Urogynecology Expert Forum
Bowel Problems after Surgery
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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Bowel Problems after Surgery

Hello, my mother had 3 surgeries in February: Pudendal decompression, rectocele and cystocele.  We expected a long recovery for the pudendal nerve, but she is also having much difficulty with her bowels.  

She is currently taking Miralax (1 capful in the morning and 1/2 to 1 capful at night) along with trying to keep up her fiber intake during the day.  Her stools most often come out as piles of tiny snakes, which can range anywhere from 2 to 5 times a day.  She has to really push to get anything out (which she was told she needs to avoid), and has to use liquid suppositories 1 - 2 times per day to empty the bowel which feels like pressure building up during the day.  She never feels like the bowel has completely emptied.  She was having painful spasms after bowel movements, which occur less frequently now, but she still gets a terrible ache in her bowel.  She has been on oxycontin (is now down to 10mg every 8 hours) since her surgery, which she knows causes constipation, but at this point, needs it for the pudendal nerve pain as well as the bowel pain.  She is also on Lyrica for the nerve pain.

Since there are only a handful of surgeons in the country who specialize in Pudendal Neuralgia and perform the decompression surgery, she had her surgery out of state.  Her gastroeneroligist suggested the Miralax (she has previously tried Milk of Magnesia, Enulose, Senecot and stool softeners), but basically indicated that he can't help her until she has a defography (not sure of spelling) test.  The problem is that her surgeon does not think she should have this test now because it could compromise her pudendal nerve recovery.  She feels that there is something very wrong with her bowel.    

Do these symptoms sound normal for someone who had rectocele surgery 4 months ago or could they be a sign of something dangerous?  What is the next step she should take?  Any guidance you could provide would be greatly appreciated.  Thank you.
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This is 4 months out, so she should not be having these bowel symptoms. Locate a urogynecologist or colorectal surgeon who can obtain a defecography, and do a detailed physical examination to determine if there is an explanation for her symptoms. A defecography should be ok to perform at 4 months post surgery.

Dr. Hoyte

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