What is Perineal Herniorrhaphy?

A perineal hernia in a dog occurs when the pelvic muscles can no longer support the rectal wall. As a result, the rectal area begins to distend. This causes different organs to fall into the anal area. The surgical procedure, perineal herniorrhaphy, is often recommended to treat a perineal hernia in a dog. The procedure can be done by a board certified veterinarian. 

The exact cause of a perineal hernia is unclear. The condition has been linked to prostatitis, cystitis, urinary tract obstruction, rectal deviation, diarrhea, and constipation. 

The goal of the perineal herniorrhaphy procedure is to relieve constipation and painful urination. Perineal herniorrhaphy is also used to help prevent strangulation of the organs inside of the perineal hernia. This surgical procedure is often the first recommendation for dogs when a perineal hernia is diagnosed. 

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Perineal Herniorrhaphy Procedure in Dogs

Prior to performing a perineal herniorrhaphy, a veterinarian will want to examine the dog. In most cases, a perineal hernia is very visible. Unfortunately, seeing how severe the hernia is may be difficult without further testing. This is why some veterinarians recommend radiographs prior to surgery. 

Veterinarians will also recommend blood work prior to a perineal herniorrhaphy. Blood work is to ensure that all organs are functioning correctly. It also ensures that the dog’s organs are healthy enough to undergo anesthesia. 

In most cases, the severity of the perineal hernia depends on how fast the perineal herniorrhaphy is done. If it is found that the bladder is trapped in the perineal hernia, emergency perineal herniorrhaphy surgery is usually performed right away. 

If the veterinarian does not believe emergency surgery is necessary, the procedure usually is scheduled within one to two days. If surgery is not scheduled right away, the dog may have to take stool softeners up until the day of surgery. 

Prior to a perineal herniorrhaphy, it’s important that the dog’s intestinal tract is empty. Veterinarians may use laxatives, enemas, and even manual extraction to ensure this. If the veterinarian discovers the bladder is in the weakened pelvic wall, a catheter will be placed in the bladder to help drain any urine present. 

Anesthesia is administered prior to making any incisions. Most dogs will also require antibiotics through an IV during a perineal herniorrhaphy. After all anesthesia and antibiotics are administered, the veterinarian will began preparing the dog for surgery. 

The dog is laid on his or her back with the neck slightly extended. The paws and front legs are brought forward. The back legs are slightly spread, with knees slightly bent. Once in position, the surgical area will be prepared for the perineal herniorrhaphy. 

All hair in the area is removed and the area is cleansed aseptically. As soon as the area is clipped and clean, the veterinarian can begin making their incisions. 

A curved incision is made above the rectal muscles known as the coccygeus muscles. The incision then continues over the perineal hernia until it reaches about 3 cm under the pelvic floor. A cut is then made under the skin, into the hernia. This cut is made to remove or repair any abdominal material or organs present in the perineal hernia. 

Once all foreign materials are removed and repaired, the veterinarian will suture the inner muscles of the rectal area. Once the inner cut is sutured, the outer incision is sutured. If the dog is not castrated, castration will be performed after the outer incision is sutured.

After a perineal herniorrhaphy, dogs usually stay in the veterinary hospital for at least 24 hours. Some dogs may need to stay up to 48 hours after surgery. Dogs are usually required to return to the veterinary hospital around five days after they are released and again in another five days to check the surgical site and remove the outer sutures. 

Efficacy of Perineal Herniorrhaphy in Dogs

Perineal herniorrhaphy surgery is successful in about 85% of dogs who undergo the procedure. Some dogs may still struggle with defecation problems after a perineal herniorrhaphy. 

Sometimes the perineal herniorrhaphy procedure cannot be performed. If this is the case, veterinarians will try to manage the perineal hernia with different techniques. These techniques may include diet changes, stool softeners, laxatives, or enemas. If the bladder is compromised, urine may be removed by using a needle or with a catheter. 

Alternate techniques for treating perineal hernias may help relieve some of the pressure caused by the hernia. Continuing these techniques for hernia repair on a regular basis is not recommended, mainly because of the high chance of organ strangulation inside the perineal hernia. 

Perineal Herniorrhaphy Recovery in Dogs

Following a perineal herniorrhaphy in dogs, the veterinarian may prescribe an antibiotic. The antibiotic must be taken on a regular basis after the dog is released from the hospital. 

Cold and hot compresses may be recommended for the first few days following surgery. The incision area should be monitored on a daily basis. It should be noted if there are any signs of redness, swelling, and/or discharge. If any of these symptoms are noticed, a veterinarian should be contacted as soon as possible.

Stool softeners should be offered to the dog for as long as up to 2 months after the perineal hernia repair. Veterinarians often recommend a diet change for dogs who undergo this surgery. In most cases, a diet high in fiber is recommended. 

Visible improvement of the perineal hernia is usually evident right away. Although, sometimes the pelvic walls will give away once again right after surgery. It may take days before your dog is back to their normal behavior. In addition, it may take months before there is an improvement in defecation.

Cost of Perineal Herniorrhaphy in Dogs

Before the actual perineal herniorrhaphy procedure, there will be costs incurred. Cost depends on where you are located and where the surgery is performed, as well as what is needed before, during, and after the perineal herniorrhaphy. 

Your dog must undergo an exam by a veterinarian prior to the perineal herniorrhaphy. Veterinary exams may range in cost from $50 to $150 or more. If needed prior to the surgery, imaging may cost from $80 to $300 or more.

Blood work is often done before a perineal herniorrhaphy. Depending on how extensive the blood work is, the cost may be between $100 and $250. 

Depending on the severity of the perineal hernia, antibiotics may be prescribed prior to surgery. The price of the antibiotics will depend on what antibiotic it is and the quantity needed. Medication costs may range from $10 to $50. 

When factoring the cost of hernia repair, you must also remember other techniques used during the perineal herniorrhaphy. Techniques such as anesthesia, pain management, and monitoring vital signs. These are all needed to ensure a successful surgery. In most cases, the final cost of a perineal herniorrhaphy include the anesthesia, pain management, and monitoring. 

Total cost for a perineal herniorrhaphy depends on how severe the perineal hernia is. Perineal hernia repair surgery may cost as much as $1,500. 

Most dogs require a night or two of overnight stays in the veterinary hospital after treatment. If not included in the cost of the procedure, hospitalization may cost and addition $20 to $100 or more per night.

Pain relievers and/or antibiotics may be prescribed after the dog is released from the hospital. These prescriptions may cost anywhere from $10 to $50. In addition to prescriptions, dogs who undergo perineal herniorrhaphy will need at least two follow-up examinations. Depending on where the surgery is performed, the follow up exams may or may not be included in the total surgery price.

Dog Perineal Herniorrhaphy Considerations

As with any surgical procedure, there are risks and benefits. Perineal hernias that are left untreated may result in life-threatening complications. This is why the benefits often outweigh the risks associated with a perineal herniorrhaphy. 

The benefits of a perineal herniorrhaphy in dogs include relief of painful urination and constipation. Repairing a perineal hernia also is beneficial because it prevents and/or repairs any organ strangulation that occurred as a result of the hernia. 

Additionally, if the dog is not castrated, he can be easily castrated during the hernia repair. Castrating the dog during the repair will help lessen the chance of relapse. It is also beneficial because they dog will not have to under anesthesia again for the castration procedure. 

Dogs who undergo a perineal herniorrhaphy may suffer from uncontrollable bowel movements and excessive flatulence following surgery. This can often be controlled with a proper diet change and medications. 

In addition to irregular bowel movements, dogs may experience rectal prolapse after the surgery. Rectal prolapse is when the anal tissue distends from the rectal area. 

Other risk of the perineal herniorrhaphy surgery include, but are not limited to, bloody stools, inflammation of the anal sacs, urine dribbling, and/or chronic lesions inside the rectum. 

More than 80% of perineal herniorrhaphy procedures done in dogs are successful. The return of a perineal hernia is decreased significantly if the dog is castrated during the surgery. 

Perineal Herniorrhaphy Prevention in Dogs

There are various reasons behind what causes perineal hernias in dogs. It is thought that, in some cases, the walls of the pelvic region weaken due to congenital muscle weakness. In some dogs, there may be a neurological cause behind a perineal hernia.

Preventing a perineal herniorrhaphy procedure in dogs depends on the reason behind the hernia developing. For example, there are several causes behind why a dog may strain to defecate. These reasons include, but are not limited to diarrhea, constipation, anal sac inflammation, inflammation of the prostate, and urinary obstructions. 

In order to prevent a perineal herniorrhaphy, the underlying cause will need to be identified. Preventing the underlying condition that causes a perineal hernia can often be done with diet changes. Medications may be used in some cases to help prevent hernias from developing.