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Are there any new, less invasive techniques available or in testing for repair of rectocele?

By June 15, 2010 - 4:28am
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I have been diagnosed with a rectocele which requires surgical repair. Everything I have read clearly states this type of vaginal prolapse, unlike others, often prevents a women's ability to have intercourse after surgery due to the amount of vaginal tissue removed during the repair. The shortened vagina prevents intercourse without severe pain post-op.
According to the statistics I available, I had less than a 2% chance of developing this condition. I am in my 50's, but began HRT as soon as my hormone levels dropped. I have never had children. The cause was severe constipation I suffered for several months in 2008 and 2009 while going through the trauma of ending a 23 year relationship. I had

lost my desire to eat, sleep, and exercise. A normal reaction to such a devastating loss.
A few times I experienced episodes of severe bleeding while trying to pass hard impacted stool. My doctor performed a sigmoidoscope and couldn't find anything. I used mild laxatives to regain normal bowel movements. Everything seemed to clear up, except I felt like I couldn't completely void and was forced to manually remove small stool left in the rectum. I planned to get a colonoscopy, but had my routine PAP exam. My doctor lifted the sheet to begin the exam and informed me immediately I had a rectocele, with a bulge
at the entrance of the vagina. Now I'm afraid to begin dating before I have the surgery.
but I'm afraid I will never experience a sexual relationship again. I feel like I should just learn to accept life without a partner.
Thank you for any information you can provide.

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EmpowHER Guest

What type of specialist do you go to for this repair? A general surgeon or a gyno?

February 28, 2011 - 4:19pm
(reply to Anonymous)

You would want to talk with your current doctor regarding a referral to a specialist.

Depending on your situation, you can either talk with your Gynecologist about the referral, as you may need a colon or rectal surgeon for your surgical repair. You can read more about this type of specialist at their professional organization: FASCRS.

March 3, 2011 - 12:19pm

Hi Again Roxanne

A rectocele is not a vaginal prolapse. It is a rectal prolapse into the vaginal wall. I am again wondering if you are discussing all of this with your surgeon. Your surgeon and you really should be going over all the possible repair scenarios, prognosis and methods of repair, because they will vary depending on your history and specific situation. If you aren't comfortable with your surgeon or your surgeon's knowledge of current techniques, I suggest you find a new surgeon. It is really important to have a good trusting relationship if you want a good surgical outcome.

That being said, there are quite a few articles if you Google rectocele and then under the more tab, hit scholar. An abstract from the American Journal of Obstetrics and Gynecology, The anatomic and functional outcomes of defect-specific rectocele repairs, states that, "Sexual function was not affected; however, reports of dyspareunia significantly (P < .04) improved or were cured after the operation in 73% of patients (19/26), worsened in 19% of patients (5/26), and arose de novo in 3 patients. Results showed no other significant differences in vaginal dryness, orgasm ability, sexual desire, sexual frequency, or sexual satisfaction."

This would indicate that having sex would be easier and less painful after the surgery than prior. If you have a rectocele, your rectum has a little pouch bulging into the vaginal wall. I believe the norm is not to remove vaginal tissue, but to insert surgical mesh to strengthen the wall between the rectum and vagina to prevent further bulging and correct the rectocele. The mesh may be inserted transvaginally or transrectally, depending on the surgeon and the situation.

If I was in your position, I would talk extensively to the surgeon about the plan for repair and the concerns you clearly have. However, my biggest concern would not be whether it was minimally invasive. That might be my second concern. My first concern would be the success and failure rate of the technique the surgeon plans to use. Sometimes minimally invasive sounds better, but does not enable a surgeon to see the entire anatomical area as well as is desired. Sometimes attempting a small patch-up surgical repair means further surgery down the road. So in your shoes, I would want the best procedure, whether it was minimally invasive or not.

I think it is good to do your own research, but it is more important to have open communication with the person who will do your surgery. It seems you don't quite understand the procedure you are to have, or the terms to describe it. So start with the surgeon, get your information and education there so you understand exactly what repair you need, and then look up information. That way you will better understand what you are looking at.

I wish you luck and if you have further questions, please let us know.

June 16, 2010 - 6:43am

Hi Roxanne,
I am confused about what you are reading, and would love to see your sources. I have not read any information about the need to REMOVE vaginal tissues during surgery.

Severe cases of retocele, from my understanding, do need surgical repair but include the repair -- not removal-- of the vaginal walls. The vaginal tissue is VERY stretchy and resilient, and I am interested to hear more about your story. Did your doctor tell you that a significant portion of your vagina would need to be removed?

June 15, 2010 - 8:36pm
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