Pelvic Organ Prolapse (POP) Expert Forum
28 year-old with enterocele, rectocele, and more...
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28 year-old with enterocele, rectocele, and more...

I am a 28 year old female (nulliparous/virginal) with a history of chronic and difficult-to-treat constipation since childhood.  It has never really been evaluated until now.  

A CT done at an ER visit 2/1 showed that I was literally quite full of crap. Colonoscopy 2 weeks later showed my colon is somewhat dilated. A recent defecogram revealed large 3 x 3 cm rectocele and moderate/large enterocele, which is causing the distal rectum to completely collapse on itself, creating a mechanical obstruction to evacuation of the stools. The defecogram also showed colonic and rectal dysmotility. Anorectal manometry was done yesterday, results are pending. In addition, I strongly suspect uterine prolapse (cervix is maybe 1.5" above the introitus when sitting on the toilet), and cystocele (incomplete emptying, anterior vaginal fullness, and stress incontinence), but I have never been formally evaluated for those... and I think I need to be.

Based on the defecogram results, I'm very afraid that the colorectal surgeon is going to recommend surgery.  However, if we do more studies and find that I do have uterine prolapse and/or cystocele, I want those fixed at the same time.  One surgery.  Can a colorectal surgeon do all of that, or would I need a gynecologist?

And then what about the dysmotility? What (if anything) can be done for a lazy gut?

Also, I really need to know - do you think I could ever carry a pregnancy, or is my poor body just not suited for that kind of pressure? I know that if I get pregnant after having a repair done, it could destroy everything, but what about before? Are my tissues just too weak?  Am I too messed up already?

This is a lot to take in and a lot to think about.  I am overwhelmed and anxious, and my next appointment isn't until 4/22.

What's the prognosis?  What is next?  Where do I go from here?

Your reply is greatly appreciated.  Thank you.
1344197_tn?1392822771
Sorry to read of your problem.  A colorectal surgeon or gastroenterologist will evaluate and treat your slow transit constipation.  This condition is often treated with medications, however surgery may be required in some patients.  Prolapse is best evaluated and treated by a Urogynecologist.  I would suggest you a Urogynecologist so that they may coordinate a plan of care.  You are not "too messed up already" and the issues can be managed.  Depending on where your are, here is a sites that can direct you to a Urogynecologist.  http://www.voicesforpfd.org/p/cm/ld/fid=1

J. Kyle Mathews, MD
2 Comments
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Thank you so much for the reply.  I found a clinic in my area (associated with a university hospital) where all they see and treat is pelvic organ prolapse:  http://healthcare.utah.edu/womenshealth/urogynecology.php  It sounds like they are exactly what I need, so I scheduled the next available appointment (on April 18th).  Now I'll try to not fret about it too much in the meantime...

Thanks again.
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1344197_tn?1392822771
J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
Plano, TX
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