Urogynecology Expert Forum
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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Rectocele Surgery

I am a 43 year old sexually active female.  I had a hysterectomy with anterior and posterior repairs in 2005 due to prolapse.  I also have asthma and chronic coughing.  I now have another rectocele that measures 3.5cm and is causing complications with bowel movements, both at the site of the rectocele and higher up, which requires me to splint both vaginally and rectally.  I have found a urogynecologist who is very honest in stating that she is having difficulty in deciding whether to suggest surgery or not.  She would be using mesh and if I had the surgery I would need to decide between synthetic or porcine.  I am concerned with postoperative sex issues and also that a second surgery might do more harm than good, however because of the coughing, it seems like a good idea to reinforce this area with mesh.  Is a 3.5 cm large enough to consider surgery?  I know I will eventually need to correct this situation, but I am wondering if I should wait until I am older, wait until the rectocele is larger, or wait until I am no longer sexually active, or is it better to have the surgery when I am younger and perhaps better able to withstand surgery and heal better/faster?  And then there is the choice of mesh I would need to consider.  Thank you for any advice you can add to my decision making.
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Get the following evaluations:

1) Defecography - It is a study that puts contrast in the rectum, and takes pictures as you defecate. It can show pretty clear where the stool is getting trapped.

2) Pelvic MRI with dynamic midsagittal rest/strain. It can show if the vagina is pressing on the rectum when you strain down.

Depending on the results, you may be a candidate for an abdominal sacralcolpopexy/rectopexy which may help your problem. You probably will not benefit from another rectocelt repair, because the problem sounds like it is higher up than the rectocele repair can reach from the vagina. If your urogynecologist is not comfortable with the abdominal sacralcolpopexy/rectopexy then find one who can perform this procedure if it is needed. The sacralcolpopexy uses a synthetic graft to lift the vagina up and tack it to the inside of a ligament high on the tailbone. The rectopexy lifts up the rectum similarly, with sutures only, no graft. It is done through an incision in the abdomen.

Avoid the porcine stuff, it can be dissolved by your body, leading to failure.

Dr. hoyte

5 Comments
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There's a group of women called u.p.r.i.s.e. prolapse you should try googling it. They have all been through many of these surgeries and can help with questions too. They know what's worked and failed for them and their insight may help you.
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527589_tn?1301681778
I am sorry you are going thru this. I did not have a prolapse but did have a mesh related surgery. The complications from the mesh far out weigh its usefulness. I'd suggest looking into ANYTHING but mesh for your repairs.
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i have just had op 3 weeks ago abdominal rectopexy i also had op for rectocele last year  dr hoyt is right in every thing hes said in his post mine was further up ive had mesh  also had resection  i really was worried as im only 40 years of age  but its amazing what they can do today my surgeon  was brilliant id got no quality of life  and was getting very depressed as this was affecting my eating  im glad i had it done  even though at the moment im taking medication to keep things moving  ? its only been a short while since surgery  and i dont expect miracles yet ? it takes time to heal  but my symptoms are 75% better and thats in 3 weeks  i did have fluid build up at sacral area and had antibiotics to clear this up   i cant tell you what to do as every 1 different  all i will say is? you know when enough is enough  good luck i will post more when i go back  to post op appointment and let you know how im doing   ps i went out shopping with hubby today  the first time in 2 years ive felt comfortable enough to do this i havent lifted any thing but glad to be out
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489896_tn?1214873391
I'm so glad to be on this website. I found out so much about how I think my rectocele(for the 2nd time) needs to be repaired. I hope my Dr will recommend it. I never heard of rectopexy before but I think it will solve my problems!   I am seeing a new Dr in a couple weeks.  Wish me luck!
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A related discussion, InteXen LP porcine dermis for rectocele repair was started.
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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
Plano, TX
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