Prolapsed rectum: living with it versus surgery

Posted by ejoy @ejoy, Apr 24, 2023

In December of 2018 I had a full hysterectomy at the recommendation of my GYN. That is another story but important to this post. In 2019 I started having a bulge protrude from my rectum and I thought it was a hemorrhoid. I started self treatment to no avail. I finally saw a GI doctor and was told I had a prolapsed rectum. I had multiple tests performed on my bladder and rectum (just awful) which were all normal. They could not see any link between the hysterectomy and my current issue. (This was the same healthcare system so I am guessing it was in their best interest not to find a link.)

So my question is does any other member have this condition and what is / was your solution? The surgery sounds horrible, the doctor said it is sometimes not 100% effective. 95% of the time it will retract when urinating or having a bowel movement. My greatest frustration is when taking long walks or hiking it and any fecal matter starts coming out.

I am 68 yo and don’t know whether to live with it and only do surgery if it becomes 0% retractable, which could mean being at an advanced age and not healing as well, or do the surgery now while in good health and healing would be easier.

Interested in more discussions like this? Go to the Digestive Health Support Group.

Teresa, Volunteer Mentor | @hopeful33250 | May 29 7:41am

In reply to @laurette04 "Hi ejoy, I have the same question as you…. Soon I will see a specialist… Thanks..." + (show)

Hello @laurette04 and welcome to Mayo Connect. I see that you had a comment for @ejoy. In the meantime, you might find the following discussion helpful to you before meeting with the surgeon,
--Keys to a Successful Doctor's Appointment
https://connect.mayoclinic.org/discussion/keys-to-a-successful-doctors-appointment/
In the first post there is a video that you might find helpful.

I hope that this information will help you approach your appointment with a bit more confidence and a list of questions and concerns that you can address with the doctor.

I look forward to hearing back from you. Is your appointment coming up in the near future?

ejoy | @ejoy | May 29 10:14am

To those that have a prolapsed rectum. I have now learned that the advice from Dr Kevin Kasten at Atrium Healthcare in Charlotte, NC to “live with it” was the worst advice a doctor could give. I followed his advice and lived with it. I lived with it until I could not walk without difficulty.

I saw Dr Laura Altom UNC Rex Hospital in Raleigh, NC and was told it should have been repaired immediately. I had a rectoplexy 4/3/24 which was done by suspension, not mesh. Because I went so long without repair I have damage to my interior anal sphincters and nerves. So now physical therapy to try to retrain my body. If the PT is not successful, then another surgery.

So please do not put off surgery. Fecal incontinence is not fun.

researchmaven | @researchmaven | May 30 10:52pm

In reply to @laurette04 "I’ve had a prolapsed rectum for many years…. I too didn’t know what it was…there is..." + (show)

I have some of what you have, but my prolapsed rectum is internal.

I was told, no coughing, no straining and no constipation could keep it from getting worse.

I eat the right foods (for me) and also take supplements so that I am not constipated.

When things go awry and I am constipated in the lower rectum due to the prolapse, I sit on a firm chair a special way to "contract" my internal prolapse. This induces a bowel movement. I do itthis way:

On a firm/hard chair, I sit on my left butt cheek only (leaning farther over to the left) and cross my right thigh over my left thigh, above the knee (leaning into it). Having a fullish belly (hot drink, hot cereal) helps too. The prolapse is pressed into a more normal constipation and I can clear the lodged stool.

This is an "engineering/plumbing" hack.

If I go down the surgery path at some point, I would only consider a Castle Connolly - listed surgeon for it. They are the best doctors. Researched. Listings cannot be bought. The company makes its money another way. Of course, there are non-listed excellent surgeons, but without an inside track on who those are, I will stick to this listing. It's never let me down.

Let us know how you are doing.

tazjess23 | @tazjess23 | Jul 26 8:07pm

In reply to @ejoy "To those that have a prolapsed rectum. I have now learned that the advice from Dr..." + (show)

Please message me. i have some questions please🥰

Colleen Young, Connect Director | @colleenyoung | Jul 28 1:40pm

In reply to @tazjess23 "Please message me. i have some questions please🥰" + (show)

@tazjess23. you'll notice that I removed your personal email address. Connect is a public forum. We recommend sharing personal contact information using the secure private message function.

I'd also like to add that by sharing here in the forum, you are connecting with several people where all can benefit from group support.

ejoy | @ejoy | Jul 29 7:33am

In reply to @researchmaven "I have some of what you have, but my prolapsed rectum is internal. I was told,..." + (show)

Thank you for sharing your story. I don’t know if you are aware of this but your prolapse being lodged against your internal anal sphincter could cause damage. I let mine go so long that it has occurred so now I have a different issue. Just wanted to share this with you.

pam110755 | @pam110755 | Jul 29 10:12am

I have lived with numerous GI issues for 30+ years and finally connected with a good specialist 2 years ago. I found out that I had a rectocele and cystocele, had surgery for both but I still have issues and they don't know what the bottom-line all-encompassing issue is. I had a good recovery from surgery but still not well. I am now seeing an excellent pelvic floor therapist and many of my issues are improving. (This is not your typical PT that has you doing Kegels and other floor exercises.) Like you, all of my pelvic floor muscles are gone, sphincters don't work, etc.

I have submitted all of my records to the Augusta Medical School 4 months ago and I'm still waiting to see what their observation yields. Mayo didn't have time to review them and now I'm seeing another Gi Dr. to get their opinion. I'm glad I had the surgery done and still have hope that I can find something that will pinpoint exactly what all of this stems from. Take care and good luck on your journey!

researchmaven | @researchmaven | Jul 30 6:12pm

In reply to @ejoy "Thank you for sharing your story. I don’t know if you are aware of this but..." + (show)

Hi ejoy, I appreciate the heads up. So far, the rectocele just seems to be a pouch. As long as I manage my IBS-C, I avoid rectocele problems. That being said, it is hard to manage my IBS-C and my gut's hypersensitivity from food and normal life stresses. So far, I am getting it mostly right. I know prolapse usually gets worse over time. Again, thanks for letting me know what to look out for. Good luck to you and wishing you comfort and health.

marysue5 | @marysue5 | Nov 2 10:27am

In reply to @erin123 "I struggle with the same question. My rectocele opened two or three years ago, in my..." + (show)

@erin123

I struggle with the same question. My rectocele opened two or three years ago, in my early '50s. For me, the problem was not leakage but managing excretion itself. The prolapse is large enough that stools get stuck in it and back up. I have spent the last several years fine-tuning my diet to keep stools soft enough to keep moving but firm enough to make it out of the malformed plumbing without the help of the surrounding structure.

When the bulge you described first happened, I did not understand what it was. I went straight to the doctor but did not get help there. I became so obstipated that I damaged myself when I finally passed too large a load. I ended up in the emergency room but the damage was already done. Then I saw a specialist who discussed surgery and prescribed pelvic floor therapy. Therapy helped, teaching strategies for how to splint, use a toilet stool, and relax the resulting pelvic floor spasming, with which I still struggle.

I had leakage with miralax, which does ease constipation, but I eventually retired it to firm up the stools enough to make it through my malformed plumbing. Now I eat pumpkin seeds, homemade red cabbage sauerkraut, tons of leafy greens, psyllium husk, and guar gum every morning.

But there's no way to undo the actual damage without surgery to seal up the herniation. It's bizarre to be able to feel individual stools from the outside with my hand and have to guide them out myself manually. With the right diet, I have been able to do more without splinting, but to finish, I have to provide a manual assist. And I have nerve pain at my pelvic floor now that I can manage but can't seem to completely resolve.

I have hypermobility and a connective tissue disorder that makes my tissues stretch too easily, which is why I have held off on the surgery so far. I understand that the surgery is often ineffective even in people without this challenge, and even more ineffective in people who have it. I've heard a fair amount of complaints from those say that their other pelvic prolapse surgeries work well but not the rectocele repair. But every once in awhile, I hear from someone who says that it was a godsend. To me, it sounds like a gamble. It could be life-changing, and I could make things even worse, with new sources of nerve pain. No way to know on the front end which way it will go.

I desperately want to be "fixed," but I am worried that the surgery will not hold and I will wind up worse. I've worked really hard to get to the point where I can manage a normal life, which I didn't think was possible at the beginning of this awful story. My onset coincided with the start of the pandemic, when getting away from my small town didn't even seem possible, so I had to learn to live with it. But even now, I worry that I won't always have the strength in my arms needed to splint manually and torque my body to be able to pass stools.

Since it started, I've now had a bunch of medical consults with mixed recommendations. One surgeon recommended I go forward with repair surgery, but others have been less encouraging. I don't know who to listen to. That's why I haven't done it so far, but I share your concern about waiting until I'm older and having the recovery prove even more difficult.

I would be very interested in others experiences with this problem. I share all these details to let you know that a rectal prolapse is in fact survivable, though incredibly frightening at first. With time and practice, things normalize that you couldn't possibly imagine could ever seem normal. At first I thought I would never leave the house again, and it took a long time, but I fully live in the world again. But I still fantasize about a magical surgery that will just cure me from this isolating and painful disability.

Jump to this post

Your story sound a lot like mine. I want to tell all of you what I have been trying. (end of the post). I have struggled with severe constipation since I had a baby delivered with forceps in my teens. I had a partial hysterectomy in my 20's and things went downhill from there. It took >20 years, but I developed vaginal vault prolapse (enterocele) which got worse and worse and I finally had 3 surgeries (different doctors) for that until one finally stuck when the surgeon used mesh. On the side of my vagina without the mesh, a large rectocele has developed. I never have been able to get rid of the constipation and the stool gets stuck in my rectum. I have removed it with a gloved finger out of total frustration and that may have contributed to the development of the rectocele and rectal prolapse. It's a real problem now (large), but about 1/2 the time recedes, and as long as I don't do ANY straining I can manage it pretty well for a while, but then it reoccurs. I have a love of cheese (which I am going to have to completely give up) and have been dx with slow transit in my colon. If I allow my stool to get hard it backs up worse behind the prolapsed lining of the rectum and after much misery finally makes its way out. I have prayed, asking for a total recovery, and at times I will go for a week or 2 without the protrusion, but then it comes back. I hate it that after I eat there is an urge to have a BM but I can't have one. That usually is when the rectum will also prolapse on the toilet. My biggest frustration now is not being able to tell when I need to have a BM because the rectal prolapse feels the same. If anyone has any hints about that, please tell me. When the rectum is out I am also incontinent but when I sit on the toilet I usually can't go, but will go when I am walking around. It is hard stool so that is good as far as that goes. I am concerned that this thing is going to go bad and I will end up in the emergency room with a surgery I don't want. Right now I am going to continue to work on my diet (absolutely no cheese) and there are pelvic floor strengthening exercises on the Internet. I am also going to start walking around the block every day to try to work the stool out. I have been doing the exercises but I am going to spend more time on that. We have an old Victorian house we are working on and exercising, walks, etc. are time consuming, but I have do more. I am on the slim side and I love working on the house and gardening and overall I am very active. I feel healthy in spite of the fact that in the past 16 years I have had a lot of surgery. I sit on a heating pad a lot, especially in the AM. It helps relieve the anal soreness. I recently discovered a great product. They are underpants that are especially designed for vaginal prolapse and vulvar viscosities. They even have a crotch design where you can put a cold pack or heat pack that you buy from them. Even though they are not specifically designed for rectal prolapse they work quite well for this. There is a drawstring. Even though there are more moving parts to a rectal prolapse (trying to tell if you need to have a BM or not) I think these things a well worth the $35.00 a pair. They also have shorts. They are made in America and ship from Miami. I like their customer service person as she was very good about answering questions. I also wear (tight pants) but they are a lot more expensive and don't work as well now that things are worse. These pants are cleverly designed. I wear my regular underpants under them and use a least a pantiliner or a pad if the problem is acting up. I feel very strongly that surgery would not be successful for me because I have had so much failed surgery in that region so these pants are a God-send for me. Without the very tight shorts (I just got the new product) I would have had to take a chance on the surgery because I would find it unbearable. Good Luck

marysue5 | @marysue5 | Nov 3 6:18am

In reply to @ejoy "I too hope to hear from someone(s) who have undergone surgery and the outcome." + (show)

If you go to a surgeon, you are going to get surgery. I have had 3 failed surgeries for vaginal vault prolapse and now I have a rectocele and rectal prolapse which has gotten bad in the past year. At times it is very miserable, especially not being able to differentiate from the prolapse and needing to have a BM and discomfort. More than likely continued constipation is the reason it has all been unsuccessful. People can and do end up a lot worse off with the rectal prolapse surgery. My prolapse has been very bad about 1/2 the time for a year and I have been wearing VERY tight shorts from a surgical garment manufacturer that are no longer working well. I recently got 2 pairs of special pants made for vaginal vault prolapse and varicosities {from a company in Miami) but they are working VERY well so far for rectal prolapse. I wear my regular underpants with a pad under them. One pair are the boy shorts which is the one I have been trying. They have a draw sting that is connected to a thick crotch that lifts things up. They come in different colors, I like black. So far this gismo has been very good and I hope it stays good. My experience is if years of bad constipation originally caused the problem, then constipation is going to cause operative failure. If they start messing around shortening your colon you can end up with diarreah which is much worse. I also do Kegals and exercises to strengthen my pelvic floor which I hope helps. Plus I'm going to finally give up cheese, which I hate to do. I have been taking one tablespoon of Metamucil with an 8 ounce glass of water which I think helps move my bowels. I wish I would have known about these pants before I got the first enterocele surgery and I may not have had it. Also, I am on the slim side and have always used the estrogen patch and vaginal cream and still haven't been able to make the surgery work without mesh.