Descending perineum syndrome
Descending perineum syndrome (also known as Levator plate sagging)  refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. The syndrome was first described in 1966 by Parks et al.
Signs & Symptoms
Abnormal descent of the perineum may be asymptomatic, but otherwise the following may feature:
- perineodynia (perineal pain) 
- Colo-proctological symptoms, e.g. obstructed defecation, dyschesia (constipation), or degrees of fecal incontinence 
- gynaecological symptoms, e.g. cystocele (prolapse of the bladder into the vagina) and rectocele (prolapse of the rectum into the vagina) 
- lower urinary tract symptoms, e.g. dysuria (painful urination), dyspareunia (pain during sexual intercourse), urinary incontinence & urgency 
Other researchers concluded that abnormal perineal descent did not correlate with constipation or perineal pain, and there are also conflicting reports of the correlation of fecal incontinence with this condition.
Diagnosis is by rectal examination. A specialized tool called a "Perineocaliper" can be used to measusre the descent of the perineum. A retro anal ultrasound scan may demonstrate the condition. "Anti sagging tests", whereby the abnormal descent is corrected temporarily, may help to show whether symptoms are due to descending perineum syndrome or are in fact due to another condition.
Normally, the anal margin lies just below a line drawn between the coccyx (tailbone) and the pubic symphysis. In descending perineum syndrome the anal canal is situated several cm below this imaginary line, or it descends 3–4 cm during straining.
One of the main causes is suggested to be excessive and repetitive straining during defecation. Other causes include weakness of the pelvic floor muscles (secondary to age related neuropathic degeneration or traumatic injury during pregnancy and labor.
Surgical treatments may be used to treat the condition, and include retro-rectal levatorplasty, post-anal repair, retro-anal levator plate myorrhaphy.
- Beco, Jacques (1 January 2008). "Interest of retro-anal levator plate myorrhaphy in selected cases of descending perineum syndrome with positive anti-sagging test". BMC Surgery 8 (1): 13. doi:10.1186/1471-2482-8-13.
- Broekhuis, Suzan R.; Hendriks, Jan C. M.; Fütterer, Jurgen J.; Vierhout, Mark E.; Barentsz, Jelle O.; Kluivers, Kirsten B. (5 February 2010). "Perineal descent and patients’ symptoms of anorectal dysfunction, pelvic organ prolapse, and urinary incontinence". International Urogynecology Journal 21 (6): 721–729. doi:10.1007/s00192-010-1099-z.
- Parks, AG; Porter, NH; Hardcastle, J (Jun 1966). "The syndrome of the descending perineum.". Proceedings of the Royal Society of Medicine 59 (6): 477–82. PMC 1900931. PMID 5937925.
- Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York: Springer. ISBN 978-1-84882-755-4.
- Baek, HN; Hwang, YH; Jung, YH (Dec 2010). "Clinical Significance of Perineal Descent in Pelvic Outlet Obstruction Diagnosed by using Defecography.". Journal of the Korean Society of Coloproctology 26 (6): 395–401. doi:10.3393/jksc.2010.26.6.395. PMC 3017974. PMID 21221239.