Rectocele - how did you decide what to do?

Rectocele repairs undertaken by Urogynaecologists are not performed rectally.

Hi SuzyQ21, good to read your positive comment. I hope all goes well for you.

No Matron, I wouldn't have wanted it done by a colorectal cons. rectally either.

Would have been too worried about infection.

Oh don't remind me of the infection SuzyQ21. I remember that vividly in the early 1970's when I started nursing. I don't think it's so common now but it's more common when the surgery is performed rectally. I hope other ladies take note of what you've said.

Hope so, infection is or was the big threat, and I'd rather avoid it!

Suzy, I'm very happy for you, hope things continues better and better!!! Big hugs!

Matron, what do you mean? Colorectal approach is riskier than vaginal approach? That would be another reason to choose an urogyn...And by the way, what about the mesh? those ladies that have mesh on the back wall, do you feel the mesh inside you? ( excuse me if I'm saying nonsense words but I'm interested in the sensations that you have after the surgery )

No you're not talking nonsense words at all. You have every right to question things I write. I forget sometimes that I'm not talking to nurses.....apologies. The colorectal approach (going through the anus into the rectum then bowel) is riskier for a few reasons. Your bowel is a dirty area and because of that you are more at risk of infection, the other reason is that it can make the muscles of the bowel weaker. 

Regarding the mesh, no you don't feel it inside you.

Ok Matron now it's clear, it's logical if it's a dirty area... Thanks for the explanation as always! Hugs!

Thank you, so far so good.

I hope all goes well for you also.

Most colorectal surgeons in the UK will not perform rectocele repairs in the UK since the new extended training came into force for gynaecologists allowing them to use the title Urogynaecologist, which is the best news because the failure rate has dropped so it's highly unlikely that he/she would even accept a referral.

Hi DorryC, my colorectal surgeon in the UK is willing to do it but although I get on well with him I think I feel better about it being done by a gynaecologist. I would have preferred it to be done abdominally but he says it's too low down for that option. I would be interested in any info you have. Thanks.

Dear Dorry, I'm very interested in the papers, could you share them with us? Hugs!

Here are some of the articles I found interesting on rectoceles: 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926474/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780205/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967328/

Just replied with the links to the papers -- it has to be approved bc it has outside links.  If it doesn't go through for some reason message me and I can send them privately.  

It's unlikely the moderator will approve it Dorry. Anything like that has to be sent by personal message.

The mods have approved my links to scholarly articles in the past so I think it will be ok.  It isn't a link to a site selling anything or promoting a product.

Hikadeonagro -- if you don't want to wait, you can search for the articles by the article's pubmed ID.

PMC3926474

PMC2780205

PMC2967328

If you paste one of those codes into a search engine you should get a high/top result with the paper at ncbi

For info - links from PubMed will always be approved. The only links we do not publish are as per the FAQ below.

https://patient.uservoice.com/knowledgebase/articles/398316-adding-links-to-posts

Regards,

Alan

Thank you. Alan

Thanks!

Ok Dorry! Thank you!

I've read the docs, very useful, thanks you! But there are some things that I don't understand and I'd like to ask if you ladies don't mind:

- the conclusion is that as Matron said, vaginal approach is better than anal approach. So it has reinforced my decision that if I finally need to have the surgery, a urogyn will do it. Thanks Matron.

- does the gyn (in the vaginal approach) cut the vaginal fascia to access the rectum, then sew the rectum to remove the deformation and then sew the fascia (or put mesh) in order to strength the wall? Is that the procedure?

Hijadeonagro I've just noticed your post to DorryC regarding the surgery. I know Dorry will know quite a bit about the surgery and how it's performed but I'm happy to answer your question but I didn't want to jump in.

Hi DorryC,

Thanks for that really useful. When I feel ready to go for more surgery I'm better informed.

I'd like to thank everyone who has offered advice and info it has been such a help. I have been in a really dark place just lately, it's nice to know I'm not the only one dealing with this horrible thing! Thank you soooo much! Xxx

Hija - matron has been a part of the team doing this surgery many times and can give you a much better answer.

i know the basics - they cut open the vaginal wall exposing the muscles and fascia of the pelvic floor.  They don't  cut your rectum or intestines.  The fascia between your intestines and vagina is the bit that needs fixing.  In a rectocele it will be torn or damaged.   

jump away - I think you can give a much better answer to this than I can.

Dorry has given a good explanation for the surgery. I'll just add my little bit. 

Your legs will be put in stirrups but at this point you will be asleep. Some surgeons put local anaesthetic into the vaginal wall just to give some added pain relief. A cut is made in the vagina over the area where the bulge (prolapse) is and separated from the small bowel that is prolapsed. Stitches are put either side of the rectum and they are then pulled up holding the prolapse back and more sutures are put in the vaginal wall to support it. Before they start the operation you are catheterised and at the end of the surgery a pack is put into the vagina. Both will be removed the next morning. During the operation air is pumped into the pelvic cavity to separate the pelvic organs so your surgeon can see what he's doing hence you may suffer from wind afterwards. Hope that explains things ok. It is difficult to explain even though I've seen the operation performed quite a few times

Matron - do you know if there is an alternative or modification to stirrups?  I know I will be unconscious, but stirrups aggravate my pain issues (si joint and lower back).  I'm worried that being in stirrups for a that length of time will cause me a lot of pain and maybe even difficulty walking post-op. 

It's the stirrups that are the cause of a lot of back and leg pain following the surgery so I can imagine why you are concerned. Obviously the surgeon needs to see exactly what he's doing but I've seen ladies with back problems had their legs supported by nurses as you sometimes see in the labour ward. This allows the patients knees to be gently bent while her feet rest on the nurses hip. The legs aren't elevated as high therefore putting less pressure on the hips. Do you think that would make things less painful for you post op?

Yes, I think that might help, thank you.  It might even be ok in the stirrups but with the knees held, just half an inch in so I am supported and it doesn't put as much pressure.  Is that the kind of thing I need to tell the surgeon well before the op?  Or can I tell them when I show up?

I don't have any appointments before surgery, though I might be able to make one.  Bottom line is that if the surgeon is only comfortable doing the op with stirrups I will just comply and live with the pain... but I'm hoping something can be done.

 

Oh, I was also wondering how long the op takes.  I'm sure it varies, but can you tell us what is typical Matron?

On average about an hour.

The surgeon will come and see you prior to your operation so you could discuss it with him then. I'm sure he'll do whatever he can to make things comfortable for you because he will have operated on ladies with back and hip problems before so he is sure to have contingency plans in place.

Thanks Dory

Has my explanation of the surgery helped?

Good explanation Matron, thanks, very useful, I needed to understand the procedure. Hugs!!

Thanks, Matron.  That really helps.

Sure Matron! I sent you a message yesterday saying thank you! Thanks again, very useful!!!!!! Hugsssss