Hernia between bladder and vaginal wall (not a cystocele)

Posted by konniehoover @konniehoover, Dec 27, 2018

I had a vaginal vault suspension and cystocele repair (bladder sling) about 10 years ago. All seemed to be going well except I developed a rectocele that made bowel movements difficult. This has been manageable until a couple weeks ago.

I had been constipated for about a week when I noticed the feeling I had when I had the a cystocele, (a feeling like a ball bulging out) except I also had a sensation of severe pressure in my pelvis. Wondering if my cystocele repair had failed or my rectocele had gotten worse I had my partner check by inserting a finger in my vagina. He felt what appears to have been a loop of bowel with hard stool between my vaginal wall and bladder.

It has since resolved when the constipation went away and the feeling of prolapse problems has gone. I have an appointment with a urogynecologist in a couple of weeks to check things out but I’m wondering if anyone else has experienced with anything like this and what was done about it.

My main concerns are that there doesn’t appear to be any way to reduce this manually (if it is a hernia), if the loop doesn’t resolve on its own is it possible it could cause bowel obstruction and should I be seen in the er if it happens again before my appointment?

Any information or ideas or information would be greatly appreciated.

Konnie

@konniehoover If you start to feel sick or vomiting ,go to E.R right away don't wait

Hi, @konniehoover – welcome to Mayo Clinic Connect. Having gone through similar surgery myself, I can imagine it's disheartening wondering if your cystocele repair had failed or your rectocele had gotten worse during the constipation episode, and discovering this loop of bowel with hard stool between your vaginal wall and bladder.

I'd like to introduce you to some other Connect members who may have some thoughts on this development and/or might share whether they've had a similar experience, like @baxtersmom, @predictable @thull @nancybev @skd43usa @sueblue @mary1234 @pizon @traveling.

Just wondering if you've had the chance to run this by your general practitioner? If so, what did he or she say?

Thanks for you response. The worst of this happened over the weekend and by the time I saw her on Monday the hard lump had moved and she couldn't feel it. She said she didnt know the best way of getting some imagining of the area and would leave it up to the urogynecologist to do any necessary testing. She requested an urgent referral but the urogynecologist's office said they don't do urgent appointments. This left me with the option of requesting another provider or waiting till mid-January for an appointment. Since the problem seems to have at least temporarily resolved, I chose to wait. I have the option of going to the er if I begin to have the same symptoms. I am now regretting that I didn't go when this began.

I have a history of a bad abdominal hernia repair that, after a number of surgeries, went from a 2 inch hernia to a 30cm hernia from below my navel to my sternum. I know that abdominal contents often move into and out of the herniated area. The concern is when bowel, or whatever, is strangulated, cutting off blood flow causing it to die. I have continued to have symptoms of intense pressure in the pelvis and constipation, on and off, since this happened. When it is painful I have had my partner check to see if the lump of bowel has come back. He has felt it much higher up but could move it a little so I didn't worry as much. I'm just trying to get through the next 2-1/2 weeks till I see the urogynecologist.

If you think there is anything else I can or should be doing or if you've had any experience with something like this, please join the discussion. I searched the internet pretty extensively and only found one Medline reference on this topic and don't have an account with them so I could only find a description. The full article is not available to me.

Thanks for suffering through this long post!

Hi, @konniehoover – glad you got to see your general practitioner to get this checked out and that the problem is at least temporarily resolved.

As you wait for the next 2+ weeks till your urogynecologist appointment, thought I'd introduce you to a few others who may have some thoughts on your situation with a hernia between your bladder and vaginal wall, like @msb18 @jenniferhunter @hopeful33250 @travelgirl @contentandwell and @pizon.

You mentioned symptoms of intense pressure and constipation on and off, and also occurrences of pain. Are you finding anything that helps with these symptoms in the meantime while you await the specialist's input?

@lisalucier Thanks for your reply.

You asked what I've been doing to deal with the symptoms of pressure, pain and continued constipation. For now I've continued with my regular doses of Colace, senna and Miralax. The doctor also recommended I increase the Miralax to twice a day and add Phillips milk of magnesia as needed. As I've added these meds, the constipation has gotten better although surprisingly I've still had some pretty hard stools on and off. The feeling of pressure has continued and I haven't found anything to relieve that. I've tried heat and massage but no relief.

I have a history of chronic constipation for the last 3 years or so. We attribute it to my use of opioids for the last 17 years for chronic pain. My type 2 diabetes is well controlled with my last A1C at 5.4 so I doubt it's contributing to the problem. I also have Parkinson's symptoms that I manage with Sinamet, which was caused by another med which we have since discontinued. Obviously I'm no stranger to constipation but this new problem has thrown me for a loop. (Pun intended)

Talking to someone who has had a similar problem would hopefully alleviate some of my concerns so I hope someone will reach out to me. I would like to know if surgery was necessary or if they found another way of dealing with it.

Thanks for your responses to my posts!

@konniehoover

@lisalucier Thanks for your reply.

You asked what I've been doing to deal with the symptoms of pressure, pain and continued constipation. For now I've continued with my regular doses of Colace, senna and Miralax. The doctor also recommended I increase the Miralax to twice a day and add Phillips milk of magnesia as needed. As I've added these meds, the constipation has gotten better although surprisingly I've still had some pretty hard stools on and off. The feeling of pressure has continued and I haven't found anything to relieve that. I've tried heat and massage but no relief.

I have a history of chronic constipation for the last 3 years or so. We attribute it to my use of opioids for the last 17 years for chronic pain. My type 2 diabetes is well controlled with my last A1C at 5.4 so I doubt it's contributing to the problem. I also have Parkinson's symptoms that I manage with Sinamet, which was caused by another med which we have since discontinued. Obviously I'm no stranger to constipation but this new problem has thrown me for a loop. (Pun intended)

Talking to someone who has had a similar problem would hopefully alleviate some of my concerns so I hope someone will reach out to me. I would like to know if surgery was necessary or if they found another way of dealing with it.

Thanks for your responses to my posts!

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@konniehoover Im sorry Im not familiar with this but working in a nursing home when a patient had constipation we gave them a Cocktail of Prune juice and Milk of Mag worked always hope this may help

@lioness – thanks for posting this. I forgot to mention I am a prune juice addict. With chronic constipation you learn to love the stuff or perish. I appreciate the advice and would love to see more strategies for dealing with constipation. Miralax is my mainstay but I use m of m when I need it too.

Liked by lioness

@konniehoover @lisalucier I have been diagnosed as having a rectocele by a urogynecologist and a pelvic floor physical therapist. I actually saw the doctor for urinary incontinence, and that was discovered. Initially, I thought the rectocele was causing problems but now I am not too sure. I do not have constipation, I am the opposite. It does seem as if some feces may get caught in the rectocele and seep out later. When that is happening I do not go to my morning water aerobic classes, for obvious reasons. I have not felt pain or pressure from my problem.

My regular PCP and gynecologist know about my urinary incontinence but I have not had occasion to speak to them about the other and do not intend to. I realize they get reports from the urogynecologist but if they don't bring it up I won't either. I figure the specialist is dealing with it, and no need to involve them. Frankly, I find it embarrassing and uncomfortable. I asked my physical therapist about prolapse and I do not have that at all.

I hope the solutions to your problem are not too invasive, I will be interested in hearing what is said.
JK.

@contentandwell

@konniehoover @lisalucier I have been diagnosed as having a rectocele by a urogynecologist and a pelvic floor physical therapist. I actually saw the doctor for urinary incontinence, and that was discovered. Initially, I thought the rectocele was causing problems but now I am not too sure. I do not have constipation, I am the opposite. It does seem as if some feces may get caught in the rectocele and seep out later. When that is happening I do not go to my morning water aerobic classes, for obvious reasons. I have not felt pain or pressure from my problem.

My regular PCP and gynecologist know about my urinary incontinence but I have not had occasion to speak to them about the other and do not intend to. I realize they get reports from the urogynecologist but if they don't bring it up I won't either. I figure the specialist is dealing with it, and no need to involve them. Frankly, I find it embarrassing and uncomfortable. I asked my physical therapist about prolapse and I do not have that at all.

I hope the solutions to your problem are not too invasive, I will be interested in hearing what is said.
JK.

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@contentandwell

I was sorry to hear not only that you were struggling with a rectocele but that you felt uncomfortable talking to your PCP about it. I find that my female provider (a nurse practitioner) makes me more comfortable than I was with male Drs.

Thanks for your response by the way. I have a rectocele as well. The problems I experience are bulging into the vagina, difficulty emptying my bowel and interference with intercourse. I have stool the gets left behind in mine like you. When I'm finally able to have softer stools, I have a little leakage as well. Sorry you have to deal with that. I find it a bit embarrassing that my husband knows about it. I manage to go to my morning water exercise class (seems we have that in common as well) by cleaning out with a small warm water enema. It helps.

The problem I originally wrote about appears to be an anterior enterocele. It's kinda rare compared to a posterior enterocele and I had to go to Yahoo search to find out a little bit about it. It's amazing what you can learn when you're determined to find answers. I still have to have it confirmed by the urogynecologist but I feel pretty certain my internet self diagnosis is on point.

If you want to talk about your issues or mine or have any questions I'm happy to chat with someone who's in the same boat. I'm planning on having the rectocele repaired and the enterocele as well. Hopefully they can do it at the same time.

Thanks again.

@konniehoover

@contentandwell

I was sorry to hear not only that you were struggling with a rectocele but that you felt uncomfortable talking to your PCP about it. I find that my female provider (a nurse practitioner) makes me more comfortable than I was with male Drs.

Thanks for your response by the way. I have a rectocele as well. The problems I experience are bulging into the vagina, difficulty emptying my bowel and interference with intercourse. I have stool the gets left behind in mine like you. When I'm finally able to have softer stools, I have a little leakage as well. Sorry you have to deal with that. I find it a bit embarrassing that my husband knows about it. I manage to go to my morning water exercise class (seems we have that in common as well) by cleaning out with a small warm water enema. It helps.

The problem I originally wrote about appears to be an anterior enterocele. It's kinda rare compared to a posterior enterocele and I had to go to Yahoo search to find out a little bit about it. It's amazing what you can learn when you're determined to find answers. I still have to have it confirmed by the urogynecologist but I feel pretty certain my internet self diagnosis is on point.

If you want to talk about your issues or mine or have any questions I'm happy to chat with someone who's in the same boat. I'm planning on having the rectocele repaired and the enterocele as well. Hopefully they can do it at the same time.

Thanks again.

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@konniehoover Thanks Konnie. Regarding my PCP, I just figure, what's the point? He's not going to do anything so why bother. I used to go women PCPs, I had three in a row, but the first was a little wacky, the second quit to become a hospitalist so she could have a more regular schedule since she had young children, and the last was a complete dodo. She should have been a Physician's Assistant, she did not have what she needed to be the doctor, plus her heart and mind were with her young children more than with a patient (me) with a complex issue. She is the doctor who told me after one HE episode that she thought I had Alzheimer's and also basically ignored my complaints of hoarseness, which turned out to be from Barrett's Esophagus.
JK

@contentandwell

@konniehoover Thanks Konnie. Regarding my PCP, I just figure, what's the point? He's not going to do anything so why bother. I used to go women PCPs, I had three in a row, but the first was a little wacky, the second quit to become a hospitalist so she could have a more regular schedule since she had young children, and the last was a complete dodo. She should have been a Physician's Assistant, she did not have what she needed to be the doctor, plus her heart and mind were with her young children more than with a patient (me) with a complex issue. She is the doctor who told me after one HE episode that she thought I had Alzheimer's and also basically ignored my complaints of hoarseness, which turned out to be from Barrett's Esophagus.
JK

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@contentandwell

Are we sharing the same body? Jk. My situation is complicated as well. I expect my primary care provider to keep a bird's eye view of my overall care. That means knowing and referring me to all specialists and keeping track of what I'm being treated for. In the case of my Parkinson's dx, she had to know my Neuro, gi and pt symptoms to know the overall symptoms together were related to Parkinson's and refer me to a Neuro who had a specialty in Movement Disorders. I didn't discuss my gi symptoms with the Neuro, or what was going on with physical therapy. See?

Keeping good communication with her is a part of keeping me functioning as much as possible. I'm in a wheelchair and knowing everything made it possible for her to get me a better electric chair that meets all my needs, helps with my circulation issues and helps manage my chronic pain. It takes a little more work on both our parts but finding her has made a huge difference in my overall health. I had to kiss a few frogs myself to find the right provider.

Hope you're having a good day!

Konnie Hoover

@konniehoover

@contentandwell

Are we sharing the same body? Jk. My situation is complicated as well. I expect my primary care provider to keep a bird's eye view of my overall care. That means knowing and referring me to all specialists and keeping track of what I'm being treated for. In the case of my Parkinson's dx, she had to know my Neuro, gi and pt symptoms to know the overall symptoms together were related to Parkinson's and refer me to a Neuro who had a specialty in Movement Disorders. I didn't discuss my gi symptoms with the Neuro, or what was going on with physical therapy. See?

Keeping good communication with her is a part of keeping me functioning as much as possible. I'm in a wheelchair and knowing everything made it possible for her to get me a better electric chair that meets all my needs, helps with my circulation issues and helps manage my chronic pain. It takes a little more work on both our parts but finding her has made a huge difference in my overall health. I had to kiss a few frogs myself to find the right provider.

Hope you're having a good day!

Konnie Hoover

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@konniehoover I know my PCP keeps track of me, sometimes too much, but he also knows when I am being tended to by a specialist that he does not need to add anything to my care. I think if he saw something wrong he would comment, particularly when I am dealing with physicians at a different hospital – I doubt he would ever say anything contrary about any physician at the same hospital that he is at.

I do feel it is up to him to be at the hub of my care, as I indicated he gets reports from every doctor I go to. If he felt my care needed coordination then I hope he would step forward.

How long have you been in a wheel chair? Can you get around at all without it? I presume it is not temporary. It sounds as if you do manage to be fairly independent and don’t let that hold you back. I commend you for that.
JK

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