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Large Rectocele and Rectal Mucosal Prolapse
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Large Rectocele and Rectal Mucosal Prolapse

I have a rectocele grade 3.4 diagnosed by a uro/gyn. I've also been diagnosed with with a partial rectal prolapse also know as a rectal mucosal prolapse diagnosed by a colorectal surgeon. I had a defecography which confirmed the rectocele but the partial rectal prolapse didn't show on this test. I've seen two uro/gyns who say they don't see the rectal prolapse and the defecography doesn't show anything significant. They advise doing nothing about the rectal mucosal prolapse and just repairing the rectocele.

The colorectal surgeon I saw says that my symptoms are coming from both the rectocele and the rectal mucosal prolapse. He feels both need to be repaired and he would do both but would do the repairs through the with a transanal approach. The uro/gyns would use a transvaginal approach to repair the rectocele.

My symptoms are all rectal. I have a sense of rectal discomfort to the point that it is mildly painful. I always feel like I need to have a bm even when I just had one. I hardly ever feel empty.

I don't know who to listen to. There are risks no matter what procedure/surgery you have but they are different. Can anyone help? Thank you.
7 Comments Post a Comment
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10225605_tn?1408638630
Good to hear that you continue seeking answers from more then just one Dr. I too had rectocele and rectal prolapse.
the defogram is nothing more then a guidance for the Dr. and many times it depend on who reads it and how well they read the tests. For my first defogram showed a mild rectocele but according to the uro/gyn it was stage 2/3 even the staging though can change depending on so many factors ~ how tired your pf muscles are so at the end of the day things will be worse then in the morning after resting all night. how much gas, stool, urine you have in your digestive tract and bladder. so there are many variants on how out pops present on testing, exams and how we feel. My second defogram 6 years later did not show much, but when I saw my surgeon she could not only feel/see on her exam when she did go in to perform the surgery it was MUCH worse then even she realized.
Since you need is directed toward the rectal proplapse and rectocele ~ my thoughts are this...although I generally feel a uro/gyn is the dr. of choice for pelvic organ prolapse ~ if it were me (actually it was me and I flew out of state to the surgeon who would handle everything) so in your circumstances I know you are VERY frustrated so let me say first ~ I am doing much better now post op. My repairs were done by a uro/gyn, all done Davinci. I also had bowel resection...it was a mess in there the surgery was over 6 hours long...but here would be the things I would want to know if I were you with your two dr. opinions ~
for the uro/gyn: Why will this dr. not correct both? it makes no sense to do only one. This just sets you up for more surgery.
For the colon/rectal: how many rectocele repairs has he done? what is the success rate he has had? how many problems has he had and with the problems (they always will have at least one case if they have done enough surgery - if they say they have not had problems I would be concerned that they may not be being honest with me)so anyway if he says he has had a couple of hard cases...ask him how he resolved this patients problems as this is key...you want a surgeon who will follow you through all facets of this journey.
Did he say why he would do it anally? I have had a rectocele repair with mesh (this was when the rectal prolapse was done as well) and I have had a vaginal repair of a new rectocele that developed right where the mesh stopped because of pelvic floor dysfunction....the mesh repairs are almost 2 years now and the vaginal repairs are 2.5 months and were suture only, these repairs are holding well too. Will he be using mesh on one or both your repairs? Is there any chance of you getting a 3rd opinion? I saw 4 uro/gyns and 3 rectal surgeons as well as some other dr.'s in the mix...
I remember all to well the days of not fully evacuting and eventually mine got to a point I could only remove stool with enemas or colon hydrotherapy because excessive laxatives quit working. This is a challenging journey to figure out what is right...I can't really tell you what you should do, but I would sure be asking more questions with the colon/rectal and I would not get one repaired without having the other repaired...it just does not make sense to me...if they are going in they should address all issues they find or you will be most likely back on the surgical table shortly after...I wish I could share experience with anal repairs, but I have no answers for that repair as I have never been through that one...good luck and let us know if you have any more questions!
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Avatar_f_tn
I agree with ipurr2.  
A have seen several Urogynes and 2 Colorectal Surgeons and had 3 defecography's done as well other tests.  On only one defecography did my grade 3 intussusception show up and on on of the tests my rectocele was seen to be small which was different to the other tests where it is seen as grade 3.
As you dont have all your answers you may wish to continue and get a further opinion.  Is your Urogyne Fellowship trained?  Have the Urogynes you have seen aver done an operation on anal mucosal prolapse?
All consultants have their own perspective and dont necessarily agree.  If you need to ask further questions do so as you still appear to have missing pieces to your jigsaw.  
Come back and let us know how you get on or have further questions
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Avatar_f_tn
Thank you for taking the time to answer me and share the benefit of all your experience. Just to clarify, what was your rectal prolapse like? Mine is just the first stage of prolapse called rectal mucosal prolapse. Just the thin layer of the mucosal is loose but not protruding at all. Do you know if that would show up on a defecography? Since the defecography didn't show mine, the uro/gyns see it as not significant enough to be concerned about. Both uro/gyns have examined my anal/rectal canal and haven't seen any signs of rectal mucosal prolapse.

The colorectal doctor I've seen says it probably wouldn't show up on a defecography or maybe he meant that it wouldn't surprise him if uro/gyns didn't see it on the defegram. He says he could see it on examination. I believe he used an endoscope. I can believe this since that is his specialty where it's not the speciality area of the uro/gyns. But on the other hand, I wonder if the uro/gyns are right and it just isn't enough of a problem to warrant surgery or it isn't there.

That sort of explains why the uro/gyns I've seen won't fix it. I've asked the colorectal surgeon how many rectocele repairs he does on average. He said 3 or 4 a month which I know is not many. He hasn't had anyone come back to his office with a complication or failure. I know that sounds pretty crazy but he has more positive patient reviews online than any other colorectal surgeon I've found and his education and credentials check out very well. I don't know what to make of that. He has a perfect 5 star rating on all the sites I look at like Healthgrades, Vitals, Ucompare, etc., with many reviews. Could he just be very talented? I just don't know. BTW, is it all right to mention Dr. names here. I've had no problems with that on other sites.

I'm also wondering if a rectocele could cause all of my symptoms. My symptoms are rectal discomfort, pain, pressure and the feeling that I haven't completely evacuated even after I just had a BM. I never have a sense that something is falling out of my vagina or have vaginal discomfort, it's all rectal.

Thanks again for your help.
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Avatar_f_tn
Thanks UKlady,

I don't think the uro/gyns have done any rectal mucosal prolapse repairs but I didn't ask assuming that only colorectal docs do those procedures. Do some uro/gyns actually do rectal prolapse reapairs? My uro/gyns are fellowship trained and do many rectocele repairs and other prolapses like uterine, vaginal and bladder. May I ask who did your repair?  Was it a colorectal surgeon or a urogynocologist?
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Avatar_f_tn
I haven't had any repairs yet mainly due to me having a bladder wall infection that is sadly well established coz it took 5 Urogynes and years to find out that the pain I was having wasn't due mainly to my POPs... it was really an infection that had been missed over and over again.
I could be on antibiotics for years and I have no guarantee of success with my treatment but as I am now I couldn't cope with a catheter.
Here in the UK I have been offered a rectocele op by one Urogyne and a cystocele and rectocele by another gynae as Colorectal surgeons here only do anal prolapse and rectoplexys and so far I haven't had an offer of an op on the NHS.  Treatment in the UK can be more conservative.

So:   In the UK a Urogyne cannot do a rectoplexy or mucosal/anal prolapse op.  Only a colorectal surgeon can do this in my experience.
In the US a Urogyne can do more operations on the bowel side, however, if you have more issues on the bowel side then a well trained and experienced Colorectal surgeon could be the best option.  
Maybe do more research before you make your final decision.
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10225605_tn?1408638630
The UK system does seem very challenging on getting the help needed...I think in the USA it does depend on the insurance you have as those with poor insurance to not have the capabilities to see whatever dr. they would like but need a referral and some dr. dismiss issues just like your bladder pain was dismissed allowing the infection to settle deeply in your system! It is very sad that to many of us have to suffer for so long. I feel truly blessed to have such good insurance so I could go to whomever I wanted to go see and to have found a uro/gyn who handles all my issues if I can afford the plane ticket to her...right now the local uro/gyn I am dealing with is like the UK dr.'s VERY conservative..Which both sides of the coin have good and bad...it is truly about pushing the best you can in whatever situation you find yourself for the best care for you and your situation...This is truly a complex journey to say the least!  
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Avatar_f_tn
Yes, I agree with individual Consultant having different ideas as well as this has happened to me.  So shopping around and remembering to use our intuition is very important and so is feeling happy with the Dr we have chosen.
The USA system is indeed very different to the UK system and the Canadian system is different again.  So it is important to utilise your system to help you.  I had no idea that the Drs had missed anything until the infection had spread and embedded in my bladder wall and there is no guarantee that I will be filled cured due to biofilm as well as depth of infection but am now more educated and will do my best to address this problem.  

The moral of the story is.. if you still have problems/symptoms and are told you are OK then you may need to see another Dr.
Thank you
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UKlady1001
United Kingdom