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Perineal Injuries in Men - Types, Causes, Diagnosis, and Treatment

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The perineal injury occurs to the perineum (area between scrotum and anus in males). Check out the article to know more about perineal injury in men.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At September 21, 2022
Reviewed AtFebruary 24, 2023

Introduction:

Perineal injury is the type of genital injury that occurs between the scrotum and anus of men, which causes bladder control problems and sexual problems. The perineum is the structure that lies below the pelvic muscles, which support the pelvic floor muscles and the bladder and protects the blood vessels and muscles that supply the genitals and the urinary tract. Perineal injuries are usually very rare and mainly occur due to road traffic accidents.

What Are the Types of Perineal Injuries?

Perineal injuries are classified as acute and chronic injuries.

  1. Acute Perineal Injuries: Acute injuries happen suddenly and can occur from trauma, sexual abuse, surgeries, burns, or some medical conditions.

  2. Chronic Perineal Injuries: Chronic injuries develop gradually as a result of pressure for long periods. Activities like sitting for long hours and bicycling for longer distances regularly can cause pressure on the perineum.

Who Is More Likely to Have Perineal Injuries?

The perineal injuries are more common in:

  • Military men who go into combat.

  • Men who do motorcycle and bicycle racing.

  • Individuals who do horse riding.

  • Gymnasts.

  • Sexually abused males.

  • Men who work at farms and construction sites.

What Are the Causes of Perineal Injuries?

The common causes include :

  • Straddle Injuries: Caused due to falls on wooden and metallic substances during bicycle, motorcycle, and horseback riding. Sitting in a narrow, sturdy bicycle seat can also cause straddle injuries.

  • Sexual Abuse: Forced and inappropriate sexual contact can cause perineal damage.

  • Burns: Contact with hot objects and hot liquids injures the perineum.

  • Surgeries: In some surgeries involving the ureter and prostate and for tumor removal, during which the surgeon needs to cut through the perineum.

  • Impalement: A fall can result in an impalement injury caused by metal fence posts and weapons that pierce the perineum. Although rare, impalement can happen when moving equipment is used. Impalement can also occur as a result of falling, such as from a tree.

What Are the Symptoms of Perineal Injury?

The symptoms of perineal injury include:

  • Pain in the groin region.

  • Bleeding or an open wound.

  • Burned skin.

  • Bruises.

  • Swelling.

  • Inability to urinate.

  • Pain in the bladder.

  • Pain in the tailbone.

  • Pain while sitting and during intercourse.

  • Frequent urination.

How Is a Perineal Injury Diagnosed?

The perineal injury can be diagnosed by:

  • Physical Examination: In the physical examination, the physician looks for wounds, swelling, or any burns and bruises, and a rectal examination is also done to detect the presence of internal injuries. Neurologic examination to know the sensation, whether the patient feels the touch or if there is any numbness.

  • Imaging Tests: The imaging tests that are done to know the internal injuries are:

  • CT Scans: Are used to know the injury to the perineum.

  • MRI Scan: To evaluate the damage caused to nerves and muscles.

  • Ultrasound: To know the damage caused to blood vessels.

  • X-Rays: To know the injuries to the ureter and urethra.

How Is Perineal Injury Treated?

Treatment of perineal injury varies with the severity and type of injury. The cuts may need to be stitched. Piercing injuries may require surgery on the damaged pelvic floor muscles, nerves, and blood vessels. Treatment of severe injuries can include antibiotics to prevent infection. The physician will focus on serious injuries to avoid blood loss and infection. However, long-term consequences of injury, like bladder problems and sexual function problems, may continue and be treated after the patient's condition stabilizes. Injuries to the urethra that cause narrowing need to be treated.

  • Treatment for Sexual Problems: Following treatment for lower limb fractures, erectile dysfunction (ED) is not uncommon. A perineal neurovascular traction injury sustained after surgery is considered to be the cause.

Phosphodiesterase inhibitors were used to create an erection, and Sildenafil was begun at a 50 mg single dosage as needed and gradually raised to 100 mg. The patient will be advised to continue the drug till favorable results are achieved and slowly withdraw from using the drug.

  • Treatment for Bladder Problems: The common bladder problem that is caused due to perineal injury is urinary incontinence and urinary leakage. This is usually treated by placing an artificial sphincter. The device is made up of three parts:

    • A surgically inserted fluid-filled cuff (artificial sphincter) around your urethra.

    • In your stomach, a fluid-filled, pressure-regulating balloon is placed.

    • A pump is placed into the scrotum that you can control.

The prosthetic urinary sphincter cuff is filled with fluid, which prevents leaks by keeping the urethra closed. The liquid in the cuff is transferred to the balloon reservoir when you press the pump. You can now urinate because your urethra has been opened. The balloon reservoir automatically refills the urethral cuff one to three minutes after urine is completed.

  • Treatment for Narrow Urethra: When urine cannot travel through a man's urethra when it narrows. To correct this, a surgery known as a perineal urethrostomy involves creating an opening into the urethra through the perineum is done. The operation usually does not cause severe complications, and no signs of incontinence will be seen after surgery.

  • Treating Infections: Infections around the perineum can cause swelling and discomfort. Infected cysts or abscesses in the anus or other parts of the perineum can grow and become extremely painful. It might be an infection if the region is red and swollen or if there is a painful cyst on the perineum. Warm compresses and numbing sprays may be used to alleviate the discomfort. Certain illnesses may need the use of prescription antibiotics. Some abscesses may require incision and drainage, whereas an infected cyst may necessitate surgical removal.

What Are the Complications of Perineal Injury?

Infections may develop as a result of burns and wounds. In addition, bladder control problems and sexual problems may develop due to injury to the blood vessels.

  1. Bladder Problems: Perineal trauma can lead to bladder and bowel problems. Through signals from the brain, your bladder's nerves direct your bladder and pelvic floor muscles to hold or release urine. Injury to those nerves can cause bladder and bowel problems. In addition, damage to the perineum could cause the urethra to tear or become narrowed, or you may experience urinary incontinence.

  2. Sexual Problems: An injury to the perineal nerves can interfere with the sensations of sexual contact. Damage caused to the blood vessels in the perineum may result in erectile dysfunction (ED), the inability to erect or maintain an erection.

How Can You Prevent a Perineal Injury?

You can prevent a perineal injury by taking precautions to avoid accidents to the perineum.

  • Bicycle, Motorcycle, or Horseback Riding: Usage of seats or saddles minimizes pressure on the perineum and shifts pressure to the buttocks. And also, adjust the height of the handlebars, pedals, or seat, and wear padded shorts to reduce pressure on your perineum. In addition, increasing the time you stand while cycling may decrease numbness.

  • Construction, Agricultural, or Factory Work: Wear appropriate protective gear, such as coveralls or bodysuits, if you are around moving equipment or sharp objects.

  • Military Combats: People who fight in war should use armor to reduce the risk of injury.

Conclusion:

Perineal injuries can cause immense pain and make daily activities difficult. Most injuries are easily treatable and will have a good prognosis. However, it is essential to treat on time to avoid further complications.

Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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