"My dog has a big lump on his left backside," said the healthy and trim 82-year-old Mr Neil Archer.



"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.

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 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. 
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? 

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).   

WHAT HAPPENS IF THE PERINEAL HERNIA IS NOT REPAIRED?
There are various scenarios as follows:

1. 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.
 

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 pain 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.