Perineoplasty is a surgical procedure performed to repair and reconstruct the perineum and strengthen the supporting muscles and tissues. Perineum is the region between the vulva (external female genitalia) and the anus in females, and the area between the scrotum and the anus in males. Perineoplasty is either performed to improve aesthetics or to address functional issues such as urinary or bowel incontinence.

Urinary incontinence is the unintentional leakage of urine due to loss of bladder control. Whereas bowel incontinence is the involuntary leakage of stool due to loss of control of the sphincter muscles at the anal opening. Perineoplasty helps tighten the perineum leading to better control of the urine flow or bowel expulsion. This article will provide an overview of perineoplasty, its purpose, and what to expect from the procedure.

Preparation for Perineoplasty

Pre-operative Evaluation:

Your healthcare provider will conduct a few pre-operative tests to assess the severity of the condition to plan for a safe and successful surgery.

• The doctor may ask you about your medical history, including pre-existing medical conditions, allergies, or medications you are currently taking to understand your overall health condition.
• A physical examination will be conducted to further understand your health status and examine the area of surgery.
• The doctor may also recommend some diagnostic and imaging tests.

Pre-surgery Instructions

• Before the surgery, your surgical team will discuss the risk and benefits of the surgery, explain the procedures, and give you an idea about how your recovery period will look like.
• Your surgeon will ask you to avoid eating before the procedure.
• You will be advised to stop taking certain medications or supplements that can interfere with the surgery or increase the risk of complications.
• They will also ask you to quit smoking, as it can slow down healing and increase the risk of complications.
• They may instruct you to avoid certain activities, like using vaginal douches or tampons before the surgery, as it could increase the risk of infection or other complications.

Anesthesia Options

Your surgical team will also inform you about the use of anesthesia during the surgery to prevent any feeling of pain and discomfort during the procedure. Perineoplasty is performed under different types of anesthesia, including local anesthesia, regional anesthesia (such as epidural or spinal anesthesia), or general anesthesia. Your surgeon will choose a suitable type depending on factors like the duration of the procedure, your overall health, and your preferences. The doctor will also explain the benefits and potential complications associated with anesthesia use.

Perineoplasty Procedure

While performing a perineoplasty, the surgeon will make incisions in the perineal area to assess the tissue effects (e.g., wear and tear and stretched tissues due to childbirth). The surgeon may also use specialized techniques to ensure proper alignment and closure of the incisions so that the wound heals properly. Sutures will be used to stretch and tighten the muscles to improve bladder and bowel control. This helps relieve issues such as urinary or bowel incontinence. 

Perineoplasty is also done for vaginal reconstruction in case of damage or structural abnormalities that affect the vaginal function or cause discomfort.

After the perineoplasty procedure, your doctor will inform you about post-operative instructions to promote recovery. Pain medications, antibiotics, etc., will be prescribed to help manage pain and prevent post-surgery infection. You need to follow these instructions accurately to facilitate proper healing and minimize the risk of complications.

Recovery and Complications

You will be kept under observation for a few hours after the surgery. Depending upon your health condition and the extent of the surgery, the perineoplasty recovery period can last for four to six weeks. Your doctor will instruct you not to insert devices like tampons and refrain from sexual intercourse during this time.

They may also provide you with specific instructions on how to clean and dry the area to minimize the risk of infection. Regular gentle cleansing and avoiding harsh irritants can contribute to a smoother recovery.

Though the recovery period after perineoplasty is usually uneventful, there are still chances of complications, such as:

• Increased pain and discomfort
• Redness and swelling in the affected area
• Infection
• Bleeding
• Scarring
• Numbness or hypersensitivity in the surgical area

Alternatives to Perineoplasty

Mild-to-moderate cases of urinary or bowel incontinence might not need perineal surgery and can be managed by alternative, non-surgical methods too. Modifying lifestyle factors like maintaining a healthy weight, making dietary adjustments, and avoiding strenuous activities and heavy lighting can help reduce the symptoms.

Doctors also recommend performing Kegels exercises by contracting and relaxing the pelvic floor muscles to help strengthen them. Timed voiding and other bladder training techniques can also help reduce incidences of urinary incontinence. Sometimes, doctors also suggest an electric stimulatory technique for strengthening the pelvic floor muscles and improving urinary control.

In some cases, doctors also prescribe medications like anticholinergic drugs to help calm an overactive bladder or suggest using vaginal devices like pessaries or urethral inserts to support the bladder and reduce stress urinary incontinence.

Conclusion

Perineoplasty is a surgical procedure that helps address urinary or bowel incontinence by reconstructing the perineum and strengthening the surrounding muscles. It helps improve bladder control and reduces incidences of involuntary leakages. We hope this article has helped you understand the process of perineoplasty and what to expect before, during, and after the surgery.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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