Descending perineum syndrome

Descending perineum syndrome is a condition in which the perineum bulges several centimeters below the bony outlet of the pelvis during straining, first described by Parks and colleagues in 1966. It is mainly caused by excessive, repeated straining during defecation, along with weakening of the pelvic floor muscles from age-related decline or injury during pregnancy and childbirth, and it predominantly affects women. The condition can be symptom-free or can cause perineal pain, bowel problems such as constipation, incontinence or obstructed defecation, and urinary symptoms, though research findings are mixed on how closely the degree of perineal descent actually correlates with these symptoms; diagnosis relies on rectal examination, specialized measuring devices, ultrasound or defecography, and treatment ranges from conservative management to surgical repair of the pelvic floor muscles and anal region.