Urogynae appt today after joint colorectal clinic on Friday

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Hello. Haven't posted for some time. Moved house and no internet so using my phone here so expect typos!

So last Friday went to joint gynae and colorectal clinic. Not the urogynae I have seen but another one plus colorectal surgeon.

Having seen missy physio who said that on examination she felt i didn't have this paradoxical muscle contraction the colorectal man says I do but it's not too bad. Gynae man agreed (I' m not entirely convinced he is a urogynae as he seems to do a lot of gynae work - but i dont know) He asked if it bothered me.

Well yes it does I entered into the rectocele surgery expecting to get better and I now have another problem. I know its not life threatening but.....

So their plan is to send me to physio - i already have an appt booked for the 17th march- for biometric feedback work. Then see how that works and regroup - their words!

Off to the urogynae appt today with the consultant who did the previous op. She went through what was said last friday. She also said they had booked me in for a proctogram i said i had had one she said no that was an mri proctogram. I said no it wasnt so she is going to query this and maybe i will have an mri one.

I asked if it was a prolapse. She said not as such as "the rather large rectocele"had been repaired. What i now have is a loose perineum. I asked if i managed to get the paradoxical muscle thing under control would the descent of waste onto the perineum at a bm be eliminated. She said no and then i could have the perineum tightened and it would be worth doing.

Interestingly she said that surgery does not always solve all ladies bowel and blader issues which is why they run this joint clinic plus pelvic physio to get better outcomes.

I said this was not said to me originally - it was that the surgery would be a cure. She said the originalsurgeon- now just retired- was a bit old fashioned. I think a new reign has begun!!

Actually feeling a bit happier . Although time is going on with no real resolve maybe i am on the right track. I did say that i hadnt had the problem at the perineum pre surgery. She felt the paradoxical muscle problem could be a side effect of the surgery - the muscles going into spasm - and they need to be retrained. I get all that. I cant really see that my perineum will tighten back up even if i solve this problem so part of me thinks why not surgery now or at least put on the list. But i will wait - if not patiently - but i will see. She agreed that we would regroup both with her and the junt cl7nic and physio.

Sorry really long post

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  • Posted

    Gosh sounds like you have really been through it. All sounds a bit confusing for them as well as you! Hope this new regime will give you a solution that makes you better x
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    • Posted

      Thank you. I fear in the end it will be surgery. But we shall see. Cant think how everything is going to 'ping back' if i get this muscle under control. My flesh is not as springy as in my youth!!

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  • Posted

    Hi trizwizz,

    Sorry to hear things seem to be dragging on. Really hope they resolve things soon and at least come to some agreement.

    Our lives can often be on hold until these things are resolved.

    I keep thinking my perineum is weak; especially when I have a full bowel it can feel like another prolapse, but once I empty bowel it feels so much better. I also have scar tissue at that end at vag... opening, really tight thin bit of skin which gets really nippy when I am on my feet longer than couple of hours. But wonder if the agonising pain is from that perineum area when it all seems to stiffen up once I sit down after long walk and go to get back on my feet.

    Anyway time will tell, will just gave to trust the last consultant got it right and try and ignore it all and continue to make progress.

    Hope you get some answers soon, take care,

    Phyl x💕

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    • Posted

      Yes it feels exactly like another prolapse especially when the bowel is full / trying to empty. I do still feel draggy especially after a full day at work. Which is annoying. As i said to the consultant today i thought the surgery would make it better but now its still going on a year after the surgery. I cant see that i will avoid more surgery but will see.
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    • Posted

      Sorry meant to add that i did have a couple of stitches in the perineum at childbirth - only three i think. I didnt have bad childbirths or labours at all. Had both babies on the day they were due! So to get these problems is mighty horrible.

      So i gues my perineum has a scar or two anyway - must have although son will be 31 this year. Never been a problem for me though.

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    • Posted

      I was the same trizwizz, was cut just as I had a tear when I had a first child, bug healed very quickly and no problem wire it until now.

      Still hoping it's just a bit weak due to surgery and may sort itself.

      Phyl x?

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  • Posted

    Hello! I'm glad you're back 🙂

    The joint clinic is such a good idea. As I've said before my gynae & colorectal people didn't communicate at all. The perineum thing is interesting, I've been told mine should be repaired at the same time as my rectoenterocele (if I decide to do it). I had a bad tear 20+ years ago in childbirth which was repaired in theatre at the time. As far as I know it was "normal" again afterwards so I don't know when the damage reoccurred. It's definitely a problem area and I think/hope it would make a difference if repaired.

    Would your team both take part in any further surgery? My colorectal surgeon said he would repair the rectocele but personally I would prefer the urogynaecologist did it as I would need the enterocele & perineum done too. Good to get both points of view though.

    I know I have been dithering about all this for ages but I really don't want to rush into more surgery when as your consultant said it doesn't always help with bowel & bladder issues.

    I think it's a good idea to have whatever tests they offer then when you "regroup" you can make an informed decision. It does sound really positive, good luck. X

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    • Posted

      Interestingly when i first went to the gp at the very begining he felt the rectocele was large abd lower down. Although as a gp urogynae is not his speciality(in the practice he does more orthpaedics ) i think he was accurate in his diagnosis which was put down by the original surgeon who said the rectocele was snall. The urogynae who dud the op i saw today said it was a big lump!

      As far as i know the colorectal team wouldnt do the further surgery as its not going into their area so to speak. If its a tighteningof the perineum thats required then the urogynae - hopefully the one whi did the previous op - will do that. I suppose it depends on what goes on with the paradoxical muscle thing though from looking it up the treatment is biometric and physio not surgery.

      I wish that the perineum had been repaired at the same time but then i dont think i had the problem there then

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    • Posted

      Yes, me too! You'd think you would feel it 'go' but I certainly didn't. My rectocele is fairly low so I think I would have to get that done at same time as perineum if not the peri repair might not hold. I don't know how much work is involved in this repair I guess it might be quite uncomfortable afterwards 😳

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    • Posted

      In fairness to the urogynae. I had very very little pain very little bleeding and wasnt that uncomfortable after the surgery. I felt ok after the surgery and great for about tnree weeks. Standing was a problem and walking for long distances but i recovered very well all in all. I was off work for 12 weeks plus 1 weeks leave and felt i needed that long to then go back on full duties.

      I did know by week 5 that all was not well though and allowed myself to be put off by the original surgeon at the post op. Who was the older man who was supposed to do the surgery but i had the younger lady doctor in the end who has now taken over from the man. This put all my referrals back by months as i had to go back to the gp and start again

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  • Posted

    Hi tripwire, just been reading some of your previous posts from last year to 'catch up' with your story. Good luck with your physio appointment and your joint clinic care do you feel like things are seeming more optimistic now as in your care? I only ask because I'm suffering similar problems. I had a posterior repair 12 weeks ago, I never felt any improvement feelings and by the time I went back for my 6 week post op I told the urogynae I felt I still had the prolapse but it felt like it was in a different place. She examined me and said I don't have a prolapse and she referred me for physio. Three weeks later I had physio I told her how I felt and she said it was best to talk to gp. Went to gp as she was still signing me off from work and I asked if she could to refer me to colorectal as I have been using private insurance - insurance found me a local colorectal surgeon who I had an appt with and told him the whole history and he examined me and said I have a rectocele yet I had posterior repair and repair of enterocele for a stage 3 rectoenterocele! This I feel more in the perineum and in the rectal area. He said I should discuss this with previous surgeon(urogynae) and continue with physio for a little bit and he recommends I see a colorectal surgeon that specialises in pelvic floor disorders. I just feel like I'm going round in circles! I know your story isn't the same but I just wondered if you feel the departments working together is the best option as I don't know how to go about finding any as no one is helping me and I don't know where to turn. The specialist who's name he's given me seems to just work as colorectal but if he specialises in pfd what do you think? Sorry to ask your advice x

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    • Posted

      Hello. Sorry typing on my phone is quite difficult as i have to keep scrolling up to see what you wrote so i may miss bits.

      Yes i do think it has helped seeing both together. It would have been better if it had been "my urogynae" rather than a different one. I do feel more positive. Mainly because i disliked missy physio intensely and felt she was more obstructive than helpful.

      Last time i saw my urogynae she was a bit dismissive with "well you have paradoxical muscle contractions so i cant do anything"

      im glad i stuck to my guns and said that wasnt good enough. Im glad i went to the joint clinic as they did examine me and confirmed then decided on a course which has been agreed by my urogynae today. Although it will take a long time and i think more surgery is inevitable i do feel im on the right course. It will just takemonths. Though i had a physio appt booked for the 17th already and that is now booked for biometric feedback physio. So i may get back to joint clinic sooner rathef tgan later!

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    • Posted

      I do apologise just saw that it had spellchecker me typing your name to tripwire! Glad you are hopefully getting them to work together for your care and treatment, good luck with your first physio x
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    • Posted

      Thats ok better than some things i have been called!

      I hope this physio will be better, my experience of pelvic physio so far has not been good. So i am hoping for better things. Not sure when the regroup will be or when the mri proctogram will be. May check this with physio next week to see if there is a timeline

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  • Posted

    Hi Trizwizz

    PIllar to post!

    I hope your Physio appt is beneficial, I would urge you to glean all you can from this rehab., Further surgery could bring on further problems - I heard a Physio say at the weekend. 'Change what you do or the same thing will happen again' - (you previously had a prolapase - you'll get another one too unless you change subtle thing about your body) if your Physio can help you adopt a good exercise routine, correct your posture and breathing for maximim support of the pelvic floor and teach you effective pelvic floor exercises you'll get the pelvic floor working properly, no pain, and no pelvic floor dysfunction.  Have you also tried a toilet stool? Great for a full elimination without straining. 

    Good luck, do let us know how you get on because you are straddling many diffierent fields of specialism, and doing brilliantly 'getting to the bottom' of what will help you. No pun intended! Good luck Triz

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    • Posted

      Thank you. I had no warning of the rectocele at all. I could give you the sate and time it first appeared. I have never had bowel problems before that, no issues with constipation or straining. I only strained once i had the rectocele as i didnt know about splinting once i did the strainig thee was gone. I had easy births with the two children. It was most strange.

      I do feel the paradoxical muscle came about after surgery. The surgeon said this can sometimes happen. I was also plynged into full blown menopause having had no symproms until then. The day after when they took rhe pack out was the first hot dlush. Periods stipped immediately etc. Most strange and my ovaries werent touched! I think my body didnt like the surgery!The surgery was successful in itself.

      I was great for 3 weeks then bang again into this "perineal descent". I still dont have issues with constipation and i am careful with diet and fluids. I do use a stool - well the bin- but it works as well. I have followed trough on thre stress incontinence exercises and the colorectal man also tlid me to 'hang on' for a biwel morion to make the urge to expel greater than the muscle contracting. The physio will be biometric plus exercises i would imagine.

      Yes the perineal bulge does get to me as it wasnt there befure the surgery and i entered into the surgery expecting to be better. Bits of me is but bits arent! I will update next week.

      It has been worth persuing i think. It has taken a bit of courage and pushing to get there.

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