Urogynecology Expert Forum
I have questions about cystocele and rectocele 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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I have questions about cystocele and rectocele surgery

I have a cystocele and rectocele grade 2-3 and my uterus is prolapsed slightly.  I have had 3 children , my first 20 years ago and had a partial 3rd degree tear.  I developed the cystocele and rectocele 9 months ago after lifting and holding some very heavy items.  I have done a lot of heavy lifting in my life.  I have been researching surgery for pelvic prolapse and it is very confusing with all the different information on the internet.  I would like to know the success of the surgery and how long  the average surgery lasts.  I have read horror stories and have been told 5 years all the way up to 15 to 20 years by  a urology nurse.  I have gone to a physiotherapist and have learnt the proper way to do Kegals and have stopped lifting heavy items.   I have changed my diet to help my rectocele, but I still have pocketing at time and need to splint. I would like to know if there are success stories...      I had been wearing a pessary, and even though the doctor told me it fit,  I had a lot of discomfort and rectal discomfort and after a few hours it would be down at my vaginal opening. I know my rectocele has enlarged since I have started to wear the pessary.  I  realize that there are risks with any surgery, but there is one website that believes you should never have surgery because of that problems that you could end up with.  I would like to ask you opinion re these surgeries.  
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Seek out a fellowship trained urogynecologist for evaluation of your prolapse. Many cases of prolapse do not need to be treated unless the bulge is visible past the labia (i.e., if you can see it without parting the labia), or if you hare having symptoms of lowback pain, pelvic heaviness, trouble having bowel movements, or urinary frequency.

Think of the vagina as a long tube (e.g., a sock), which is suspended at the top and the sides. If the top or side support is lost (as in with childbirth), then over time, with coughing, lifting, straining, the sock can turn inside out, and this is called prolapse The repair surgery is geared to resuspending the vagina at the top and sides. This is a surgical procedure, and can be done through the vagina or via an incision in the abdomen. Many urogynecologists will use permanent sutures to resuspend the vagina to ligaments in the abdomen or near the tailbone. These types of surgeries are cauled apical suspensions, and they work extremely well if done correctly. On the order of over 80% success over the long term. In times past, some physicians tried to fix prolapse by narrowing the vagina (called anterior/posterior repair). By itself the anterior/posterior repair does not resuspend the vagina, and these types of procedures have lower success rates on the order of 30%. Most modern doctors do a combination of vault suspension and anterior/posterior repair, and these will have very high success. If it is done correctly, it should last for a very long time.
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I had rectocele 8 weeks ago.  Except for some discomfort for the first 3-4 weeks with sitting, standing, etc., it went pretty well. I was only in the hospital overnight.  My bowels were moving way to frequently after surgery, with several accident because I was taking too many stool softeners. I was so afraid of getting constipated.  I cut back to 1-2/day, and take fiber capsules daily (2)  My bowel movements are more regular now with no accidents.  My only problem is painful intercourse because the vaginal area was shortened due to the rectocele surgery.  I am told that this area will stretch out over time, that I just need to be patient.  Hope you decide to have the surgery.  I got very tired of pushing my rectal wall up to finish a bowel movement.  Good luck!
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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
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