Is it always best to have a rectocele repaired by a urogynecologist?

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Hi, I'm in the US and have a large rectocele (3.4) and I also have rectal muscosal prolapse. The mucosal prolapse was found by a colorectal surgeon and the rectocele by a urogynecologist. The colorectal surgeon would be happy to repair both but the urogynecologist says the transvaginal approach used by uro/gyns for repairing rectoceles is much more successful than the transanal approach used by colorectal surgeons. My colorectal surgeon doesn't agree with her. I don't know who to have do what. The uro/gyn doesn't even want to address the rectal mucosal prolapse saying that it is insignificant but the colorectal says part of my discomfort is coming from the rectal mucosal prolapse and both should be repaired. Does anyone have any ideas on this or any experience with this? Thanks.

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  • Posted

    Hi Shirley, I am in the UK and had the same problems as you; a rectocele and cystocele prolapses. I was referred to a urogynacologist who did the operation in which she repaired both at the same time - with brilliant results. She said she could have referred me to another surgeon to do the rectocele repair, but she preferred to do both herself. 11 months later, here I am, absolutely delighted with her work. Everything is so much better and working well - and 'bedroom activity' is better than ever. I would certainly ask your urogynacologist do all of the work. There's more important bits in the gyno area after all! Good luck it's well worth it. LadyPink
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    • Posted

      P p p tell me the name of who you saw ? I have a metal pelvis due to bone cancer and the urologist I've seen is a little apprehensive. I'm desperate to have front wall prolapse and a tape to stop wetting myself. Sex is embarrassing x
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    • Posted

      Hi LadyPink

      Realise this  is an old post but wondered whether you were still happy with the work. Where are you in the UK are you? I'm trying to find out about urogynaecology consultants but the nhs site doesn't even recognise the word!! lol

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    • Posted

      Hi Iv just joined and wonder if you have a contact for a uro-gynecologist in the uk. Iv been suffering with repeated bladder infections and have a rectocile. Its been going on over 2years and i am sooo miserable with the pain and discomfort -its driving me mad!! Hope you can help as doctors keep giving antibiotics etc but nothing stops the abdominal pain!
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  • Posted

    Hi Shirley

    I have had very similar problems, and initially thought it odd that such problems were dealt with by different surgeons, but agree with Ladypink, it is far better to let the gynocologist deal with the rectocele as they are the experts in this area.  I have been seeing a colorectal surgeon who repaired my rectal fissure and a gynochological  surgeon who repaired my posteria rectocele. I did need mesh to raid this, and 8 weeks on all is going well in that area, unforunelty the fissure has returned, and as me colorectal surgeon warned, i may need another op as there could now be a rectal prolapse. I am now awaiting a test to see exactly how things are. I have found both surgeons have been wonderful in explaining all the procedures, and also in forewarning me of further difficulties that might arise.

    wishing you good luck - all the best

    Jo

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    • Posted

      Gardener Jo,

      Did you have your rectocele and fissure repaired during the same surgery or did you have different surgeries to deal with each issue?

       

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    • Posted

      Hi Shirley

      i had two seperate ops,my rectal fissure first, then the rectocele. I developed the  fissure as a result of the rectocelE, due to straining to defecate. My gynocologist was able to do extensive repairs in the vagina and has told me he avoided shortening the vagina, so sex life should be as before, if not better as the vagina was now more like it had been before children. We haven't tried it out yet, as mesh was used the recovery time has increased from2 months to 3 - 6,  but I am sure it was worth it. By the way the mesh used is the new sort. That eventually dissolves like stitches, it just takes a little longer. The old sort of permeant mesh has had a very bad press, and I would suggest that if mesh is needed you make sure they use the sort that dissolves.  

      In the UK I think it is common to have these procedures separately, I had them 2 months apart, so I was only suffering from one localised pain at a time.  Also for the rectocele op I had a spinal block rather than a general anaesthetic, and although I had been concerned, I was so well sedated I knew nothing about the procedure until I was out of surgery, plus avoided the side effects of a general anaesthetic, if offered I would take this option again. 

      Currently awaiting a further test - a fluoroscopic proctogram to see if I have rectoanal intussusception.

      It is confusing, I know, so take time to seek out from advice from the various consultant surgeons. 

      Good luck

      Jo 

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  • Posted

    Hi.

    This must be difficult for you.  So sorry. I  would suggest that you go for the transvaginal approach.  This has been very successful in the UK. Every surgery has potential complications.  But u should self asses also which bit will bring u quality life. Thats all we ladies are in search of. 

    Just go with the rectocoele repair. Recover see how you go. Its such a sensitive area that if the surgeons do too much that in itself can add to your woes. 

    Pray about it. Go with your instinct and information you have.

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    • Posted

      Jane, you may have the best suggestion but I wrote a little more about my conflicts in this thread. Thanks.
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  • Posted

    Hi Shirley. I had a rectocoele posterior repair some 4 weeks ago and am doing quite well; swimming now and walking, driving etc If the surgeon is dealing with the rectocoele vaginally then i would think the gynae. surgeon is the better bet if only that they have more experience. Here in the UK I think that is the usual practice; though that alone doesn't mean it's the best of course. It's unusual here for the colorectal surgeon to deal with just that repair; I suspect if you have other bowel problems the issue is different. Why does the colorectal surgeon think he is the best person to do it? Are you paying?

    good luck.

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    • Posted

      elsae,

      I was wondering what your symptoms were. BTW, congratulations on such a successful surgery. That's wonderful. My symptoms are a little unusual for a rectocele alone, but maybe not. I have rectal discomfort, pressure and pain. I almost always feel like I need to empty my bowels even after I've just had a BM. Pushing the bulge in my vagina helps a little but not a lot. 

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    • Posted

      Hi shirley. My symptoms were pretty obvious! It happened after a 4 days walking holiday in Venice: I suddenly realised something was dropping out of my vagina. I had had several months of difficulty passing a motion; often needing to push through the vaginal walls. When I examined myself in Venice I could clearly see the prolapse; I knew what it was since I'd had one previously aged 42 after my son was born at over 10 lbs. My husband was so concerned he called the emergency team before I could stop them and they turned up in a gondola looking like night club bouncers. Luckily my italian just about managed to get rid of them! Before the operation, symptons continued; feeling that I hadn't emptied my bowels; diffuculty in doing so etc. discomfort more than real pain.

      It's too early to say whether everything is abolutely OK; but I'm hopeful although I am on constant anti constipatio medication. by the way having a hysterectomy makes the whole thing a much bigger op. Make sure it really is necessary! I have fibroids in the uterus but they are adamant that it's better to leave them since I'm asymptomatic.

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  • Posted

    Thanks everyone for your responses. I feel like I'm in a catch 22 situation. I feel like the uro/gyn I saw was excellent. I also feel like the colorectal doctor was excellent. If I listen to the colorectal doctor's advice, then I need to have both the rectocele and the rectal mucosal prolapse fixed before I will be relieved of my symptoms. If I listen to the uro/gyn, I only need the rectocele repaired and the rectal mucosal prolapse isn't even significant so I should ignore that. I'm so afraid that if I only have the rectocele repaired, I will still be feeling rectal discomfort.

    I've also heard that a small rectal prolapse will keep getting worse if ignored and soon become a full rectal prolapse. I've also read that it is easier to fix a rectal prolapse when it is still small. Just to be clear, a rectocele and a rectal mucosal prolapse are two different things. I wish these two doctors could work with each other but I don't think that's possible. One's in private practice and one is part of a university hospital. To answer the question about money. We have no free healthcare in the US.

    To complicate things even more, the uro/gyn wants to remove my uterus during the surgery. That's because I'm postmenopausal and it keeps showing up with abnormalities like thickened uterine walls and fluid in the uterus, etc. I just had a biopsy that came back negative for any cancer but they have to keep tracking my uterus. Ever since the uterine biopsy about a month ago, I've had a slight amount of bloody discharge, very slight but there.

    Any more thoughts out there? At this point I really would like to know what others would do if they were me.

    Thanks again. 

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    • Posted

      Oh dear dear me, Shirley.  You are in a bit of a predicament! 

      I understand how u feel. Im like that with making decisions. But maybe this might be a case of "over information". Take a break. Leave it for a few days.

      But for me I will do rectocoele first if Hysterectomy absolutely necessary do it at same time

       But my scan showed same as urs with utetus findings.

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    • Posted

      Hi Last year at 58yr I had posterior repair at the same time as hysterectomy, due to prolapsed uterus.  Everything fine, 8 week recovery worst part about the whole op was the virginal pack!!!!  Four weeks ago I had anterior repair, still recovering but hope it has been successful.  im told the mesh used was permanent so now a bit worried as some replies above say not good !
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