Colorectal Surgery

Symptoms and Warning Signs of Perineocele

At a Glance

A perineocele may cause a soft perineal bulge, pelvic pressure, or bowel and urinary changes that worsen with standing or straining. Severe pain, a hard or discolored stuck bulge, vomiting, inability to pass stool or gas, fever, or skin breakdown requires urgent care.

The symptoms of a perineocele (perineal hernia) can range from a mild, distracting pressure to intense pain that interferes with your daily life ^[1]. Because this condition involves a hole in the pelvic floor, the symptoms you feel are often tied to which internal organs are “dipping” into that space and how much pressure is being placed on them ^[2]^[3].

Common Daily Symptoms

For many people, the first sign is a soft, squishy lump in the perineum (the area between the sit-bones) or near the labia or surgical scar ^[4]^[5]. This bulge is often reducible, meaning you can gently push it back in, or it may disappear on its own when you lie down ^[6].

The “Sitting on a Pillow” Sensation: Many patients, especially those who have had surgery like an Abdominoperineal Resection (APR), describe a strange feeling of sitting on a small ball or a firm pillow even when they are on a flat chair ^[7]^[8].
Pressure and Heaviness: You may feel a persistent “dragging” sensation or a deep ache in the pelvis that gets worse as the day goes on ^[9].
Activity-Related Changes: The bulge often becomes larger, firmer, or more visible when you increase “intra-abdominal pressure.” This happens when you:
- Stand up for long periods ^[6].
- Cough or sneeze ^[10].
- Strain during a bowel movement (Valsalva maneuver) ^[10].
- Lift heavy objects.

When Organs Are Involved

A perineal hernia can contain various structures, and the symptoms will change depending on what has moved into the hernia sac ^[11].

Bowel Involvement: If the small or large intestine enters the hernia, you may experience fecal urgency (a sudden, strong need to go), constipation, or a feeling that you haven’t fully emptied your bowels. If you have a permanent colostomy, you might notice changes in your stoma output or intermittent abdominal cramping ^[1]^[11].
Urinary Symptoms: While uncommon, if the bladder is involved, you might notice urinary retention, incomplete emptying, a weak stream, or pain during urination (dysuria) ^[12]^[13].

Emergency Red Flags (When to Seek Immediate Care)

While most perineoceles are managed with planned, non-emergency care, certain symptoms indicate a life-threatening complication ^[14]. Never forcefully push back a painful or stuck bulge.

Go to the Emergency Department Immediately If You Experience:

Incarceration and Strangulation
Incarceration occurs when the hernia contents are trapped and cannot be pushed back into the abdomen. Strangulation is the most dangerous stage, where the trapped organ loses its blood supply ^[15]^[16].
- Signs: Sudden, severe, or escalating pain in the bulge; the lump becomes hard, very tender to the touch, or changes color (turning red, purple, or dark) ^[15]^[16].
Bowel Obstruction
If the intestine becomes kinked or blocked within the hernia, it creates an obstruction ^[16].
- Signs: Persistent vomiting, a swollen or “bloated” abdomen, and the total inability to pass gas or have your usual stool/stoma output ^[1]^[16].
Systemic Signs
If the trapped tissue begins to die or becomes infected, it can cause a body-wide inflammatory response ^[16].
- Signs: High fever, chills, rapid heart rate, or feeling suddenly faint and extremely ill ^[15]^[16].

Call Your Surgical Team Urgently (Same-Day Assessment) If You Experience:

Evisceration or Skin Breakdown: In rare cases, especially after recent surgery, the skin over the hernia can become thin and eventually fail ^[15].
- Signs: Any spontaneous leakage of fluid from the perineal skin, spreading redness, abnormal warmth, a wound that begins to open up, or the sight of pink/red tissue (bowel) visible through the skin requires urgent assessment ^[17]^[15]. While mild, dry rubbing from clothing is common, rapidly changing, hot, or dusky skin is not safe to ignore.

Common questions in this guide

What can a perineocele feel or look like?

People may notice a soft, squishy lump in the perineum, near the labia, or by a surgical scar. The bulge may shrink or disappear when lying down and may feel like sitting on a small ball or pillow, with pelvic pressure or heaviness.

Why does a perineocele bulge become more noticeable during activity?

Standing, coughing, sneezing, straining during a bowel movement, and lifting increase pressure inside the abdomen. That pressure can make the bulge larger, firmer, or more visible; do not forcefully push back a painful or stuck bulge.

Can a perineocele cause bowel or urinary problems?

Yes. If bowel enters the hernia, symptoms may include urgency, constipation, incomplete emptying, cramping, or changes in stool or stoma output. If the bladder is involved, uncommon symptoms include trouble emptying urine, a weak stream, or pain with urination.

How can I tell whether the bulge is reducible or trapped?

A reducible perineocele may become smaller or disappear when you lie down and can sometimes be gently returned. An incarcerated hernia is trapped and does not go back in; if it is painful, hard, very tender, or changes color, seek emergency care and do not force it back.

When should perineocele symptoms be treated as an emergency?

Go to an emergency department for sudden or worsening severe pain, a hard or very tender bulge, or a bulge that is red, purple, dark, or cannot be pushed back. Persistent vomiting, a swollen abdomen, inability to pass gas or stool or normal stoma output, fever, chills, rapid heartbeat, faintness, or feeling extremely ill are also emergency warning signs.

What should I do if the skin over the perineocele changes?

Contact the surgical team the same day for leaking fluid, spreading redness, unusual warmth, skin that becomes thin or shiny, a wound that opens, or pink or red tissue visible through the skin. These changes can signal skin breakdown or tissue protruding through the wound and should not be watched at home.

Get notified when new evidence is published on perineocele.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References (17)

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6
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PMID: 32239652
7
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8
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9
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10
Laparoscopic repair of perineal hernia and unilateral inguinal hernia after rectal cancer surgery: A case report.
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11
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12
Perineal herniation of an ileal neobladder following radical cystectomy and consecutive rectal resection for recurrent bladder carcinoma.
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13
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14
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15
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16
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17
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This page is for informational purposes only and does not constitute medical advice. It explains perineocele symptoms and warning signs, but your surgical team should assess your individual symptoms; seek emergency care for severe or rapidly worsening symptoms.