Colo-Rectal Repair to Bladder Therapy

To say I was devastated when I discovered a rectal prolapse less than six months following the surgical repair which led to my requiring a blood transfusion was an understatement. I had the transfusion, abscess, and now a complete failure of the surgery itself. My body was exhausted, my emotions depleted, and the correct surgery was definitely major surgery.

It was in-hospital with a five-day stay. The incision went from belly button to bikini line. I don't recall the exact medical steps but it was basically pulling the rectum up. I was told some of my colon might have to be removed and a very small part of it only, thank goodness, had to be excised. A mesh sling holds my colon up so it doesn't place pressure on the rectum.  In preparation for the surgery, Dr. McKenna recommended an epidural for pain. I had always been terrified of anything going into my spine.

The day of my pre-admission testing and consultation, I argued ardently against it. The anesthesiologist said the pain would likely be unbearable without it. I relented and signed the release. The morning of surgery I was terrified of the epidural because it had to be done while I was wide awake. I was taken to a room where I was surrounded by good looking young interns. lol. One person reassuringly held onto me and told me everything that was going on. Honestly, there was no pain. I was so relieved to hear "it's in". Apparently having an epidural was a procedure not often viewed by interns or they had a new class but I had plenty of reassuring looks and hand holding.

Following surgery and for the next four days, I was amazingly pain free. The wire had actually just come loose and I was feeling around for it when Dr. McKenna's team came in for their daily rounds. They said they were there to see if the epidural line should be removed. When I said I thought it had just come out they said that was highly unlikely and the team leader went behind me. He held up the wire that had indeed come loose and announced, "The epidural is officially removed." Another lol.

A morphine drip was hooked up immediately. From no pain to OMG pain in a matter of hours. I requested oral painkillers about six hours later because the morphine seemed to do nothing. Pain was manageable with the oxycodone or hydrocodone, whichever they gave me, and I was released on Day 5.

After several follow up visits, I realized there was still some weirdness which turned out to be a mucosal prolapse. Dr. McKenna had warned me that, because of what Dr. DeLeo had done, he wasn't able to guarantee the outcome. Had he been the first to repair it correctly, he could have pretty much guaranteed there would be no more prolapses. This secondary prolapse was not as large and was manageable. While the doctor had described what he could do to "fix" it, he must have been having a bad day because it was something he would have done in his office without anesthesia. He stated it rather gruffly leaving me to believe I was a pain in his *ss. I was not going to have anything to do with a repair without anesthesia. I hoped exercise over time might tighten the muscles and lift it naturally. It did create pressure from the inside; however that didn't become as noticeable until after my bladder therapy.

While I was urinating up to 20 times a day, I kept being advised the bladder would have to be the last of the three orifices to be addressed. Finally I was referred to the bladder specialist.

P.S. More to come about Dr. McKenna and repair of the mucosal prolapse. He became very caring and respectful with help from my family doctor. Dr. McKenna was, to me, like Dr. House. The best surgeon...no bedside manner. I wouldn't have wanted anyone else doing the repair.

Hysterectomy to Mayhem

While an awful topic to address, I believe it is necessary because it might save someone else from having the same problem when it would have been so easy to stop. Since the time of my abscess, I had virtually non-stop, uncontrollable bowel movements. It was such a horrid time. As much as anyone hates to think of ever wearing Depends, I have to say they never let me down even though I froze in horror on so many occasions.

I became a recluse except for doctor appointments. I had gone into my ob/gyn appointment with that problem but Dr. Harkins said the main issue was to do the hysterectomy which might resolve the problem. It didn't. After several follow ups to the hysterectomy and no resolution to the bowel problem, I was referred to a gastroenterologist. He took one look at my medication list and immediately took me off two medications, each prescribed by Drs. McKenna and Harkins.

My body responds differently to most medications than one would expect. I was being monitored so closely but no one was monitoring the meds. Two were to prevent constipation and, at that time, I just did what I was told.  The great lesson here is to be your own advocate and ask about medications if your body is not doing what it is supposed to and no one seems to know why. I lived with that awful problem from early September 2007 until January 2008. I was simply in survival mode and really not thinking about one moment to the next. Hopefully anyone reading this will think to ask if you find yourself in a similar situation. Medications can cause very unusual body responses.

Within two days of following the gastroenterologist's advice, I was back at a more manageable level. No more Depends but needing the bathroom 10 or more times a day. I had a special diet that also helped. It was January 2008. I tried returning to work in February with clients understanding I might need a mid-session break which I hated to do.  But I was back at work.

Later in February,  I was accompanying a client to a meeting as her advocate. When I stopped in the restroom on arriving, I saw my rectal prolapse had returned with full force. Dr. DeLeo had "repaired" it in my near death surgery only six months earlier. I was once again devastated.

Returning to Dr. McKenna, he informed me that the previous surgeon had used the incorrect method of repair for my age and level of activiy (prior to the prolapses). He scheduled me for a colorectoplexy, abdominal surgery to repair the rectal wall and possibly remove a portion of my colon.

I tried to return to work until just before the surgery but my emotions were in meltdown and I could no longer keep my focus on my clients. My life as I knew it was changing.

Not so fast...

Of course when the rectal prolapse suddenly appeared again, I panicked. These are body parts falling to the outside. Very disturbing. Because of the holiday, Brian placed an emergency call to Dr. DeLeo. That's when we learned the doctor does not do emergency call backs. I spoke to her office the next day and secured an appointment for July 6.

Dr. DeLeo confirmed the presence of a "slight" rectal prolapse. She asked me to have a "second opinion" with a colo-rectal specialist. I left her office wondering why she asked me to have a second opinion. Isn't that something the patient requests? She didn't say, "I'd like you to see a specialist because I'm not sure what is going on." Seeing a male colo-rectal person was not an option for me.

I returned home and hit the internet searching bladder and rectal prolapse. That was the first time I ran into the term "pelvic prolapse" or "pelvic floor disorder". They were articles about the big picture. The bladder, vagina, and rectum are all connected in terms of issues. When the bladder prolapses, it bulges into the vagina. The vagina can also prolapse causing pressure on the other two organs. A rectal prolapse can cause pressure on the vaginal wall. One of the main causes of pelvic prolapse is weakening of the pelvic floor muscles which can be due to age, childbirth, frequent lifting, and (while not specifically stated) I would imagine long-term sexual abuse.

I extensively researched the best way to evaluate pelvic prolapse. The NIH highly recommended a specific type of MRI. I printed out their recommendations and requested an appointment with Dr. DeLeo right away. I cancelled the appointment with the colo-rectal surgeon because I wanted the "big picture" approach. If that surgeon confirmed the rectal prolapse, he would have recommended a rectocele without taking the condition of my entire pelvic region into consideration.

My thinking at that point was Dr. DeLeo had performed the cystocele well. The explanation given for the immediate rectal prolapse was that one prolapse usually leads to another. "Nothing to worry about. I can fix that." While she was board certified, I realized she was certified in General Surgery but held herself out to be experienced with ob/gyn issues. Because she had been recommended for the colonoscopy my assumption was she knew that area of the body well. I didn't mind working with her.

In the meantime, I was concerned about additional time away from my clients. I didn't have an ob/gyn because my PCP since 2004, Dr. Bogdan, had been doing my annual Pap smear and checkups. I called her office to find out if she could get me in to see a female ob/gyn because I was in a mid-pelvic crisis and wasn't positive I was with the right doctor. Each ob/gyn I called either wasn't accepting new patients or had a wait until January. It was July. The prolapse was too uncomfortable for me to wait that long. I also assumed Dr. DeLeo was sending reports to Dr. Bogdan so she could monitor what was happening with me.

Returning to Dr. DeLeo's office with research in hand, she ordered an MRI for me. During my next meeting with her, she reviewed the MRI results with me. I had a rather large cyst on my left ovary, likely a "chocolate cyst" also called an endometrioma. She indicated she would have to remove the cyst before she performed the rectocele. Both procedures were scheduled.

Lesson: Even if your PCP performs your annual ob/gyn checkup, make sure you are on record with an ob/gyn in case of an emergency.

But she's the doctor...she knows

As Dr. DeLeo told me I had no evidence of a rectal prolapse but clearly had a bladder prolapse, I was speechless. I was pretty darn sure I knew which orifice was my rectum. The definition of the prolapse was that the bladder pushed into the vaginal wall causing pressure to occur in the vagina. I had no problems with urination. Since my body has always been weird, I figured maybe the bladder had caused pressure over to my rectum? I didn't ask those questions. I didn't speak of the photo out of embarrassment.

"Why would my bladder have fallen out?" The doctor assured me it was common in women over 50, especially women who had lots of babies. When I informed her I had never given birth, she was silent. She said she would be unable to repair the bladder the next day when she did the colonoscopy but scheduled a date for the cystocele, an outpatient procedure.

Walking out the doctor's office with Brian, I sarcastically noted that my bladder must have prolapsed on the walkway into the office. Surprisingly, since that visit, I no longer noticed the rectal prolapse but did have increased frequency of urination. Whatever happened, she must have been right. The colonoscopy went well, or so she said. For some reason I didn't get photos of my colon like Brian had after his. I didn't think much about it at the time.

With the cystocele already scheduled for June 29. I returned to my full work schedule not thinking much about the surgery. The cystocele went well. I had very little pain. I was discharged with a catheter that would be removed a few days later. My thinking was that she did an excellent job with minimal pain. The catheter was removed in Dr. DeLeo's office during the afternoon of July 3. The morning of July 4, the rectal prolapse returned.

New health issue reveals itself

It is not easy to identify a rectal prolapse. Especially when we don't know such things exist. Most people want nothing to do with discussions about this area of the body. What happened to me should be mandatory education for women before it happens. What is supposed to remain tucked up inside the body, begins to fall out. What should never see the light of day, becomes quite prominent as well as physically and emotionally uncomfortable.

Some of my symptoms that had been dismissed for months were feeling like I had to go or still had to go when nothing was there. I'd had lower back time for many months but chalked that up to sitting most of my working day. I also had a pinpoint pain on the left side of my body that wasn't quite forward in my consciousness. I had begun to pee more frequently, although I thought it was my body adapting to my therapy schedule. Each hour in between clients. I was six months into menopause so was having no vaginal symptoms. Nothing in my mind put anything together.

Once I spotted blood, I became more aware of what was going on with that orifice, especially after elimination. One day, a week before my colonoscopy, I had been waiting for what seemed about 20 minutes because I didn't feel as if I were finished. I reached back to check (understanding I don't recall ever really exploring my anus) to find about a golfball sized "balloon". It felt rubbery and had no excrement on it whatsoever. In a panic, I quickly cleaned up and ran to the computer.

Initially I searched the symptoms and body part...rectum, balloon, outside. That's when I first learned of rectal prolapse. I had the symptoms. At the stage it becomes visible (on the outside of the body), is the final stage. Some women choose to live with the prolapse that undergo surgery. Once mine came out, it sometimes retracted on its own. Sometimes I had to push it back inside on my own (ewww). Sometimes I could feel it outside the body while I was in session and had to completely ignore it to focus on my clients.

I had called Dr. DeLeo the day I discovered the prolapse. I wasn't sure if the colonoscopy needed to be delayed or what other doctor I would need to see. She gave me an appointment the day before the colonoscopy. While I often had cautioned my clients not to self diagnose from the internet, I had found images of a prolapsed rectum on the internet. Being the inventive person I am, I placed my camera on a stepstool and stood over it while the prolapse was fully exposed and took a picture. It was identical to the internet photo. I did not think to bring the photo with me on the day of my appointment. In fact the whole topic was totally embarrassing. The fact that I took the photo still surprises me. I'm glad I did it though.

When I saw Dr. DeLeo, she asked why I thought I had a rectal prolapse. She claimed she found no evidence of one while in a Pap smear position. She had me stand up and probed my orifices. She proclaimed me to have a bladder prolapse.