hi there, my 10 1/2 year old entire male gsd has just been diagnosed with a perineal hernia.  i was expecting an enlarged prostate to be the problem from the symptoms he's been showing ie straining to defecate and the groove in his pooh. he has a slight swelling to the bottom left of his anus. his prostate may be the cause of the PH but the vet was unable to feel it during a rectal examination. the vet has suggested surgery.

i have always preferred a natural approach to the care of my boy but understand that this condition may only be helped with surgery.  my boy has been fed a natural type diet since 12 weeks of age and is exercised daily.

it appears to be a minor hernia at present. 

if any one has experienced this with their dogs any advice would be greatly appreciated.

if i go ahead with surgery i will arrange for a specialist to do it and again any recommendations would be great.

many thanks

A friend of mine has two old boys with this and, the contributing factor was feeding bones as part of a raw diet (note not the cause) but it did agravate it. 

One has it one side the other has the weakness in the muscles both sides, which means the poo dams up in the pocket/hernia formed by the weakened muscle wall.  An operation is expensive and amy nto be successful

The best option is to ensure that motions are softer and encourage them to go more often (walks more thna once a day)

thanks brainless.

i've had to stop feeding raw bones too because his poo was so firm and then difficult to pass.  i use the herb tablets from dorwest to help him pass the poo and have put him back on tripe (frozen type).  i've always observed his poo throughout his life and know what food produces what poo and i know that what he's fed one day he passes out the following day, so hope to keep on top of this until i decide what to do.
the vet suggested adding fibre to his diet to bulk out his poo so that it was more likely to pass along the rectum directly and not bypass into the herniated part but i know firm poo is painful to pass so keeping it a bit softer also makes sense.  i'm a bit confused on this point but am judging things by how my boy is.
he is on such good form with a healthy appetite (always been the case) and lots of energy, always wanting to play 'ball'.  he amazes me.

My friend won't be back home until after the weekend, but I will pass this thread onto her so she can share what advise and management strategies she has adopted.

Her vets feel management is best option as surgery might well be not only very costly but not assured of success.

thanks again brainless, that would be so helpful.

in the mean time i hope to arrange a second opinion from a vet who combines conventional and holistic treatments.  even just diet advice that could help me to continue to feed as natural as possible will be of benefit to me.  my gut feeling is to hold fire with surgery but i will be happy with the advice from this vet. i would love this to be controlled through management.

it's the start of a journey to find out as much as possible about PH's so i can help my boy as much as possible.

My boy developed a perineal hernia which went undiagnosed for several months, inspite of a costly visit to a veterinary referral practice for an ultrasound. It was only through finding a cheaper option for doing a colonoscopy when I was at my wits end that the correct diagnosis was made. (With reference mainly to the case history, NO invasive colonoscopy and a quick confirming physical exam). My boy had been seen by four different vets including the specialist before we saw the vet who made the diagnosis (have changed vets nedless to say!) so I think you are very lucky to have had an early diagnosis. :-)
In my boy's case there was quite a major hernia on one side and a minor one on the other. Because your vet has spotted this quickly you have more options than I did. My boy had the surgery a few days after diagnosis, this was a couple of years ago and he has been fine since and all post op checks have been fine with no deterioration so surgery in our case was 100% sucessful. There is a slim chance he may need further surgery if it develops again but this is now unlikely. Yes the surgery was costly, £1200 - but it was done by a specialist surgeon at a veterinary hospital and included full post op care, the drugs and subsequent checkups. I had already spent well over that amount with the unsucessful visit to the referral practice and his increasingly frequent visits for enemas to have the blockage removed. :-( The referral practice's quote for the (unnecessary) colonoscopy had been almost as much, hence I had been shopping around! It was worth every penny as without it there wouldn't have been any other options for my boy as his condition was rapidly deteriorating. Seeing his distress and suffering trying to poo before the condition was diagnosed was heartbreaking. I was lucky as my insurance company paid for everything connected with the problem which had been ongoing for almost 6 months.

Post surgery, the recovery period took about 6 weeks and required cage rest and minimal excersise for a while. He was on i/D as well for about 3 months while everything settled down. Now I am happy to say he eats the same food as he has always done, treats etc no problem. My excellent vet recommended adding 'ISOGEL' to his meals which would assist with keeping everything regular. Unfortunatly it is not currently available, hopefully this is temporary. Initially we were making do without it and for a couple of weeks no problem but then I noticed he was straining again and there was one day where it was particuarly bad. However, a friend put me on to FIBROGEL which you can buy in boxes of satchets, my local supermarket sells it and chemists certainly will. I put about 5mls (for a small dog) on each meal. Initially I didn't think he would like it as it is orange flavoured but no problems and my younger boy also has had some on his food to avoid a PH developing in the future as he occasionally has issues with straining. I would certainly suggest using this, as a powder sprinkled on the food as it will definitly help. At the same time as the surgery, my boy was also castrated, not something I was keen to do but it greatly reduces the risk of him needing further surgery so that made the case for me. This may also be something you would like to consider. It will help and a far less expensive and major proceedure than the hernia repair. It will also mean he won't have prostate problems to contend with.

I feed Naturediet but I did ask my vet about raw feeding and he cautioned against it with the PH in case it aggrivated the condition. You might find that compromising a bit with a more processed food (Naturediet, NaturesMenu etc) is necessary but without the need to change to a perscription diet.

Fairly obviously keep an eye on his pooing and what he is producing, my boy's poos were very 'dry' looking - almost tacky so that is a warning sign, plus blood as well. The first indication I really had was a significant amount of bright red blood one morning when we were on our walk which was very scary. Please feel free to ask or PM if you would like any further info. I am more than happy to help in any way I can, knowing exactly what you  are going through. The good news is that becasue your boy's PH was diagnosed early, you have every chance of being able to manage it and he can continue to lead a healthy life. My boy is exactly as he was before, no change in temprement, coat, food, excersise etc. You would never know that anything had been wrong at all. :-)

wow, thanks for all that information tricolourlover. i'm delighted to see that your boy is now doing so well.  i will be reading your post over and over so that it all sinks in.  i have just made an appointment with the vet i want to see and am waiting for the referral to be sent from the 1st vet.
i am thinking now though that my boy may have had this longer than i thought, because there has been on and off straining, never any blood and i put this down to his prostate playing up.  i would give him a homeopathic remedy for this.

i was told by the vet that any one doing the repair op would castrate at the same time.  i've always been worried about castration because of the possibility of excess fat problems, lack of energy and any feminisation problems but hopefully at 10 1/2 years (if i have surgery) he is very much 'set' as a dog.

> i was told by the vet that any one doing the repair op would castrate at the same time.  i've always been worried about castration because of the possibility of excess fat problems, lack of energy and any feminisation problems but hopefully at 10 1/2 years (if i have surgery) he is very much 'set' as a dog.

I was worried about that too, but there has been no change at all. The only thing I did find was that when the hair grew back over the operation site, it grew back quite profusely and I had to do a bit of a scissor job because he was looking silly! I put it down to the castration initially but as there was no change to the rest of his coat I now think it was more due to being shaved to the skin in the middle of winter! Now it has blended with the rest.

My boy had digestive problems for most of his life, but not straining. He would have bouts of colitis on and off and this was part of the reason why the PH went undiagnosed for so long as the upset tummy was a red herring. When the PH became so severe that he couldn't pass the poo, he was often sick at the same time through the straining which also didn't help towards a diagnosis.

I must correct a mistake though, it is FYBOGEL that I am currently using :-)

tricolourlover, how old was your boy when he had the surgery? apologies if u have already said but i get brain freeze! there seems to be different types of surgery, some using a mesh type material to make the rupture site stronger. do you know what the most up to date surgery involves? can i ask what kind of surgery did your boy have?

do you know what part of your boy's intestine was herniating?  i don't know if it's the same location in all PH's and if it's the rectum (last part of the gut, i think) that herniates.

i'm looking at adding psyllium husk to his diet, to bulk out the poo but keeping it at a consistency to travel and pass easily and hopefully stopping any problems with his anal glands.  he's never had anal gland problems, the small, firm poos produced on his raw diet seen to that so this is now a concern too! i will check at his referral appt about this first though.

more questions will follow i'm sure!

tricolourlover, what did your boy's PH look like?  what size was it?  could you feel anything in it? my boy has a slight (i think it's slight compared to some pictures i've seen) swelling and it doesn't look or feel like it's holding any contents.  i hope i'm making myself clear but don't know how else to describe it. 

My boy was 7 when he had the surgery a couple of years ago. He is a long coated breed so a bit difficult to see at a glance whether anything is wrong but I certainly did not feel a swelling at all, even after the diagnosis. I went home and looked it up on the internet and also saw some really alarming pictures but with my boy there seemed to be no outward signs whatsoever which is why I think getting a diagnosis was so hard. One of the vets we initially saw said he had an infection of the anal glads and did empty them, but he has not had a problem before or since so this seemed to be another red herring. The PH was either side of the rectum, my excellent vet drew me a picture to explain what was going on! :-) As far as I'm aware, there was no mesh involved and it was all reconstructive surgery. I know it took a long time, one and a half to two hours although that included the castration. I'll have a look back over his notes and see if they say any more

I was dreading him having a huge shaved area but actually the insicions were only about 2-3" and they'd tried to be discrete and shave as little as possible. He was looking peculiar anyway as he'd been shaved in all sorts of places and they actuallytook the most hair off for the ultrasound. He also had a heart trace to check for irregularities prior to the surgery so a little shaved patch on each foot!

He stayed over one night after the operation and I collected him the following day with quite a few meds, painkillers and antibiotics and a wonderful inflatable donut collar. I can thoroughly recommend one of these it had to stay on for at least a week and the normal bucket would have been far more uncomfortable.

The Fybogel contains Physillium husk and does seem to work as well as the Isogel, although I would still prefer to be using the Isogel as it did not have the orange flavour. My boy dosn't seem to mind that fortunatly. Certainly I would not go more than a couple of days without using it as there were definitly problems brewing when they stopped making Isogel and we had to do without it until we tried the Fybrogel.

Just to say...

>the vet suggested adding fibre to his diet to bulk out his poo so that it was more likely to pass along the rectum directly and not bypass into the herniated part but i know firm poo is painful to pass so keeping it a bit softer also makes sense.

Adding fibre does not make poo harder to pass - the opposite - the fibre absorbs water and makes a bigger but softer poo, rather than hard dry bullets..(!).  That is why people who are constipated are advised to increase their fibre intake.

I wouldn't recommend Nature Diet because it has a high bone content and bone makes poos v hard.  My dogs always have paler and harder poos on Nature Diet and it's because of the bone.

Also not sure about Fybogel:  I know this for human reasons(!) but it has added saccharin to it, which is an artificial sweetener.  I know that chewing gum with artificial sweetener is very toxic to dogs.  They may be different sweeteners and you might be ok, but I wouldn't feed it unless you've checked with the vet first.

is it 'xylitol' (spelling!) thats toxic to dogs?

Yes it is Xylitol that should be avoided.

The Fybogel is a (hopefully) short term alternative to Isogel while the manufactures are apparently rebranding. My boy has been taking it since May with no ill effects and the other dogs have occasionally had it without problems. The saccharine isn't Xylitol and is in minute amounts.

> I wouldn't recommend Nature Diet because it has a high bone content and bone makes poos v hard.  My dogs always have paler and harder poos on Nature Diet and it's because of the bone.
>
>

Composition:
Turkey 55%, Rabbit 10%, Rice 10%, Vegetables 7%, Natural Ground Bone, Seaweed Meal, Vitamin A 2,556 IU,

It's less than 7% and I believe that if no figure is given then it is less than 1%? I changed the protein source for my biy from Chicken, which he never really got on with, to Turkey and Rabbit. There have been no problems in either direction since then. My vet was quite happy with him being fed the Naturediet with the addition of Ispaghula Husk (Isogel) but did caution against raw food.

The Ispaghula Husk (phyllisum) works in a way that it controls both constipation and diahorrea through the interaction it has with water. It seems to coat the poos with 'slime' (sorry!) but not mucous. I don't think adding ordinary fibre (such as bran) would help as it doesn't have the same properties. The surgeon who operated suggested adding green beans to his food to soften the poo post surgery, but I didn't have to do this. However, it might help if you are looking at a maintainance diet.

My boy was put on Lactulose post surgery for a while (2 months), before we put him on the Isogel. I think it might have some side effects used long term and the Isogel is considerably cheaper but again, it might be something to try for the short term if there were some acute symptoms.

Just looked at the notes and

the vet who diagnosed the PH correctly found during the rectal exam that there was a right sided deviated rectum (pouch/diverticulum) associated with a significant perineal hernia, milder changes on the left side. Prostrate mildly enlarged but in the normal position. I've checked all his notes to be sure and there was never a mention of any external swelling so it's not always indicative.

On reading his notes through I am again amazed that no fewer than 4 vets, including a specialist referral vet, performed the same physical examination on numorous occasions over 2 1/2 months and all of them managed to miss this. He also had 2 enemas to remove faeces that he couldn't pass, poor boy. We had diagnosis from possible cancer, through chronic colitis, food intolerance and parasitic involvement. If this episode taught me anything it is that sometimes you need to go with your instincts and seek a second or even third opinion if necessary. Oddly, although we'd never heard of a PH, I had been going through the symptoms with my friend, another experienced dog owner and we both felt it was a mechanical issue, a blockage or something, rather than a digestive one. Many of the suggested diagnosis just didn't seem to fit the bill but when the PH was diagnosed then everything fell into place. I see that Lactulose was also pescribed on several occasions and seemed to help.

Ok, I should have said 'high bone content in comparison to other foods' - which have none!

I think ND is an excellent food, but whenever I've fed it to mine, they have done hard, pale poos like bullets.  Very easy to pick up, so I'm not complaining.  But I wouldn't want to feed it to a dog which is supposed to have soft, easily passed, poos.

You might want to try a product called 'Pro-Fibre' which is a combo of probiotics and fibre.  It is made by Protexin, who make loads of probiotic products for animals.

thanks again tricolourlover for all your info, it's so detailed and helpful.  your wording makes sense with my boy's PH, from the drawing the vet did, my boy has a left sided deviated rectum.  he couldn't feel his prostate, so will hopefully know more after my referral appt.

i have just started adding psyllium husk (powder) to his diet and am increasing the amount daily.  no slime seen yet! but he seemed more comfortable this morning.

can i ask if your boy found the rectal examinations painful?  i know my boy did but the vet said he just didn't like being examined!

i have used naturediet but it's been off the menu for a while because it had become difficult for my boy to pass and now i know it's because of the PH.

my boy is a touch particular with things added to his food, the psyllium husk is easy to hide! i have tried the pro-fibre for diarrhoea years ago but my boy just didn't like it.

sticking with tripe for the time being (hopefully he continues to digest it and pass it okish) until i make a decision. i miss the variety of his raw diet but hope he isn't too bothered.

I'm very glad to be able to help :-)

Now I'm going to ask a question! Where are you getting the psyllium husk? I'm thinking that might be better for my boy than the Fybrogel and it looks as if the Isogel is going to be unobtainable for the foreseeable future. :-(

My boy didn't seem to find the rectal exams painful, although I don't know for sure! :o He had them so frequently I think he became resigned to it.

One very weird thing was that after having the surgery for some months we didn't hear or see him drinking and he has always been a really noisy drinker so not easy to miss. There were no ill effects and he obviously was drinking as the water went down, altough possibly not as much. After about 6 months he went back to normal.

Good luck with your referral and please keep us updated on how things are going.

i purchased a jar of psyllium husk from my local health food shop, for quickness really, so i could start using it straight away.  it's made by the 'solgar' company of supplements and it's been brill.  so far my boy has been able to poo normally again - no straining!!  i can't tell you the relief of seeing him not straining.  i just add it to both his AM and PM feeds and so far he's very much accepted it.  hope that continues!  i am still tweaking things but have been told by the referral vet that the amount you feed is not based on the weight of the dog, you just work out the amount as you go.  i will probably source other suppliers over time, just to compare prices really.

my appt with the referral vet went well.  he is a very gentle vet. during the rectal examination (much better than the 1st examination) he was able to feel the prostate.  it is enlarged, but not the biggest he's felt and he feels that this is the cause of the PH.  the enlarged prostate has been vying for space with the rectum and has won, pushing the rectum into the pelvic wall!

my biggest concern was that i may be causing suffering to my boy while i decide whether to have surgery but he told me that i'm not.  he did say that surgery is the only thing that can repair the hernia but now that the psyllium husk is working i have time to decide and my boy is comfortable, well in fact in super form judging by this morning.  the vet prescribed 3 homeopathic remedies that may help to shrink the prostate and that would be of benefit as well.
i'm thinking of holding fire with the surgery decision til after christmas at least but that is dependant on how well the management goes.

thanks again for your help and advice.

> i can't tell you the relief of seeing him not straining.

Believe me, I know! :-)

Thanks for the information on the Psyllium husk, I think I'll give it a go with my boy and see how he gets on with that. I found not much (of the Isogel/Fybogel) was needed and just adjusted it up or down to get the balance right.

I'm glad your referral appointment went well. It makes all the difference to speak to a vet that is familiar with the condition. My boy's prostate wasn't the cause of his hernia but my older dog had issues with an enlarged prostate/acute prostatitis seeral years ago. I have him on one capsule of Saw Palmetto complex and a couple of drops of echinacea once a day on alternating days and he has had no reoccurence of the problem. I used to use Prospet drops made by Pet Alive Natural Remedies which contained Saw Palmetto and echinacea, but as seems to be the story of my life, they 'temporarily' stopped making it back in March! I haven't tried getting it recently though as what I'm currently using sems to work just as well.

I'm really glad the psyllium husk is working for your boy, hopefully you won't have to make any desicions about surgery for a while if it can be maintained.