Rectovaginal fistula after rectal radiotherapy

Posted by verol65 @verol65, Dec 4, 2023

Last December I had a transanal resection of a polyp clase to the anus and sphyncter. Biopsy revealed positive margins for adenocarcinoma. So I had radiotherapy combined with Xeloda. Afterwards, I developped a rectovaginal fistula. Last week, I had a colonoscopy that besides confirming a low-lying fistula, also shows a polyp, which can be a new one or can have grown back from cell of last year's polyp. The surgeon suggests a radical approach: a two-stage Turnbull-Cutait pull-through coloanal anastomosis, as a way of solving both the risk of recurrent pre-cancerous polyps and fixing the fistula.
Could someone who has undergone this procedure tell me what it was like. I understand how the surgeries work. I wonder about the days/week between the two surgeries and the immediate post-surgery period.
The surgeon has told me of the risk for LARS.

Interested in more discussions like this? Go to the Colorectal Cancer Support Group.

@verol65

Update
Last Monday morning, I had a 3-hour-long period of going to the bathroom with light BMs. Tuesday evening and night were five hours of the same, at the end, the BMs turned to liquid. The skin of my butt cheeks and of the vulva was terribly irritated. I ended up calling my surgeon after midnight. Still I had a few mor trips to the bathroom during the night and early morning.

When I called my surgeon, he suggested going back to the hospital, but I would not have it. So he told me to take a fairly strong analgesic I had at home and see him at 8 in the morning. Since I had barely slept, I got in touch with him at that time and explained I could not make it. He was leaving on holidays, so he set me an appointment with his fellow surgeon who had operated on me together with him. I saw that second surgeon early in the afternoon. He took out my abdominal drain, examined me, noted a very inflammed hemorrhoid, and changed my meds to try to regulate my BMs. He called my problem: Low Anterior Resection Syndrome (LARS).

Since then, I had a soft BM on Friday, then since Saturday, I've had periods of about 6 BMs, well-formed and firm, but small, and because of the hemorrhoid, they hurt. I'm also never sure that another BM is not coming. In a way, I'm better, because the urgency is less as to going to the bathroom, no more ardor of the skin, but pain from the hemorrhoid and not being able to push out the BMs.

I've messaged the second surgeon earlier today to explain what's going on and if there's something I could do to make it easier. He's not answered yet.

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What an ordeal. I'm glad you persisted eventhough you were in such a horrible state. You might find these related discussions about LARS helpful:
- Dealing with LARS (low anterior resection syndrome)
https://connect.mayoclinic.org/discussion/dealing-with-lars/
.
- Looking for a Low anterior resection syndrome (LARS) specialist
https://connect.mayoclinic.org/discussion/lars-any-specialists-here/
How are you doing today?

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@colleenyoung

What an ordeal. I'm glad you persisted eventhough you were in such a horrible state. You might find these related discussions about LARS helpful:
- Dealing with LARS (low anterior resection syndrome)
https://connect.mayoclinic.org/discussion/dealing-with-lars/
.
- Looking for a Low anterior resection syndrome (LARS) specialist
https://connect.mayoclinic.org/discussion/lars-any-specialists-here/
How are you doing today?

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Thank you!

REPLY

Hi verol65,

Sounds complicated. Wish I could advise, but hope well-wishing will help some. So sorry to hear that you're distressed. There's nothing more annoying to me that not being able to sleep due to pain. Several years back I endured a 2-3 week spate of idiopathic peripheral neuropathy and was thoroughly miserable. So, I hope your docs can help in making you as comfortable as possible under your circumstances.

Hugs from itchy.

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@itchyd

Hi verol65,

Sounds complicated. Wish I could advise, but hope well-wishing will help some. So sorry to hear that you're distressed. There's nothing more annoying to me that not being able to sleep due to pain. Several years back I endured a 2-3 week spate of idiopathic peripheral neuropathy and was thoroughly miserable. So, I hope your docs can help in making you as comfortable as possible under your circumstances.

Hugs from itchy.

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Thank you, @itchyd !
It's been a complicated couple of weeks. I've picked up information on LARS from trustworthy sources and the FB group, like this article: https://onlinelibrary.wiley.com/doi/10.1111/codi.15517?.
I'm now taking half a packet of macrogol every morning. My surgeon, whom I've seen twice since my last post, changed my meds somewhat last Friday. He reduced the Omuro to once a day and prescribed Tramadol at a low dose for the pain, which seems to be working.
Taking less Omuro seems to have decreased the number of times I go to the bathroom, a little bit, but also, it has made my BMs harder and more fragmented. I will have to message him about that.
He also changed my med for gases, but since these haven't really been an issue, I was only taking the previous one occasionally.
And I'm doind psychotherapy again.
I'm in a better mood.

REPLY
@verol65

Thank you, @itchyd !
It's been a complicated couple of weeks. I've picked up information on LARS from trustworthy sources and the FB group, like this article: https://onlinelibrary.wiley.com/doi/10.1111/codi.15517?.
I'm now taking half a packet of macrogol every morning. My surgeon, whom I've seen twice since my last post, changed my meds somewhat last Friday. He reduced the Omuro to once a day and prescribed Tramadol at a low dose for the pain, which seems to be working.
Taking less Omuro seems to have decreased the number of times I go to the bathroom, a little bit, but also, it has made my BMs harder and more fragmented. I will have to message him about that.
He also changed my med for gases, but since these haven't really been an issue, I was only taking the previous one occasionally.
And I'm doind psychotherapy again.
I'm in a better mood.

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Hi verol65!

Glad to hear that you have a doctor who isn't afraid to prescribe opioids. A lot of people suffer needlessly today because too many in the medical community have adopted a perverse philosophy regarding them, and, well, too many lawyers out there chasing a quick buck at the expense of many folks' welfare.

Also, happy to hear that your mood is brightening. I have had colon issues myself: history of early adenomatous polyps beginning at age 24 (I'm now 66). But, so far, I've been lucky and haven't had to face what you're facing. Wish I could give you a hug, but electron love will have to do, for now.

Itchy

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@itchyd

Hi verol65!

Glad to hear that you have a doctor who isn't afraid to prescribe opioids. A lot of people suffer needlessly today because too many in the medical community have adopted a perverse philosophy regarding them, and, well, too many lawyers out there chasing a quick buck at the expense of many folks' welfare.

Also, happy to hear that your mood is brightening. I have had colon issues myself: history of early adenomatous polyps beginning at age 24 (I'm now 66). But, so far, I've been lucky and haven't had to face what you're facing. Wish I could give you a hug, but electron love will have to do, for now.

Itchy

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Thanks, @itchyd !
I can't imagine having to deal with adenomatous polyps since a young age!
I gladly accept your hug and reciprocate.

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