Descending perineum syndrome is a rare condition in which the perineal body has become weakened to the point that it can sag beyond 4 cm below the bony pelvis during the Valsalva maneuver. The constipation caused by this laxity often requires digital manipulation in order for the patient to have a complete bowel movement.

Risk factors include chronic straining with bowel movements, weakening of the tissue due to trauma or childbirth, weakening of the sacral and/or pudendal nerves, prior pelvic floor surgery, and pelvic floor muscle hypotonicity.

Patients may present with difficulty with defecation, outlet obstruction, inability to have complete bowel movements or incomplete bowel movements, deep perineal pain, constipation, rectal bleeding, and/or fecal incontinence. The condition worsens over time.