PERINEAL CONTUSION |
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DESCRIPTIONA perineum contusion results from a direct blow to the floor of the pelvis and associated structures including the genitals, causing bruising of the skin and underlying tissues. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons, nerves, or other soft tissue. The perineum, vaginal lips, mons pubis (pubic mound), vagina, anus, penis, scrotum, and testicles can be involved, as well as the skin, subcutaneous tissue, tendons, ligaments, blood vessels (both large vessels and capillaries), periosteum (the outside lining of bone), muscles, and connective tissue.
Appropriate health care includes:
Doctor's care unless the injury is quite small.
Self-care for minor contusions.
SIGNS & SYMPTOMS
Swelling in the perineal area--either superficial or deep.
Pain in the perineum.
Feeling of firmness when pressure is exerted from outside.
Tenderness.
Discoloration under the skin, beginning with redness and progressing to characteristic "black and blue" discoloration.
CAUSES
Direct blow to the perineum, usually by a blunt object or because of a fall.
Damage to tiny blood vessels causing bleeding that infiltrates into the child's muscle and other surrounding tissue.
RISK FACTORS
Ice skating; gymnastics; cycling; horseback riding; medical history of any bleeding disorder, such as hemophilia; poor nutrition; inadequate protection of exposed areas during sports; obesity.
PREVENTING COMPLICATIONS OR RECURRENCEUsually cannot be prevented.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries. The total extent of your child's injury may not be apparent for 48 to 72 hours.
X-rays of the child's pelvis to assess total injury to perineal soft tissue and to rule out the possibility of underlying fracture.
POSSIBLE COMPLICATIONS
Excessive bleeding leading to disability. Infiltrative type bleeding can (rarely) lead to calcification and impaired function of the child's injured muscle.
Prolonged healing time if the child's usual activities are resumed too soon.
Infection if the skin over the injury site was broken.
Scarring and narrowing of the birth canal in females.
PROBABLE OUTCOME
Healing is usually complete in 1 to 4 weeks, depending on the extent of injury.
TREATMENT
FIRST AIDUse instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation (if possible). See Appendix 39 for details.
HOME CARE
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the child's injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Provide the child with whirlpool treatments, if available.
Protect the child's injured area with pads between treatments.
MEDICATION
For minor discomfort, use non-prescription medicines such as acetaminophen or ibuprofen (available under many different brand names). Do not use aspirin for injuries involving bleeding.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITY
Your child should begin activities slowly and stop exercise as soon as pain begins but may increase activity as healing progresses. Sexual activity should be delayed until healing is complete.
DIET & FLUIDS
Your child should eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk, and eggs. Increasing fiber and fluid intake helps prevent constipation that may result from decreased activity.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
The injured perineum doesn't improve within a day or two.
Signs of infection (drainage from the skin, headache, muscle aches, dizziness, fever, or a general ill feeling) occur if the child's skin was broken.
There is discomfort with sexual activity after healing.
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