A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. While hernias can occur throughout the body, a high anal hernia is a distinct type affecting the pelvic region, involving a protrusion near the anus. This article explores its characteristics, causes, diagnosis, and treatment.
Understanding High Anal Hernias
A high anal hernia, also known as a perineal hernia, involves the protrusion of pelvic or abdominal contents through a weakened area in the pelvic floor. These contents might include portions of the rectum, small intestine, fatty tissue, or even the bladder. The pelvic floor is a group of muscles and fascia that support the organs within the pelvis, including the bladder and rectum.
This type of hernia is distinguished by its location in the perineum, the area of skin situated between the anus and the outer part of the genitals. The weakness typically occurs in the muscles and fascia of the pelvic diaphragm, a sheet of muscles around the rectum that forms the back wall of the abdominal cavity.
Causes and Recognizable Symptoms
High anal hernias develop when damage to the muscles or fascia in the pelvic floor causes the tissue to stretch or weaken. A major cause in humans is perineal surgery without adequate reconstruction. Other factors that increase pressure within the abdomen can also contribute to their development, including chronic coughing, straining during bowel movements, heavy lifting, and pregnancy. Genetic predispositions, where individuals may have abnormalities in collagen fibers, can also increase the risk.
Symptoms include a noticeable lump or bulge in the perineal region, often near the anus or in one buttock. Discomfort or pain is common, especially when sitting, standing, or during physical activity. Patients might also report difficulty with bowel movements or a sensation of incomplete emptying, alongside urinary issues like difficulty urinating.
Accurate Diagnosis
Diagnosing a high anal hernia involves a medical evaluation. The process often begins with a thorough patient history, where the doctor inquires about symptoms and potential risk factors. A physical examination, including a digital rectal examination, allows the clinician to palpate the perineal area and assess for any bulges, weakness, or abnormal pockets in the rectum.
Imaging tests are frequently employed to confirm the presence and assess the extent of the hernia. Magnetic Resonance Imaging (MRI) of the pelvis, with or without contrast, provides detailed images of soft tissues and pelvic organs. Computed Tomography (CT) scans of the abdomen and pelvis can also be used, though MRI may offer better delineation of pelvic anatomy and pathology. In cases involving bowel or bladder function issues, MR defecography is a specialized MRI technique that visualizes pelvic organs during a bowel movement, offering insight into their function and structure.
Treatment and Recovery Pathways
Treatment for a high anal hernia primarily involves surgical repair, as this type of hernia typically does not resolve on its own. The main goal of surgery is to return the protruding organs or tissue to their proper position and strengthen the weakened pelvic floor. Surgical approaches can vary, including open surgery, where a larger incision is made, or minimally invasive laparoscopic techniques, which involve smaller incisions and specialized instruments. In some complex cases, a robotic approach might also be utilized.
During the repair, surgeons may use sutures to close the defect, or they might employ a synthetic mesh to reinforce the weakened muscle and fascia, which can reduce the risk of recurrence. For severe hernias, or those that recur, mesh implants provide additional support. In certain situations, particularly if the rectum or bladder has moved into the hernia sac, procedures like colopexy or cystopexy may be performed to secure these organs back within the abdomen.
Recovery after high anal hernia surgery involves managing discomfort and gradually returning to normal activities. Patients can expect some soreness around the surgical site, especially during the first 24 to 48 hours. Pain medication is often prescribed to manage discomfort. Most patients can resume light activities, like walking, within a few days to a week. However, heavy lifting, pushing, or strenuous activities are typically restricted for several weeks to allow the repaired tissues to heal properly. Full recovery can take several weeks to a few months.