one side, he potentially could develop the condition on the other side at some point.
Overall, following surgery, the prognosis is quite good, although a few dogs may require stool softeners or may have some degree of straining.
12/07/00
