Perineal descent is a condition in which the perineum prolapses or descends below the bony outlet of the pelvis. Symptomatic perineal descent is often associated with chronic straining in patients with chronic constipation. Other conditions that weaken the pelvic floor musculature can also lead to symptomatic perineal descent. Some amount of perineal descent is often present in conjunction with pelvic organ prolapse.
Symptoms include the need to hold up the perineum during defecation, and the sensation that the floor of the pelvis is dropping with weight bearing activity such as walking.
Treatment begins with treating the underlying cause which is usually constipation and the need to chronically strain. Pelvic floor physical therapy to strengthen the floor of the pelvis is sometimes employed. If surgery is performed, the focus is on elevation of the perineum and pelvic floor with either a da Vinci Sacrocolpoperineopexy or a posterior vaginal mesh placement with perineopexy. The choice of surgery depends on the presence of other conditions such as cystocele, rectocele, or uterine prolapse.