advice

[hockeymom011]

Hi, Hopefully someone can help me. I have been dealing with rectal pressure for 3 years and can't have a bowel movement without taking milk of magnesium and even when I do take it I dont empty all the way. I have seen numerous doctors had a anorectal manometry test done that showed minimal ability to perform a balloon expulsion suggestive nerve damage. I have had two proctograms done the first one show small rectocele so he fixed it and didn't change anything. had another one done few weeks ago showed the same thing but the are saying it is small to moderate so they don't seem to think thats the problem. So they are giving me a colostomy which could be reversable. I'm just getting a little nerves about it what if it is the rectocele causing this. any advice would be great

[patient915]

Nope, no one on this forum is a doctor (expect for the doctors that occasionally visit).

[hockeymom011]

are you a doctor? Just wanted to know if you were.

[patient915]

True, it isn't good to live on laxatives, but my opinion is that is 1000 times better than getting a colostomy.  I am in a very similar position to you.  I am chronically constipated needing many laxatives to have a bowel movement and I have a rectocele.  I am 100% tube fed though a GJ tube and I have a central line in my chest.  But I know that for me, the situation I am in now is better than getting a colostomy.

[hockeymom011]

oops hasn't helped me at all

[hockeymom011]

this is what my anorectal manometry w/balloon expulsion test read:

Resting anal sphincter pressure reflecting internal sphincter function was normal. Maximum squeeze pressure reflecting external sphincter function was abnormally low. the rectoanal inhibitory frflex was present helping to exclude Hirschsprung's disease. With coughing, there was a normal increase in anal sphincter pressure. with simulated defecation, there was normal decrease in anal sphincter pressure. Rectal sensation was likely normal. the balloon expulsion test was prolonged at 1 minute and 50 seconds with normal less than 1 minute. in summary, key findings of this study include decreased maximum squeeze pressure and relevant to this patients complaints , an abnormal balloon test. this finding might be further evuated with a defecography before considering a referral to physical therapy for pelvic floor neuromuscular reeducation.

So We did what they suggested and that has helped me at all.

[hockeymom011]

Yes I have tried that it doesn't work. And I would agree with you on that if that would work but the laxatives are just bloating me and it isn't good to live on laxatives right? Even if I do enema to clean out the rectum I get major pain there like I go into spasms. My colon is fine according to all the doctors so I don't want to mess that up.I have been to three pelvic floor physical  therapist and it didnt help. thats all it mentioned on my report is to do therapy. Trust me I don't want this done I'm going today to see my doctor just to make double, triple sure it's not the rectocele. And she really didn't want to do the surgery till I had more opinions than just one doctor so I went to cleveland clinic and that doctor agreed with the first doctor so that's the only reason why she is doing it. cause that was the 4th doctor that said I need this, I just can't believe this day and age they can't do something with nerve damage.

[patient915]

In my opinion, if you are able to have bowel movement (even if you need laxatives to do it) you are much better off without a colostomy.  Did the doctor mention pelvic floor dysfunction to you at all during the anorectal manometry?  A colo-rectal surgeon would usually fix a rectocele.  Have you tried putting your fingers into your vagina to temporarily "fix" the rectocele to see if that helps you to have a bowel movement?

[hockeymom011]

would a colon doctor fix a rectocele or a entorcele prolapse or would a obgyn do it.

[Steph16921]

A UROGYNECOGIST

[hockeymom011]

I go everyday as long as I take something but as I said I just go a little bit than I have to remove the stool manually from the rectum cause I cant empty and it's like water in the rectum so it's difficult sometime and if it's not watery it's very soft stool and that's the only way I can empty the rectum .

[patient915]

Ok I just wanted you to understand that you have not had every test done nor have you tried every med out there.  Do I think you should get these tests done or try these meds?  Probably not, but it is always good to understand what is out there.  Although tegaserod is no longer easily available in the US, it can still be prescribed in special circumstances.  How often do you have a bowel movement?

[hockeymom011]

no I have not had the smart pill cause my insurance company doesn't  pay for that I did have a test that I ate eggs with stuff in it and they watched it through xray. and that came back fine and the marker test I did was fine done a breath test also that came back fine. they say there is nothing wrong with the colon it's the nerves in the rectum that don't work I have a very hard time passing gas to. and that tegaserod is Zelnorm that they have taken off the shelves years ago. I will have a bowel movement very watery one if I take something but I don't empty all the way I sound like I have a pool of fluid in the colon.

[patient915]

An anorectal manometry only tests the rectum (the very last part of the colon).  A colonic manometry tests the entire colon or large intestine.  So I assume you haven't had the smart pill or tried tegaserod?  What do you mean you are not constipated?  How often do you have a bowel movement?

[hockeymom011]

what is the difference between the anorectal manometry test and the colonic manometry test. and yes I have tried the amitiza both mg. And Im not constipated I can't even get all the fluid out and if I don't take some thing I don't go and if I do it's thin and very soft and than I have to manually remove the stool from the rectum.

[patient915]

I can almost guarantee that you have not had every test possible done or have tried every laxative.  Did you have a smart pill/pill cam test?  Did you have a colonic manometry?  Have you tried amitiza? Have you tried tegaserod?  Have you tried pyridostigmine?

How often do you have a bowel movement?

[mammo]

I would get a second and even a third opinion before having a colostomy, this is serious stuff.  What are they thinking...that your colon will work better with a colostomy?  This is what they do if there is an injury to your colon like a gun shot wound where the colon needs time to heal but I don't understand their reasoning here.  Pressure on the bowel can also be caused by Irritable Bowel Syndrome and can also cause constipation.  Colostomies are no fun and a lot of work, make sure this is what you want.  My sons both had colostomies as did my grandson.  They can be reversed but not always.

[hockeymom011]

Hi I have had every test that could be done ct's colonoscopies 2 of them, scopes down my throat, marker test, small bowel series, baruim enema's botox injections & nerve blockers physical therapy 3 different ones you name it I have had it done. Everything comes back fine the only thing that didn't was the nerve test. I have used every laxative that's out there. And I have seen numerous doctors from cleveland clinic to U of M hospital and many more this. This is pretty much the last resort doing the colostomy the only good thing is it's reversible  but you did answer my question on the rectocele thank you for that. They said the same thing they didn't think that would be causing it either but it's good to have many opinions on it. thank you  Hockeymom 011

[patient915]

Welcome to the gastroenterology community!  Why are they giving you a colostomy without doing more testing?  A small to medium rectocele is unlikely to cause all of these problems.  How often do you have a bowel movement?  What different laxatives have you tried?  Have you had a colonosocpy or a CT scan or any other testing done?  I would highly recommend you get more testing done and get a second opinion before having a colostomy.