Health and welfare information about your cat from Vetlexicon Felis.

Perineal hernias

There are several types of hernia (also known as a rupture) seen in the cat and the causes
vary between the different types. Some hernias can be minor, but in certain circumstances
they can be very serious and often require surgical treatment.

What is a hernia?

A hernia is a swelling caused by structures from the abdomen bulging out through the
muscle wall. This may be through a natural opening, which is meant to be there but has
become a larger opening than normal, or a gap that has developed; this can occur due to old-
age or due to trauma. The swelling may appear as a lump under the skin on the abdomen
(umbilical, inguinal) or beside the anus (perineal). Typically the swelling contains some fatty
tissue from the omentum, a fatty membrane which lies within the abdomen, but abdominal
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organs could be present.

There are other hernias that occur between the muscle layers internally and so you cannot
see any swelling when looking at your cat but may have noticed signs of illness (bringing up
food/regurgitating for hiatal hernia) or rapid or difficulty breathing (diaphragmatic hernia).

What is a perineal hernia?

Perineal hernias are fairly uncommon in the cat, in particular when compared to the dog
where it is seen in middle to older male entire dogs. In a perineal hernia the swelling occurs
between the muscles surrounding the bottom. The function of these muscles is to provide
firm backwards pressure when the abdominal muscles contract to force feces out from the
rectum via the bottom (anus). If these muscles become weal or damaged, it becomes very
hard for your cat to pass feces. When straining is performed, to try and pass feces, it is not
effective and instead the area around the bottom (perineum) may be seen to bulge. There
may be a permanent swelling beside the bottom where contents from the abdomen have been
pushed out through the weakness in the muscle. This is most often omentum (fat) but can
sometimes contain the prostate and bladder which can become very serious. If you are
awaiting treatment for perineal hernia and your cat has difficulty passing urine too then
please seek urgent veterinary advice.

How will I know if my cat has a hernia?

You may notice a soft swelling besides your cat’s bottom (anus). This may bulge when your
cat is trying to pass feces and may vary in size at other times. Your cat may struggle to pass
feces, taking a long time and more straining than normal, passing small amounts more
frequently, or becoming unable to pass feces at all. If your cat is unable to pass feces they
will become unwell and may vomit and lose their appetite. Perineal hernia is a rare condition
in the cat and can be difficult to diagnose because of cat’s private nature when toileting.
Urinary tract issues (cystitis and bladder stones) are a far more common diagnosis in the cat
and it is not uncommon for the initial clinical suspicion to be that there are problems with
urinating rather than passing feces. This is made more complicated by the fact that, in the
cat, the underlying cause of the hernia developing can be repeated straining from urinary
tract problems.

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How will my veterinarian diagnose my cat’s hernia?

The diagnosis of a perineal hernia is made by examination of the rectum with gentle digital
examination. Due to a cat’s small size this must be performed under sedation or general
anesthesia. Your veterinarian will be feeling for a weakness in the muscle layer to the side of
the rectum. Diagnostic imaging: x-ray or ultrasound of the abdomen and the perineum (cat’s
bottom area) may be helpful to further assess what is involved in the hernia. Further
investigations may also be performed to try to identify another cause for straining, leading to
the hernia, in particular assessment of the urinary tract, which may be performed by
ultrasound or require contrast studies (dye which appears on an x-ray) in some cases.

How are perineal hernias treated?

Severe constipation is often present at the time of diagnosis of a perineal hernia. The first
therapeutic step is to remove the impact feces with gentle manipulation under sedation or
anesthesia and to then perform an enema to help to empty the backed-up feces in the colon.
Once the blockage has been removed, various strategies can be used to achieve medical
management as a palliative approach, or before or after surgery has been performed.
Lactulose is a laxative that makes the feces more liquid and reduces the risk of further
blockages. Once surgery has been performed it is better to have a formed stool that contains
adequate fiber, than a very loose soft stool, and the use of an agent that modifies fecal
consistency, such as Peridale granules (Sterculia) in food. Liquid paraffin is best avoided if
other therapies are effective, as it can be difficult to administer and causes the risk of
pneumonia if swallowed down the wrong way.

Surgery to treat a perineal hernia involves making a surgical wound alongside your cat’s
bottom (anus) and then using one of the muscles between the hip and the pelvis to repair the
gap in the layer of muscles, thereby providing support when your cat passes feces. This
muscle can be used safely as there are a number of other muscles that have the same
function. Your cat will need some attention to diet and the use of agents that modify fecal
consistency for some time after the surgery, depending upon their progress.

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 How can I prevent my cat developing a hernia?

In many cases there is no specific action that will prevent this problem arising. However
keeping your cat in healthy, fit condition can reduce the risks as being overweight can
predispose to some hernias in older age. Being aware of your cat's toilet habits can help to
pick up on a problem sooner rather than later and reduce the severity of the condition.

What problems may occur after my cat’s hernia surgery?

There is a risk with any surgery of bleeding, wound infection and wound breakdown. With a
hernia there is also the risk of recurrence. It is important to monitor for signs of bleeding,
swelling of the area around the wound, recurrence of swelling beneath the wound and wound
discharge. If you see any of these signs please speak to your veterinarian for advice.

The wound itself is left open to the air after surgery and should be kept clean and dry,
however do not bathe the wound unless specifically directed to by a veterinarian. Often
making the wound moist can increase the risk of infection. Your cat, and other pets, should
be prevented from interfering with the wound. Please use a buster collar, post-op coat or T-
Shirt to prevent interference and keep other pets separate when not supervising interactions.

Please monitor your cat for normal behaviors such as passing urine and feces normally and
having a good appetite. In particular following treatment of a perineal hernia there could be
problems that occur with passing feces or urine. Please notify your veterinarian if any
concerns arise. It is important to keep your cat's exercise restricted during the recovery
phase, until your veterinarian has completed a post-operative check and is happy with the
healing.

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