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Prolapsed rectum: living with it versus surgery
Digestive Health | Last Active: Nov 26 6:13am | Replies (56)Comment receiving replies
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.
Replies to "I struggle with the same question. My rectocele opened two or three years ago, in my..."
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
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Thank you for sharing your experience. Thank goodness I have not had quite the issues since mine is a prolapsed rectum and the vaginal wall is strong. I eat a whole food, plant based diet and have no issues.
Again thank you and I hope the best for you.