Urogynecology Expert Forum
Prolapse
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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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Prolapse

I am 32 years old, at the age of 22, I had to have a hysterectomy.  I also had bladder and vaginal prolapse. This was corrected around the same time.  It has been 10 years since I had all of my surgeries. I noticed right away that I was having problems with bowel movements. I have lower back pain, pain and pressure, and I have always noticed that I have a bulge in my vaginal wall when I do need to make a bowel movement. Most of the time I have to manually help with my bowel movements. I did mention this to my doctor awhile ago,when I had the surgery.  I was told that nothing was wrong.  It has been ten years and this still is bothering me.  I just read about enterocele, could this be what my problem is?  If so, what should I do? Could this be a serious problem?
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Having to manually assist bowel movements is not normal, and it never has been normal. Regarding your question about the anatomy, think of the vagina as a long tube. The tube is anchored off to the insides of the pelvic floor (to something called the white line- there is one on each side), and off to the top by the ligaments that also hold up the uterus (also called the uterosacral ligaments). the vagina then supports the bladder and urethra (urine tube) in the front, and pushes back on the rectum in the back. Weakness in the front wall of the vagina leads to a bulging of the front wall out through the vaginal opening, and usually the bladder bulges out with the front wall. That is sometimes called a cystocele. When there is weakness of the back wall of the vagina,  the back wall bulges out, and the rectum usually is behind the bulge. That is sometimes called a rectocele. When there is weakness at the top of the vagina, then the top bulges down and out (kinda like an inside out sock), and the small intestines can fall down with it. That is sometimes called an enterocele. Together, these bulges are called pelvic prolapse, which is a kind of hernia of the vagina. When women have to put their fingers in the vagina or on the perineum (the spot between the anus and vaginal opening)  in order to help have bowel movements, this can sometimes be because of the rectocele. Sometimes (but not always) fixing the rectocele or perineal defect can help to make this problem better. There are several ways to repair the weakness which causes the rectocele, these involve surgeries performed through the vagina or abdomen, which can use your own tissues, but can sometimes require the use of artificial tissues or grafts to get the job done. In my practice, I ask my patients to do a test called a defecography to evaluate the movement of stool during a bowel movement. For the defecography, a special gel is placed in the rectum (like an enema) and you sit down and try to have a bowel movement. Special XRAYS are taken as you try to have the BM, and these show how the rectum, vagina, and pelvic floor moves as you strain down. The results of this test can be very helpful in identifying if the problem can be treated surgically. Lower back pain and pressure are often assiciated with prolapse. YOu should get an appointment with a trained urogynecologist to have this evaluated. go to sgsonline.org, or augs.org, and put in your zip code to locate a urogynecologist/pelvic surgeon in your area.

Dr. Hoyte
3 Comments
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Probably a rectocele rather then enterocele, I have the same issues along with cystocele, prolapsed vaginal vault and uterus. It surprises me that your Dr. would brush it off. My PCP couldn't DX anything other than my cysto so she sent me to a urogynocoligist. Try getting a second opinion. Good Luck!
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Thank you so much for answering me. Could you tell me the difference between the two?  I will be going to the doctor as soon as possible. Pains are much more serious now.
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