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Post op complications from a Rectocele Repair
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Post op complications from a Rectocele Repair

I am 42 y/o and I had a Right Lap Oophorectomy/salpingectomy and Vag Hysterectomy and Rectocele Repair.  This was done approx 4 months ago.  I feel great as far as the ovary/uterus removal....the right ab pain disappeared.  My problem has been d/t the rectocele repair and my BM.  Beginning approx 1 week post surgery, I began to have problem with severe constipation (even though I was taking stool softners 1 week pre-op and continuining thru post op)  the rectal pain/constipation was so severe, I tried Gylcerin Bulb Syringes and (2) enemas and had to resort to manuel removal of the stool.  The stool appeared to be stuck in two places.  Immediately inside the rectal opening and approximately 3 inches higher.  The pain was so severe and the process was so horrible that I went into the hot shower to help the rectal/lumbar pain subside.  D/t the straining and pain, I actually passed out and had a mild seizure during this.  (my husband was outside the shower and witnessed this)........I immediately called my surgeon and she added Miralax to the stool softners and did an internal and stated my body was still trying to heal with the mesh used for the rectocele repair and the opening was very narrow but it should get better.  In the meantime, continue same treatment and I also was to take the pain med/Percocet and Valium to help relax me during the process.  I continued this and the Percocet/Valium combo did help me relax somewhat but the problem continued.  I went back to MD again and she added Citrocel to my regimen which actually changed the shape of the stool and was very helpful.  After approx 10 weeks post op....I was still having issue with constipation and having a BM but it was approx 50% improved.  Throughout this time, I was also having severe pain with sitting, severe right hip/sciatica pain and pain all along the top of the right leg and inside the right thigh and lumbar pain.  I assumed it was d/t to severe straining.

In my desperate attempt to get back to work, I had my surgeon release me to work. (I work as a telephonic case manager which involves sitting at a computer).....I DC'd all the meds, because they were just making me so sick (nauseous, bloated and gassy) and because I thought it would just continue to get better.  I worked (3) days and the sitting increased my pain to level that was untolerable (standing and walking does not cause an increase in pain and actually feels much better, unless it is prolonged)....now I was back at square one.

Back to MD and was told to just give it time and as the mesh for the rectocele repair continued to heal and my body scarred over it, things would get better.

I just could not tolerate this anymore, so I went to see my Physical Medicine and Rehab physician and explained everything.  She did some injections (trigger) which definately  helped calm down the right buttock/hip and sciatica pain.  She also performed a Caudal Injection and an injection into the sacroilium ligament which again was helpful to calm down the pain.  She also referred me to three different specialists:  1. GI for the rectal pain, constipation and 2. Anesthesiologist who is an expert diagnostician for possible Prolotherapy for Dudendal Nerve Neuropathy. 3. Physical Therapist who specialized in pelvic pain for Pelvic Myofascial Release therapy.

I have started the therapy which has definately been somewhat helpful.....It is helpful but then I have the horrible BM experience which just exacerbates the right leg/nerve pain.

The GI ordered a CT of the pelvis and I am pending a Colonoscopy and he also stated I would just have to give it some time.  As I explained to him, I cannot tolerate this anymore.  The GI did order  Amitiza and continue colace, Miralax but to decrease the use of Enemas/Gylcerin bulb syringes......I had an allergic reaction to the Amitiza (although, it started to be helpful....my throat was closing, so I definately cannot continue with it)........The GI then advised to DC all of the meds and just to use fiber sol since the meds were not really making such a difference and he has now referred me to a Colo-rectal surgeon for additional evaluation and testing.

I will be seeing the surgeon and  Anesthesiologist this week, but in the meantime.......I am scarred to death to have a BM.  The pain is so horrific, I panic and cry and I have to strain so much, that I constantly feel like I am going to faint.  I have no choice but to try to use the enemas (limited to 2x weekly) but that is not even working.  I manually remove the stool that I am able to reach but it still seems like it is just stuck higher up.  The bathroom experience is anywhere from 45 minutes to 1.5 hours....I just feel that I cannot tolerate this much longer.  Between the Rectal pain and the horrible Dudendal nerve pain, I just cannot take this.  The PT advised that there is such muscle atrophy on my right side (buttock and leg) and right leg weakness.....that this is just one of her worse cases.

Can anyone just advise me on any possible problems that this could be and what I might have to do to resolve it?  I am a nurse and I have a very high tolerance for pain and I try the best that I can to get through this, but I know I am also avoiding going to the bathroom and I am just making it worse....but how can I continue to just tolerate this severe pain?  The PT stated part of my problem is I don't show obvious signs of such severe pain, I am more stoic and that medical providers might not understand and that is why I keep being told to "give it time".

My Gyne surgeon is wonderful and she kept telling me that she does not know how she would have done anything different.  I advised her that I did not think it was anything she did wrong, but my body's reaction to the surgical procedures........that is why it is called post op complications.  I also know that Dudendal Nerve Neuropathy is a rare complication, but unfortunately it is something that happened to me.

I have just run out of any other suggestions......and was hoping someone could give me any other suggestions or as I stated advice on what to expect in the future.

(PS: I have already tried the sitz baths, baths with epsom salts (helpful after painful BM), towels lining the toliet seat, fiber rich foods, lots of water and fluids, grape juice (I cannot tolerate prune juice), donut ring)

Thank you for any advice
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Hi welcome to the hysterectomy forum...as I read your story , I was amazed as to how familiar it sounded. i really think I can help you, Been personally through something very very similar...I had a hysterectomy followed by a BSO and the last fall a internal(several ) and external (3) hemmoroidectomy,.,,not quite the same as retroceyle but same area,,,

first and foremost ,it took me a while ( and 3 er trips) to figure out how to deal with this, You may know this but its so VERY important and I dont see it on your post,,,ok  a vicious circle,,,pain medications are needed after this surgery but(hahaha) they cause constipation and the last thing you want after any rectal surgery is to be constipated...I took colace 3 times per day, Mostly I had to drastically change my diet,,,cut way down or no meat at all, eat the most fruit you can handle,Rasins and dried prunes are excellent especially the dried prunes they dont taste so bad (like prune juice does)  
Also drink as much water as possible especially when you take pain meds drink a big glass of water with every time.
sitting in a very hot bath tub with watercovering abdomen before you try to poop helps a bit,,,as for digital manipulation for fecal impactation,,yes it works but I would not recommend doing it, as per your negative experience of passing out.
I like you had problems sitting , used a donut for quite a while,,I also temporarily took a small dose of flexeril to relax the muscles a bit,,once I had one experience with impactation it became my biggest fear,,,,
The three times I went to er I had to be placed on a Dilaudid Iv drip and they used a enema which I could not even insert the tip of at home per pain.
The only thing that worked was a very big drastic change in diet,,,a nurse in the er recommeded Kellogs Crackling Oat Bran,,,its like Cherrios is shape only way bigger and loaded with fiber, I ate them like you would potatoe chips straight from the box,,,very sweet,,a good treat and it helped.
it sounds like your advocating for self well, sometimes when we go to see a specialist they tend to want to do a corrective procedure, which again causes the vicious circle.Like I tell women on here all the time, ie. how many operations does one have to remove scar tissue,,knowing each surgery is infact creating more scar tissue...My meaning I would give an incredible amount of thought to corrective surgery if recommeneded.   good luck hope some of the food tricks helps,,,I was eating all most nothing but High Fiber foods ,,and a plus I dropped 16 lbs.....Take Care ,   Cherie
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I am an RN who has seen "B & O Suppositories" given for severe rectal pain in another post op situation involving rectal pain. They worked wonderful for a women who had a more extensive rectal surgery. The suppositories contain two narcotics and are rarely used anymore; so a younger surgeon might not recognise the name.
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remar
st. louis, MO