Perineal hernia

　　Perineal hernia is caused by weakened pelvic floor muscles, reduced tension, and factors such as multiple pregnancies, deliveries, pelvic tumors, etc., leading to increased pelvic pressure. Perineal hernia is divided into anterior perineal hernia and posterior perineal hernia according to the relationship between the hernia and the perineal transverse muscle.
　　1. Anterior perineal hernia:The hernia sac protrudes through the levator ani from the urogenital diaphragm in front of the perineal transverse muscle, and is almost only seen in women. Due to the different locations of the hernia, it can be further divided into pudendal hernia, vaginal hernia, and labial hernia. The hernia contents can be small intestine or sigmoid colon, and usually includes a part of the bladder, and almost all of them can be reduced.
　　2. Posterior perineal hernia:In men, the hernia sac descends between the rectum and bladder and appears in the ischiorectal fossa or near the midline of the perineum; in women, the hernia protrudes from the levator ani hiatus or between the levator ani and coccygeus muscles, and can appear in the ischiorectal fossa, and can continue to extend below to bulge at the lower edge of the gluteus maximus. Therefore, it should be differentiated from ischiorectal hernia. The hernia increases in size when the patient stands, and can cause dystocia if combined with pregnancy. Posterior perineal hernia is less common than anterior perineal hernia, and can occur in both men and women, but it is much more common in women.

　　Perineal hernia generally does not cause complications. When the hernia mass is small, it is usually located on one side of the labia majora or near the anus, protruding forward, and sometimes causing pain or discomfort during sexual activity. The mass gradually increases in size with the progression of the disease, occupying one side of the perineum, and some reports suggest that it can be as large as a child's head, making daily activities very inconvenient, but it rarely occurs in incarcerated or strangulated conditions.

　　Perineal hernia is rare in clinical practice, generally occurring in women, with a history of multiple pregnancies and deliveries or diseases that increase pelvic pressure, such as pelvic tumors. Patients often report the appearance of an unknown cause of a perineal mass, which appears when standing, walking quickly, or when intra-abdominal pressure increases (labor, coughing, or forceful defecation), and disappears after lying down and resting or pushing the mass upwards with the hand. The hernia mass is usually located on one side of the labia majora or near the anus, protruding forward, and sometimes causing pain or discomfort during sexual activity. The mass gradually increases in size with the progression of the disease, occupying one side of the perineum, and some reports suggest that it can be as large as a child's head, making daily activities very inconvenient, but it rarely occurs in incarcerated or strangulated conditions.

　　Perineal hernia is caused by weakened pelvic floor muscles, reduced tension, and factors such as multiple pregnancies, deliveries, pelvic tumors, etc., leading to increased pelvic pressure. There is currently no effective preventive measure for perineal hernia, and early detection and early diagnosis are the key to the prevention and treatment of the disease.

　　The diagnosis of perineal hernia, in addition to relying on clinical manifestations and signs, also requires essential auxiliary examinations. The main clinical examination methods include ultrasonography, X-ray, gastrointestinal contrast examination, and CT scan.

　　In addition to routine treatment, diet is also an important auxiliary treatment measure for perineal hernia. Common dietary注意事项 include:

　　Appropriate diet
　　1. Diet should be light, easy to digest, and low in residue to avoid increased frequency of defecation.
　　2. Patients with habitual constipation or poor defecation should eat more vegetables and fruits rich in fiber to keep the stool soft in their daily life.

　　Contraindicated Diet
　　1. Patients should avoid eating刺激性 foods such as chili oil, mustard, and chili peppers.
　　2. Avoid overeating greasy foods; avoid eating fish such as hairtail and crabs.

　　Surgical repair is the only effective treatment for perineal hernia, including traditional perineal, transabdominal, and combined repair surgeries, as well as laparoscopic perineal hernia repair surgery. The surgical method is determined based on the patient's age, health condition, sexual activity requirements, and the hospital's equipment and technical conditions.

　　1. Transabdominal hernia repair surgery:The advantages of this method are clear exposure, reliable treatment of the hernia sac, especially suitable for those with incarcerated and strangulated hernia contents. The patient takes a supine head-down position, makes a lower abdominal midline incision, carefully explores the pelvic floor, especially the common locations in front and behind the broad ligament. Use saline gauze pads to separate the intestines, expose the hernia, carefully pull the hernia contents out of the hernia ring, and check for strangulation and necrosis before returning to the abdominal cavity. After freeing the hernia sac, turn it into the pelvic cavity, ligate the neck through and excise the excess hernia sac; if the hernia sac is difficult to free and turn into the pelvic cavity, a purse-string suture can be made at the neck of the hernia sac. If the muscle gap is small, it can be directly sutured to close the defect; if the muscle gap is large, the lower end of the broad ligament can be sutured to the uterorectal ligament, or part of the rectal wall can be sutured to strengthen the repair.

　　2. Perineal hernia repair surgery:Take the lithotomy position, make a 'U' shaped incision on the skin and mucous membrane line of the affected side of the labia, cross the perineum horizontally from the opening of the vestibular gland to the same point on the opposite side, and incise and free the hernia sac, separate and excise it, and perform high ligation and repair as much as possible. The advantages of this method are small trauma and easy access to the hernia sac; however, the field of vision is small, repair is difficult, and it is contraindicated for those with strangulation. If necessary, combined transabdominal approach can be used for hernia reduction, high ligation and repair of the hernia sac.

　　3. Laparoscopic perineal hernia repair surgery:Laparoscopic surgery has a history of over 20 years, but the application of laparoscopic technology for perineal hernia repair has only been reported by authors in the past 2 to 3 years. This operation has small incisions, light injury, mild pain, and quick recovery. Those who have the conditions can choose this method.