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

Posted , 12 users are following.

shirley33103
shirley33103

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.

0 likes, 22 replies

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  • shirley33103
    shirley33103

    Edited

    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. 

    • jane58107
      jane58107 shirley33103

      Edited

      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.

    • christine63500
      christine63500 shirley33103

      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 !
    • noree23933
      noree23933 jane58107

      Posted

      Hi Shirley i have put up with many things to do with rectocele vaginal prolapse etc for many years but no one helps and GPs ignore but more recently sent me to a. 'continence nurse' who was nice but not what was needed i feel given her 'its nothing much you are just imagining (!) comments. It has worn down my mental health for many years due to the embarrassment of the symptoms. i think it is wrong that you have to choose from the two specialists when they should work together even though they are not in the same place, payment scheme. i had this for many years where a gynaecolgist would not repair vaginal looseness but rectal surgeon woudl nto repair vaginal so that would be two ops. Horrible consultant made fun and 'fixed' both. The rectocele was not mended but some prolapse repaired....

      I dont know all the facts but, depending how old you are, maybe think a lot before having your womb removed even if you have had children. it is easy for them to say it needs doing but... The bleeding is from the biopsy by the look of it but that is your decision of course. Are you able to get a second opinion ie two consultants at the same place willing to work togther to get the best solution for you? Here in the UK the consultants often have horrendous egos and strut around like royalty and will only do what they want to do not what is needed it seems. Good luck I am still looking for my rectocele to be mended after 40 years. Its disgraceful but not unsual it seems ie womens problems not always treated respectfully.

  • DorryC
    DorryC shirley33103

    Posted

    Is the mucosal prolapse bad enough that they would want to operate on it?

    i know urogyns are the standard, but if you already need colorectal surgery for something else (and you don't need any other vaginal repairs) I think it is a bit different.   I thought I read a paper on something like this.  Let me go look it up.

    • DorryC
      DorryC

      Posted

      i missed your follow up before I posted.  Basically both your docs want to do 2 procedures, is that right?  Do you want the procedures they recommend?

      fwiw - I was diagnosed with a rectocele and when they did a defecography they found some other bowel issues.  A colorectal surgeon ordered the defecography but sent me to a urogyn and didn't think any of the other issues were bad enough to need surgery.   I had my repair done by the urogyn.

      thats a tough situation.  It's really hard when experts disagree.

       

  • shirley07151
    shirley07151 shirley33103

    Posted

    Heelo Shirley, 

    I'm new to the site, I had a Ultrascan that show my bowel prolapse against the wall, I had a full blown Hysterectomy  37years ago, I was 26yrs old. I'm under a urogynacologist  and having a Cystoscopy on the 11.7.17. I knew the date when this happened to me, the prolapse, I can feel it as well as I can see it through the Uteres, I'm hoping that this will get sorted do not know the grade of this until the 11th July. I may go and see a Urognyacoloist private to see her remarks, then I'll know where I stand regarding this, I donot fancy a Wire Mesh, as I have heard many a Ladies report they had infections through this and I donot want the ring, this has to be cleaned every few months, I had one of these when I first had a prolapse of the womb before my Hysterectomy, I couldnt walk literally I had to then call my GP to have it taken out, so a Little against these procedures as one can appreciate.

    Has any one seen privately a urogynacologist,if so do you get your report

    straight away

    Thanks Ladies

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