Prolapsed rectum: living with it versus surgery

@ejoy totally makes sense. I wish you very well!

@erin123 Erin,
I read your post from 2023 about your rectal problems and could really relate to what you’ve been going through. I’m wondering if you ended up having surgery since then, and if so, what kind of surgery it was? Also, could you please share what diet or supplements have helped you manage your symptoms?

Thank you so much, and I hope you’re feeling better now.
— Catalina

Hi Catalina – So sorry you are suffering. I have not yet had any surgery, although I’ve been trying (without success) to get a consult with the Florida Mayo urogynecologist to get a consult about it. I’ve learned to do some difficult splinting that is working for me in my 50s, but that I can’t imagine doing in my later years. I still don’t know what I’ll do.

I started making progress diet-wise by eating lots of bok choi and spinach, daily red-cabbage sauerkraut (lower fodmap), and roasted pumpkin seeds, in addition to Fiber Choice tablets, psyllium husk, and Sunfiber (guar gum). The sauerkraut helps with healthy gut flora, the bok choi and pumpkin seeds help move stools through, the fiber tablets and psyllium husk give them good form, and the guar gum helps things flow more smoothly through my digestive tract. (Collard greens are also good at moving things through, but I really dislike them!)

The most important thing I had to learn the hard way was to stop taking miralax. At first, that seemed important to avoid obstipation, which caused some serious internal damage for me. But after about a year, I realized that it wasn’t helping me because I couldn’t form hard enough stools to make it through my challenging vault. Stools need to be firm enough to make it all the way through without pooling in the rectocele, but not so firm as to get stuck on the way out. It’s a complicated dance, and it’s tiresome to manage, but you get used to it. I hope this is helpful to you! Best, --Erin

@ejoy well, I just got the results from the defaegraphy test and evidently I have pelvic prolapse and rectal prolapse. Next step is talking to the surgeon who is in my network. My GI doctor didn't indicate what type of pelvic prolapse I have. I wonder if you can have a pelvic prolapse without any symptoms. I don't feel anything from my vagina. Maybe the symptom is the constipation. If I choose to try surgery, I will try to get into the best. I am getting Medicare in January and will get the MediGap coverage to hopefully allow me to go anywhere. Any thoughts on this, please share.

Hi @cc510 - here's some information on pelvic organ prolapse that may be helpful:

- Pelvic organ prolapse https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/symptoms-causes/syc-20360557

I had bladder prolapse after my second baby arrived. There are different degrees of bladder prolapse. At a lower degree you probably notice nothing. At this stage for me, it was causing some odd leakage and urgency issues, but not actually protruding from my body at all till a few years later, at which point I also learned I had a rectal prolapse. I originally had a sling, but I ultimately had to have a hysterectomy with repairs.

When do you anticipate you'll have the appointment with the surgeon in your network?

@lisalucier thank you for writing. I had no idea I have a pelvic prolapse. Absolutely no symptoms. I am seeing the surgeon this coming Tuesday. I have been told through email of my doctor that a urogynecologist would do the pelvic surgery and a colorectal surgeon would do the rectal part. To be honest, I have never had surgery and can't imagine the pain involved in that and then my thought is could I stand it if it came out worse than what I deal with everyday, and that answer is, no, I couldn't. So I guess I just need to ask some questions and find out the answers and then ponder it over....the only question I can come up with for him is "how many of these surgeries have you done and how successful have they been." Any questions I should ask would be very helpful. Thank you!

@cc510 About the pain, having had one rectal prolapse surgery I can say the worse part was the prep. I did have severe pain in my sacrum where the pins used to suspend my rectum were inserted. It only lasted a day or so and responded to ibuprofen. It was done using the Davinci so I just had multiple small incisions on my abdomen which weren’t bad. As far as the pelvic prolapse, I don’t have any knowledge. I had a full hysterectomy which started all these issues, so I don’t have anything there to fall. My issue is the bladder. I don’t get the testing until mid November so time will tell. But same plan as you, two surgeons in OR. I wish you the best of luck on this journey.

@ina9 Catalina, I did have the surgery and in a post dated recently I shared that my “fix” failed. It was done by suspension, I now will have to have another try using mesh. The colorectal surgeon feels this failure may be due to bladder involvement, so we are going down that path now.
As far as diet and supplements…my husband and I eat a whole food, 98% plant based diet. Minimal salt, sugar, oil (no seed oils). We occasionally have salmon, and I occasionally will have chicken. I take supplements due to age, diet, and inherent nutritional or genetic deficiencies. I am an active 70 yo, in good health with no chronic diseases. I have recently learned I have food sensitivities. Dairy causes head congestion and coughing, gluten/wheat causes anxiety. I hope this answered your question. I wish you the best of luck along this journey.

@cc510 - sitting down and writing your questions for the surgeon ahead of your appointment on your phone or a piece of paper, like you mentioned, is a great idea. I often forget to ask a doctor something I wish I'd asked if I don't have a list or don't refer to it often at the appointment. The questions you mentioned are both important: How many of these surgeries have you done and how successful have they been?

My understanding from going through this surgery personally is that they usually do it when you have symptoms to be addressed. You might ask about this since you mentioned having no symptoms.

But I also got the impression from speaking to the surgeon that some women just choose to ignore their prolapse and use a pessary to hold things up. (I personally didn't care for a pessary, but some women like them).

I will point out that this was major surgery and that the recovery was not a piece of cake. I had the surgery in January and was not fully myself again till early May.

I had to have a partial hysterectomy to have my bladder prolapse repaired. In 2012, very few hospitals did uterine-sparing bladder prolapse repairs, and I think very few do this today. I believe you said you didn't yet know if your bladder is what has prolapsed, along with your rectum? If they have to do a hysterectomy to rebuild the architecture, so to speak, in your pelvic region, are you okay with that?

You could ask each surgeon about ‘failure’ rates and/or longer term ‘re-do’ surgery issues. I had a total hysterectomy, vaginal prolapse repair and bladder sling
procedure about 12 years ago (in mylate 50s) not one of the surgeons mentioned the fact that there could be the possibility of issues 10–15+ years later. I am now feeling things have shifted and have a uroynecology consult next week—ugh; Wish I had a 2nd opinion back then and discussed options;
recovery was indeed lengthy and there is absolutely no ‘heavy lifting’ or
Heavy housework allowed; best wishes.