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Date:   27 August, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
2001 Case was first written: 16 April, 2001

2010 Case is written:  27 August, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129
2001 CASE: The dog has a big and hard backside swelling. Is it a perineal hernia or not?
"My dog has a big lump on his left backside," said the healthy and trim 82-year-old Mr Neil Archer.

Orange-size swelling left of the tail and anus

"Will you make a house-call and see what's wrong.  He is a very aggressive dog who guards the house well.  A 10-year-old male mutt, " said Mr Archer whom I had not seen for over 10 years since I met him at the Singapore Turf Club.

It is much easier for doctors to make house-calls but not veterinarians as the  aggressive canine patients would be much harder to manage at its own home territory.  Many owners prefer house-calls and may think that all veterinarians should be able to control any fierce dog.  "Just one look and the dog would shiver." But   veterinarians do not have the magic and some of the younger ones had been mauled by aggressive dogs while doing house calls. 

Singapore was having one of its heat waves in 2001.  It was real hot on this May 14, Sunday afternoon.  Visions of struggling with the canine client and everybody getting bitten formed in my mind. 

For all you know, the dog might even escape out of the house.  He was said to be a good jumper, having grown up with kittens.  It sounded as if an operation might be needed and it would be futile to make house call for this sort of canine condition.  A big swelling could mean lots of things.

The dog transport service brought the cross-bred to the clinic.  The lump was as big as the biggest orange, located on the left side of the anus.  It was a swelling with 2 irregular hard lumps of over 1-inch-and-a- half-circle edge.  It was discovered 3 weeks ago and the dog was irritated by it as it would not go away.

Perineal swelling had 200 ml of blood
If it was a perineal hernia, it would not have an encircling rim of hard tissue although one could not rule this out.  This hard tissue rim could be nature's effort to seal up the swelling and fluid such as blood.

Butch was tranquilised after his heart was checked to be in good condition.  He was having a good appetite but nobody knew whether he had trouble passing stools or urine.  

He was well looked after judging by his excellent body condition and coat.  No signs of skin disease except for the big pigmentation near the big left backside swelling.  Dogs do lick at big swellings trying to get its size reduced.     

15 minutes later, Butch could not stand up.  He was put on the table and  the tail area was clipped.  A small half-inch incision (see red spot on image) near the left side of the anus was made with a scalpel.  Over 200 ml of pinkish fluid with no smell, spurted out like a fountain spout.  The swelling deflated.

It was a haematoma.  An artery must have burst and the blood must have clotted to consolidate into the hard tissue and lumps.

It appeared to be a traumatic injury. 

"Is there another dog in the house?"  There was a 2 year-old male Dalmatian who was hyperactive, jumping onto Butch all the time.  Was it attempting to mate with Butch?  Could it have caused more than a haematoma?  Butch might still have a perineal hernia.  The next 2 days would reveal any more swelling but for this hot afternoon, his discomfort had been alleviated and the swelling was reduced by 90%.

This procedure definitely could not be done by a house-call.  It was good that the drainage of the haematoma was done 3 weeks later as the bleeding would have stopped by the back pressure.  Any earlier incision would cause considerable blood loss.

The grandfather, son and grown up daughter came. Therefore,  Butch was not so worried at being alone at the veterinary clinic.  The family was a close one as you seldom see 3 generations bringing a dog on a Sunday afternoon to a veterinarian.  Butch himself could be considered 70-year old in human years and was certainly a member of the family.   

Would this be the end of the story?  Would the bleeding recur again as the big blood vessel must have originated from inside the abdomen and had ruptured in this big herniated area.

There are sometimes surprises for the veterinarian. This case was not resolved by drainage of the blood as the swelling returned the next day.  An operation was needed to remove the hard
perineal lump and the gap was stitched up.

It was not the typical perineal hernia case as there was no intestinal tissues or abdominal fat falling into this gap as to be expected in a perineal hernia described in standard veterinary text books and in a following case.

A big spherical like swelling of the size of the biggest orange you can see at the supermarket, left of the tail and anus in a 10-year old male Cross-bred.  There were 2 hard lumps at one edge of the swelling giving an impression that the intestine with stools were prolapsed.  A curved edge of around 3 inches could be felt under the skin at another area.  It would appear to be a perineal hernia but the palpation revealed lumps.  Orange-sized fibrous swelling in left perineum of 10-year old X male bred
A small incision withdrew over 200 ml of pink fluid and the swelling collapsed to 20% of its size.  The next day, the big orange swelling re-appeared in full bloom. What was it?  It was not the typical perineal hernia described in all veterinary textbooks.  The big swelling was a fibrous capsule with two finger-like ends containing lots of pink fluid.  What caused it is unknown. Could be the frisky young Dalmatian? 

2010 CASE: The dog has a large and soft backside swelling. He strains and takes a long time to pass stools. Why?
 Perineal hernia in an old male dog presents as constipation in many cases. Dog owners usually ignore constipation by not consulting the vet.
male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore
male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore  
  male shih tzu constipation backside swelling perineal hernia repair toa payoh vets singapore repaired perineal hernia in male not neutered shih tzu - toapayohvets - singapore
The family discovered that their 10-year-old Shih Tzu had a big right backside swelling some 3 weeks ago. "The swelling is a perineal hernia," I said. "The muscle layers are weak and permit the abdominal fat and intestines get pushed out of this defect. "Surgery to repair the hernia is the only solution."

The dog was put under isoflurane gas anaesthesia and the extremely large hole was closed with 3/0 absorbable sutures. I stitch the anal sphincter muscles to the atrophied muscle layers. There was not much areas for me to anchor the stitches. A surprising finding was a horizontal muscle layer dividing he hernia into two halves. Will wait and see if the hernia can be repaired.

2 different cases are described here for veterinary students. The hard perineal sac in the first case is an unusual and rare finding. The second case is commonly found in male dogs. Neutering at a young age of one year old would have reduced the possibility of developing perineal hernias as such cases occur mostly in male dogs.  But many young Singaporean dog owners find neutering cruel or it may change the dog's temperament. It is important to check the dog's backside during bath times so that the hernia can be repaired early.

In large defects in the pelvic diaphragm as in the 2010 case, anchoring of sutures to the muscles to the anal sphincter muscles was difficult as many muscles have atrophied or thinned down over time. The perineal  hernia repair might breakdown. 14 days after the repair, it looked as if the dog had a swelling of the backside. He had fever and difficulty peeing and could not control his bladder. Urinary analysis indicated a urinary tract infection and prostatitis (from rectal digital palpation).   

There are various scenarios as follows:

large backside swelling, licking, perineal hernia not operated, painful peeing, pooping, toapayohvets, singapore1. Nothing happens for some time as the dog lives in pain and has difficulty pooping or peeing. The dog relieves its pain by licking the backside swelling till it is hairless and gets much more bigger. It may then get ulcerated and infected.

Intact Male PekX, constipation. Rectum with stools diverted. Perineal hernias.Toa Payoh Vets 2. The dog can't poop normally and screams as if he has constipation. 

3. The dog can't pee normally and screams as if he has urinary tract infection.

4. The dog can't poop or pee normally as the stools and bladder are stuck inside
the hernia. This causes great pain to the dog.

5. The bladder and intestines get stuck inside the hernia. The dog is in great repaired right perineal hernia in an old male dog constipation toapayohvets singaporepain if the blood supply to the intestines get twisted. This is an emergency as the dog will die soon.

If you don't want your male dog to be neutered, watch out for signs of constipation, backside swelling or tumours and consult your vet early. It is advised that you spare some time to have your dog checked by your vet yearly if you want your dog to live longer.  


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