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Focus: Small animals - dogs, cats, guinea pigs, hamsters, pet rats and mice, birds and turtles      
February 19, 2020 

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written:  Feb 12, 2008
Updated: Feb 19, 2020

What is a perineal hernia?
It is a condition whereby the pelvic and/or abdominal organs (bladder, small intestines or rectum) protrude into the region around the anus, known as the perineum. This condition is most commonly seen in older, male, uncastrated dogs.

What is the cause of it?
The exact cause of perineal hernias is still unknown. It has been postulated that hormones are responsible for the weakening of the muscles that form the pelvic diaphragm.

Is it serious?
A perineal hernia does not require emergency surgery unless the animal is unable to urinate, defaecate or if the intestines are twisted. Under such circumstances, the animal may die within a short period of time.

How can it be treated?
Non-emergency perineal hernias can be managed by giving stool softeners to prevent the animal from becoming constipated and straining. Switching to a high fiber diet helps to keep stools soft. Perineal hernias can also be corrected by surgery.
Concurrent castration during the time of hernia repair is also recommended as it lowers the risk of a recurrence.

What are the risks of surgery?
Risks of the surgery are dependent on factors such as the age of the animal, body condition, general health, liver and kidney function, seriousness of problem, size of hernia and length of operation. In this particular case, the Shetland is an old dog (12 years old), therefore there might be anaesthetic risks involved. Due to the size of the hernia (15cm x 17cm), the surgery will take at least an hour, increasing the risks. A blood test should be performed to test kidney and liver function. The dog is also slightly thin and has gingivitis and decaying teeth, which may add to the complication of the surgery. 

What is the success rate of the surgery?
Success rate of the surgery is also dependent on the factors stated above.

What is the cost of the surgery?
Estimated cost of the surgery will be approximately SGD$900 - $1,800, excluding anaesthesia, medication and nursing costs.

Will the problem recur after the surgery?
There is a risk of recurrence even after the hernia has been repaired. As mentioned, stool softeners and a high fiber diet can help to prevent constipation and straining. Neutering is also recommended as it lowers the risk of a recurrence. In very large hernias, simple suturing of the sides will not be effective. Aa mesh may be used to close the defect or the rectum may need to be stitched to the abdominal wall.

How long can the dog survive if the surgery is not undertaken?
If the dog is still able to carry out its basic functions such as urinating and defaecating, it should be able to live a few more years. However, if the dog is unable to urinate or defaecate or if its intestines are twisted (may present as pain), it may die within a short period of time and emergency surgery is required.

Dr Sing's comments on the gigantic perineal hernia in the Shetland Cross:
Perineal hernias are best repaired when they are small in size (less than 10 cm across) even though the dog has no problems with urination and defaecation, as the defect is much easier to repair at the early stage. Castration should be done too.
The success rate is usually very good. Sometimes, the hernia recurs due to the owner's fault in letting the dog jump soon after the surgery and the vet permitting the owner to take the dog home 1-2 days after surgery to save the owner some veterinary costs.

There is simply no time for the wound to heal. When the hernia recurs, the owner does not want to pay for another surgery as in the case shown below.
Intact Male PekX, constipation. Rectum with stools diverted. Perineal hernias.Toa Payoh Vets  
The perineal hernia of the Shetland X is enormous compared to my 2008 case described at: Perineal hernias in a male Pom X. Therefore, the duration of surgery will exceed 1 hour and the dog may just die on the operating table.  The owner came for a second opinion and declined any surgery.

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