Perineal injury happens to the perineum, which is the part of the body between the genitals and anus. In males, the perineum is the area which is situated between the scrotum and the anus, the pouch of the skin which holds the testicles. Injuries to the perineum can happen suddenly like an accident or as the activity which puts the pressure on the perineum. There can be sudden damage to the perineum which is known as an acute injury, while gradual damage is known as a chronic injury.
Why perineum is important?
The perineum is important as it contains blood vessels and nerves which supply the genitals and urinary tract with nerve signals. The perineum likes below a sheet of muscles which are known as pelvic floor muscles. These muscles support the bowel and the bladder.
Perineal Injury- Complications
Injury to blood vessels, muscles in perineum can lead to complications like
- Bladder control problems: The nerves which are present in perineum carry the signals from the bladder to spinal cord and brain. These nerves carry the signals from the brain to the bladder and pelvic floor muscles which directs the muscles to release the urine. Injury to these nerves can block the signals which cause the bladder to squeeze at the wrong time. Damage to pelvic floor muscles can cause bowel and bladder control problems.
- Sexual problems: The perineal nerves carry signals between the brain and the genitals. Injury to those nerves can interfere with sensations.
Perineal Injury- Causes
The common causes of perineal injury include:
- Perineal surgery
- Straddle injuries
- Sexual abuse
Perineal surgery: A prostatectomy is the removal of the prostate to treat prostate cancer. The prostate is the walnut-shaped gland in men, while it surrounds the urethra at the neck of the bladder while it supplies fluid which goes into the semen. The doctor will choose the location for incision which will be based on the patient’s physical health. The doctor will make an incision between the anus and the scrotum.
Perineal urethroplasty is surgery to repair the stricture of the portion of the urethra which runs through the perineum. Without following this procedure, some men would not able to pass urine. This procedure does not require an incision in the perineum which can damage nerves.
Straddle injuries: This results from falls onto objects like metal bars, wooden rails, where the person’s legs are on either side of the object and the perineum strikes object forcefully. These injuries can also include horseback riding, falling on playground equipment like monkey bars. In some rare situations, an injury to the perineum can burst a blood vessel inside the tissue of the penis. This condition is known as high-flow priapism. If it’s not treated, erectile dysfunction can happen.
Sexual abuse: Forceful sexual contact can result in perinal injury. When the doctor evaluates the injuries in the genital area, the might consider the possibility of sexual abuse, even if the family members say the injury is because of straddle injury.
Impalement: Impalement injuries can involve metal fence posts, weapons which pierce the perineum. Impalement is rare, it might occur where moving equipment is in use. Impalement can occur as a result of fall, such as from the tree. If an impalement injury pierces the muscles, the injured person will need medical attention to stop the blood loss and repair the injury.
Perineal Injury- Treatment
Treatments for perineal injury vary with severity and type of injury. Incision might require stitches. Piercing injuries might require surgery to repair damaged pelvic floor muscles, nerves and blood vessels. Treatment from acute injuries can include antibiotics to prevent the infection. The doctor can treat high-flow priapism caused by the blunt injury to the perineum with medication, blockage of the burst blood vessel or surgery.
Perineal Injury- Prevention
Preventing perineal injury requires being aware of and taking steps to minimize the dangers of activities like bike riding:
- People should talk with the doctor about the benefits of perineal surgery before the operation.
- People who play around the moving equipment should wear protective gear whenever it’s possible.
- People suffering from constipation should talk with their doctor about whether to take a laxative to minimize straining during the bowel movement.
- People who ride motorcycles, ride bikes should find seats to place the most pressure on the buttocks and can minimize the pressure on the perineum.