Rectoseal repair surgery?

Welcome KT,

I think more importantly than telling you horror/success stories is to make sure you really understand the surgery so you can visualize what will be done to your body and therefore be better able to make an informed decision.

Posterior colporrhaphy, or rectocele repair, is always done by dissecting the back vaginal wall, removing a narrow section of it, and then suturing the two sides back together. This tightens the vagina and removes the stretched out portion the rectocele filled. Some surgeons talk about a clearly defined rectovaginal fascia that is identified and “repaired” and others say a separate tissue, although certainly there, is very difficult to distinguish from the outside of the back wall.

There is no pulling up of any muscles. Surgeons have long known that when the pelvic wall muscles (the ones you feel when you kegel) are sutured together the probability of bowel symptoms – such as inability to empty properly – increase dramatically. Classic rectocele repair only sutures the vaginal wall. The fascia, which does exist on the outside of both vagina and rectum and allows for independent sliding and functioning of the two organs, is inevitably damaged in the process unless the surgeon is extremely careful, or lucky, to only dissect to just before the outside of the back wall. In either case, the problem, which is a prolapsed rectum, remains. But now the shape of your vagina, which is a critical factor of pelvic organ support, has been changed.

This operation has one of the highest failure rates of all “pelvic floor” surgeries.

Wishing you well,

Christine

Many women experience a reoccurrence of their symptoms – often higher or lower than the original rectocele. I have not had the surgery. I do not know the failure rates of the anal approach to rectocele repair, only that it is a very old procedure and generally discontinued due to the rectum not holding up well to suturing and the anal sphincter sustaining permanent damage from dilation. There are newer stapling surgeries based on the old approach that probably do not greatly dilate the anus because a firing gun is inserted into the rectum instead. I do not have statistics on this surgery.

I can't say anything about the statistics on this procedure, nor have I had it done, but I will just tell you how I handle my symptoms.

I have a rectocele as well as a cystocele and uterine prolapse. The rectocele causes me to have trouble evacuating my bowel at times. The large pouch into the vagina is a pool for stool to accumulate into a big mass, and if I don't watch to keep it soft, the hardness will make it extremely difficult to push out. The rectocele means I have less "muscle tone" to push out stool so "going" can be a tedius, timely process. But I do get it accomplished.

I have evolved several solutions to deal with this, without having to try surgery. First, I manage my diet so that the stool does not get too hard. But of course that sometimes fails. So when I do get hard stool, I endeavor NOT to strain very much to "go". Straining might make all my prolapses worse. So I push only a little, while supporting the "pouch" with my fingers, and experimenting with positions (Christine talks about this in her book). Failing that, I keep the little Fleets on hand. I keep medical gloves in the bathroom for the times I don't wish to soil my fingers in supporting the rectal tissues and assisting the evacuation. It is not so bad as it sounds because I'm used to it, and it only takes 20 mins at the most. And this is only if I slip with my diet and become constipated, probably twice a year. The key is to remain vigilant to avoid hard stools. I make use of oral laxatives every other month or so, if I need to take a constipating medication or otherwise predict I might "seize up".

I have come to regard dealing with the rectocele as just one other health care routine, such as brushing my teeth, or maybe the way a diabetic would accept doing daily blood sugar checks. I accept it as an inconvenient but necessary part of life and FAR preferable to the horror stories I have read about post surgical nightmares.

As I said, I really have no statistics on how often such surgery fails, or god forbid, leaves you worse off than you were, but I know it does happen, and no matter how rare that might be, the risk is not worth it. Not to me anyway.

I commented to you before, after you responded to my message about the surgery. I would have been scared to death if I read all the reponses you got before my surgery.

I'm glad I had it done because I do know for sure that I didn't want to live the way I was for the rest of my life. I'm 40 and feel too young to have to worry about going to the bathroom all the time at least I've given being "normal" a shot. I will now trust in God that I will be better.

I think there are 2 important questions you need to ask yourself:
1 - do you want to live like this forever?
2 - do you trust your surgeon?

Good Luck! I will say a prayer for you Friday morning!!!
Dew

My questions would not be as the below - They would be...

Have you tried the posture? This has made many of us no longer in need of any surgical intervention (To be honest trusting your surgeon is not holding as muchmeaning as trusting your hairdresser - Your body is not my body and will heal as it decides - Everyone is different to a point...

I would also ask - How bad is it - If postur e has been tried I would then try the pessary before opting for the no-return option.

Thirdly - This site is not 100% adverse to surgery - We have just found a better way for us and not many of us understand the surgery as 90% of people we have read of who have had it - Go on to have a list of other surgeries in the following years meaning it aint a FIX if you hafta fix the fix of the fix.

Have you tried the posture? You know you can always put off surgery for a few months to see if it will work for you. Personally posture is now something that is normal - Its not hard work or anything lol - I am 39 and have had a prolapse since I was 20yrs old... My life did not end because of it... And now - there is like 1-2days a month when i even notice I havce it - And that is not even every month (Maybe every few months just before my period)

To be honest - For me - I would go through the more simle versions instead of jumping into something that you can never undo. :) But I - Even though I trusted the surgeon who fixed my hernia in March07 - The look on his face when he thought the hernia was back less than a month later and he said he would go backin - Do another Op - To just take a LOOK to see what had happened - showed me 10000% that NO SURGEON on earth can tell what the after effects of their surgery will be. Luckily for me it was a Haematoma (Huge blob of blood) and I didnt need to go take a peek surgery. But the look on his face when I asked the question 'Is it back again' Told me that he was worried and he said its a 50-50 chance it was back!

Sugical procedures run along a theme - They do what they are taught to do... Someone makes up the Op then teaches someone else and so on. No surgeon is God and no surgeon can ever 100% guarantee you will not have any problems (Cos I was told my repair stood 99% chance of no problems and as I said - I had a grapefruit sized problem!) lol

Good luck
Sue

Look into the eyes - They hold the key!
http://www.bringmadeleinehome.com/img/maddy544x150Banner.jpg

Well if you have a constant feeling of being "turned inside out" I'm not sure what you are having to endure. It may be very different from the sort of problems I have. All my prolapses are pretty severe, but I don't have rectal PROLAPSE (outside the anus) whatsoever. It's just a rectocele, if you understand the difference. When you say "turned inside out" I think of external prolapse. For me, everything is trying to slide out of my vagina. First of all, since I have all three, they tend to crowd the door, and so nothing ever really exits. Secondly, whenever it feels too much like it's all too "there" I can put in my pessary. As far as I know there is no pessary equivalent for the anus.

So again, I'm not sure what sensation you are having to endure. Don't call yourself a baby. Just because I have adjusted well to what I have to endure doesn't mean anything. Your situation may be quite different.

In 2000, I had a graft augmentation to try to correct my rectocele. Seven years later, I am back to square one with even more pain than I started with. I had had vaginal pain with intercourse, as well as pain in my anus upon evacuation since the surgery in 2000. Now, the prolapse of my rectum is back, and I deal with the same bathroom habits as you. I am frankly tired and depressed about it. In addition, I am experiencing extreme lower back, hip, thigh and abdomen pain, all of which is in sync with the rectocele. I can feel the pain even more when I go to the bathroom. I can tell that the pain is all the strain on the muscles from within my rectum. A physiotherapist, who I saw this past year, treating me for pelvic pain, said that all those muscles are connected. And boy, can I tell. I don't know what do at this point. I am totally afraid of addition surgery, but I feel like I can't live with this pain and discomfort of my bathroom habits. If I get more surgery, it will probably come back again, and my muscles will get tugged on again. That can't be good. I'm about to lose my mind.

...I want to respond to your post and will do so as soon as I possibly can.

Christine

When I say "rectal prolapse" I am referring to the interior of the rectum literally turning inside out like pulling off a sock, and exiting through the anus. This is what happens when you hear those stories of kids sitting on pool drains, only usually it is very extensive, involving not only the lower rectum, but many feet of bowel. In women with weak pelvic floors, or damage to the rectum through trauma (too much and too rough anal intercourse? - or childbirth/episiotomy damage) usually it is only a short length of rectal tissue that will protrude from the anus. Whereas a "rectocele" is a prolapse of the rectum into the vaginal canal through the vaginal wall. Actually nothing is going "through" it but the wall itself collapses into the vagina. It may begin to "exit" through the vaginal opening by pouching out that way but in that case it is the lining of the vagina you see, not the lining of the rectum. And yes, that is where the feces will tend to want to go. You can have quite a bulge of feces trying to come out your vagina, but of course it won't, because it's contained behind the wall separating the areas... unless of course you develop a fistula which is a whole nother story.

...and it appears the most common risk of the new transanal surgery that cuts and staples in one shot. It is a very fine line between rectum and vagina.

Natural treatment for all the prolapses is the same. I have a lot of information in the FAQ and Tips sections. The rest is in the book!

The major keys are posture, diet, and discontinuing ALL straining on the toilet. For some women, rectocele is the most responsive of the bulges and for others the least - especially if you've had extensive tears and episiotomies. As you can see, though, we have scores of women who have stabilized their conditions through this work.

shorten the url in your address bar to www.wholewoman.com

If you go into the FAQs on wholewoman.com it explains the posture which is a wat of standing so internal pressure helo your body to hold themselves in a different more natural fashion and the prolapses become less of a problem and for some not a problem at all :-)

*EDIT* OK I repeated what everyone else said lolllllllll

See how a girl stands?

A much deeper natural back stance (even though her arms are raised) Remember a lil girls belly is kinda puchy but firm but not ab-firm it is held but not had it is a 'proud' belly if you get what i mean...

Girl 1

Girl 2

Also this is the old pic of the posture (I am unable to open PDF files so i saved this)
The Posture

Does that help any?

Grief hyperlink is a pain lol it always puts link at bottom of post

Sue

Look into the eyes - They hold the key!
http://www.bringmadeleinehome.com/img/maddy544x150Banner.jpg

Here's a good article. Scroll down and read "Transanal repair" if this is the one you are going to have.

http://www.emedicine.com/med/topic3325.htm

Another article I read said one study showed that as your rectocele worsens, your subjective symptoms do NOT worsen. I can't find that one again at the moment but I thought that was interesting.

Anyway, I googled "posterior colpopexy via anal" and got a good list of stuff. That might give you some insight into your original question; facts about results.

More thoughts about it: The "splinting" of the rectocele while defecating is very important. That's when you apply pressure on the perineum. That alone helps me defecate normally. Also, once in a while I resort to "digital" assistance to get everything out. I was horrified at first and reluctant to do that but ultimately got used to it and now it is no big deal. I know you are feeling uncertain and might be rethinking the surgery. I can't say whether you should or not, just that I have worked out over the past three years how to handle it so that I no longer view it as an issue.

Also, my pessary helps sometimes. When it is in place it seems to keep the stool pushed back where it belongs, although when I go #2 I have to hold the pessary in manually, otherwise it threatens to fall into the toilet.

My feeling is that even if everything drops out to my knees I'll just cram it all back up and stuff the pessary in after to hold it, rather than ever have surgery. But I've been scared off from surgery by a hand surgery that went very bad and left me without a right hand for two years, so I'm biased. I'm not really an objective person on the matter of surgery. And also your symptoms might be different from mine, worse, and maybe not as easily handled. It's hard to know subjectively, or to guess how the surgery will go or the results will be.

One thing is FOR SURE... there are MANY, MANY women out there with this problem, yet we feel all alone because we DO NOT talk about it. I for one never discuss it with my female (certainly not male) friends and acquaintances. Yet surely some of them have the same issue. We all feel alone yet one of those papers I just googled said the rate of pelvic organ prolapse is estimated to be between 30 and 93% (!!) Now the higher number will include mild cases that might even be asymptomatic. Still many are severe; there is a lifetime risk of 11% that a woman will have surgery for it; I presume that can be interpreted as severe enough to be very bothersome. Also, of those who have surgery, there is a 30% reoperation rate. That tells you it isn't the most effective of surgeries. That seems to indicate about 4% of all American women will have MORE THAN ONE surgery for POP!

So if it makes you feel any better... you are in large company.

I just wanted to reiterate the idea of delaying your surgery. i'm a real believe in fate, and you found this site which is not the first site to come up when you google prolapse. but here you are!
and it's probably for a reason.
surgery will always be there, but there's a lot of wisdom here that could change your life.
i'm living very well with 3 prolapses that were, 8 months ago, grade 2 - 3. now i hardly notice them.
i've had to play around a lot with my diet, but i'm getting there. i've cut out dairy, chocolate (so sad!), and eat about 7 - 10 servings of fruit and veg a day. and with that, i really don't notice things very much! when i do, it's always because i've felt so great i let my eating slip. so a few days of eating well and i'm back to feeling okay.
not that things are gone, or totally asymptomatic. but i can live with it, especially when i think about the idea of things getting worse outside of my control...

and surgery is always there if i decided i need it. but as i've been told it would last about 5 years max at this point, that would be a lot of surgeries...

just a thought.
good luck with this.

Kiki

There is no harm in delaying the surgery if you aren't absolutely sure. Even if your doctor seems to disapprove. When I was first told I needed a hysterectomy, my doctor said it should be done "soon". His argument was that I was approaching menopause and that things would only worsen. He also said it is a lot easier for him to do the repair now than if it is worse and the repair is more likely to hold up better in the long run if I do it sooner rather than later.

I considered what he said, but the logic just didn't entirely fall into place. I haven't been able to find a lot of published documentation showing CLEARLY that I am at less risk of needing further surgery if I have it done sooner rather than later. Everything I've read seems to indicate that further problems are due to 1) the absence of the uterus and 2) time and age. There is nearly nothing to tell me that "delaying the repair" is a significant contributor ON TOP OF the first two. On the contrary, "delaying the repair" definitely eliminates number 1, so I must conclude that in reality, perhaps the reverse is true... that for the best long term result I am better off delaying the surgery.

I have to qualify this with the comment that I am not a professional with access to all the journals and research, nor should I comment on anyone else's particular situation. I grant that there may be cases where surgical repair is the right thing. The lady who was carved up with a knife by a criminal comes to mind - we're talking about radically abnormal damage here, not our typical prolapse patient. But the conclusions I arrived at applied to ME, I am sure.

After I refused the surgery and some time passed, I spoke again with my gynecologist. Now, he tells me that he agrees with my plan, and that he no longer feels I will be worse off for not doing it now. He seems to think that because my prolapse has stabilized that I have a good chance at living the rest of my life managing it as I am now and never needing surgery.

So don't let the surgeon's sense of urgency pressure you into doing it, because even he may see things differently later on. Remember, the guys (and gals too I suppose) make their livings doing these procedures. They are very invested in them. They REALLY DO believe they are helping - they have to, they need to justify their whole career. My gyno doesn't deliver babies anymore; a large part of his practice is now surgery and a large part of that is POP repair. It took a big man to support my decision not to do it. So if your doctor reacts badly if you decide to delay the procedure, don't freak out. He might come around in time. If he doesn't then you might wonder if he only has a "surgery is always the only solution" mentality, which I would shy away from any doctor who is like that.

Here's a study that showed excellent results from the transanal rectocele repair. HOWEVER the results are taken only 6 months post surgery. I would want to know what happens 5 years post surgery.

The summary also points out anal sphincter problems as a risk.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uid...

My mother was told she needed a Hysterectomy in Hmmmmm well at least 15 or more years ago. She put it off and now she just won't have it.. Just shows Doctors say things that aren't truly needed he said this to her to alleviate heavy periods and with the line you are approaching menopause etc etc if I remember correctly - I will hafta ask her. But she is now retired and doesnt even think about it.

I think what your heart tells you not to do - Is a good time to listen when it is fiddling with female anatomy...
Sue

Look into the eyes - They hold the key!
http://www.bringmadeleinehome.com/img/maddy544x150Banner.jpg

Hi AnneH

We must have the same gyno. More likely they trained under the same model. He wanted my uterus. I wanted it more. I won. In Oz we get our annual gyn checkup with the family doctor, so I have no reason to go back to the gynaecologist. I really cannot see how I can have a rapport with this man. He poo-pooed the idea of 'managing' prolapse. Well, that was like a red rag to a bull!

I too got the 'have it done now, it will be more major if you leave it more than a year' story. It is now three years adn I am better than I was then!

Looking back over your posts you seem to be in a similar time frame. I am 54 and getting closer to menopause by the day. It will be interesting following my cervix and its friends over the next few years just to see what does happen.

This Forum will probably be the first diary of POP's during menopause. We could rewrite the wives' tales. I hope so, and I cannot see why not. I figure that, post-menopause, there is no ovulation so there is no accumulation of fluid from preparation of the uterus for pregancy, so there is no worsening of the prolapses prior to a period that is not going to come. I guess it must be permanently like the first few days after a period, before ovulation, but with a drier vagina and a smaller uterus. I gather it may take years to get to this point where there is no evidence at all of a monthly cycle, by way of a long time where mucous comes and goes, there can be some light periods and some very heavy ones, then it all just stops, to be maybe replaced by hot flashes, sleep problems, fuzzy head, sweats etc if you are unlucky. If you are lucky menstruation just stops and that is that.

Is this what happens, all ladies who have experienced menopause??

I am getting the feeling that menopause is about as sexy as prolapse. I have never been able to find information on what order everything comes or goes. It all gets very brief treatment, supported by lots of graphs and statistics. And I am left sitting there thinking, "But what actually happens apart from periods stopping?"

Cheers

Louise

Hi OhBoyOhBoy

I guess I had better add my tuppence halfpenny and agree with the others who suggested delaying surgery if you are not sure that it is going to solve your problems, which in the medium and long term it probably won't. You are only 32 years old. That bod of yours has a long time ahead of it.

Try Wholewoman techniques first, for a few months. You can always go for surgery anytime.

I investigated surgery, decided it was not a good idea for me. I am not a risk taker medically. Besides I wanted to keep my healthy uterus and I didn't want my vagina compromised by scar tissue (ouch). So I put off even considering it. That was three years ago, the deterioration the doctor promised has not happened, I am better than I was, and I don't even bother considering surgery any more.

I hope you take the time to really consider how your body will be fundamentally changed by this surgery, and what you will do if / when the repairs break down.

Cheers

Louise

Dear Hazel,

Your story broke my heart and I was glad to read Louise's lovely response to you, which summed up my feelings as well.

A major focus of the Whole Woman effort is to enlighten both the medical field and the world of women about the urgent need to treat human birth with the utmost care and respect for the female body. This would include discriminating use of cesarean.

I think if you look into it, you may see that a point in time comes for many post-surgery women when they realize more surgical procedures are not going to change their condition. I have no way of knowing if that might pertain to you or if you would benefit by another operation. However, I believe we will see the day when even surgeons themselves will be forced to admit that many of the second, third, and fourth surgeries are likely to cause more harm than good.

It would be impossible for me to suggest how you might live your life in your present condition, but I can tell you that I can imagine my life being worth living if I were disabled by pelvic surgery. It would not be the life I'm living now, but I know I would find fulfillment as well as a way to care for my injured body as best I could.

We live at a time of great access to deeply healing modalities. What springs to mind is the work of Jon Kabat-Zinn at the University of Massachusettes Medical School. I know he trains practitioners and probably has a whole network of people offering his method (try www.umassmed.edu/cfm/index.aspx) He wrote a book called Full Catastrophy Living and specializes in patients dealing with chronic pain.

Please know our hearts are with you.

Christine

I am glad that I finally found someone with a case similar to mine.
Thankfully I do not have bowel/ bladder problems but I hate seeing that THING bulging at my entrance. Please share with me how your surgery went but also, let me tell you what is happening with me:

1. The bulge is very unattractive. The other night I was preparing to the intimate with my husband but when I opened my legs I could see the muscle "Peeking" out. I was so horrified, I felt like going to sleep. I had to contract my muscles to pull it in!

2. The recovery period seems long (6 weeks) but I am wondering if I have no bladder or bowel problems if the procedure would be less painful/ have a shorter recovery period.

Sometimes I worry that this will get worse and I should deal with this while I am young (29 years). Please respond as soon as you can. How was your experience etc. since you didn't have to insert mesh/ or repair and enterocele.

PetroP

are you "new" here? It sounds like you are. Welcome to the forum. Have a look around. Look at the FaQs, read the blog, and use the search function at the left of the screen.
Hopefully you will find a way to "manage" your bulge.

Hi, this is my first time on here. I,m schedule for a laproscopic supracervical hysterectomy in January keeping one ovary losing my uterus and keeping my cervix. I had a D&C and an ablation prior to this to help with the constant bleeding since they didn't work I'm going to have the hysterectomy and at this point am looking forward to this. My concern is I also have a stage 3 rectocele and uterine prolapse. The hysterectomy will take care of the uterine prolapse but the rectocele is were I get nervous. My Dr. is going to be using a prolift mesh has anyone had experience with this any information would be great! Leensy

you've gotten great advice, on putting the surgery off. It is such a major thing, and the doctor probably told you its a common thing, and a simple surgery..but if you think about what they are really doing, it's not that simple.
I'm not anti surgery, but I am for myself. I did just have anal fissure surgery, which was unrelated to my rectocele, but the rectocele was making my fissure worse.
I've found keeping up with fiber throughout the day (Arnolds makes a bread called "Fiber Bread" it has 6grams in one slice!!) Fiber may not be the tastiest...but I'd rather eat things I don't particularly like, than have an invasive surgery.
My fissure was causing extreme pain, some days the rectocele is painful, but not nealy as excruitiating as the fissure. It took me 5 years of at home treatment to finally do the surgery.
I also have a cystocele(bladder prolapse) and a uterine prolapse. I'm 21 years old, and I do know I will live with this the rest of my life, but thinking of it that way is like saying it's taking over my life.
I let it consume me when I first found out and was obsessively doing research and checking my vagina..
and you know what? it was ruining my life. I stopped checking, I stopped researching, other than this site, and I enjoy life. I don't let it get me down.
Some days I am so depressed about it though, and I vent on here or to my boyfriend.

A previous person said, her "bulge" embarassed her before sex...don't let it! My boyfriend and I go about our business like it's not there..
honestly, I HAVE to have sex at least 4 times a week (not always fun) and I'm completely serious, it's like my physical therapy. It makes me go the same day. Sex does wonders for my rectocele!
Don't give up.

Ihearted

Have you found that the rectocele makes your vagina feel looser?
Has kegel exercises helped with the muscle?

Awaiting your response.

No, I haven't foudn the rectocele makes my vagina feel looser. I do kegels though because sometimes I feel like I'm just spilling out, and I thin kI like to do them because I feel like I can pull myself back in. So I lay down, and do some kegels.
My rectocele has been getting somewhat better, I definitely still have flare ups, and I can just tell I'm going to have one soon.