Rectocele Repair: To have it or not to have it

Okay, I'm scheduled for a hysterectomy and have gotten two doctors' opinions about having a rectocele repair done simultaneously. I'm trying to decide whether to do it. Since I've had rectal surgery in the past, I have weak muscles, thin walls, scar tissue... I've been told that if I have the rectocele repair (rectum tacked up in place), there's no guarantee that it will not prolapse again in the future, especially after having the hysterectomy. I'm due to get an opinion from another colorectal surgeon. But I have anxiety after reading posts here from people who have had the surgery. While I'm suffering from some rectocele discomfort now, if the surgery is not guaranteed to "work" then I'm not sure I want to go through with anything more than the hysterectomy and make things worse. Can anyone relate or give me some food for thought?:

That's tricky Laurie when you know you already have thin walls and scar tissue. I would want to work out what I'm weighing up.

You know that the repair may not hold, but what are you weighing that against?
What problems have you got at the moment that the rectocoele repair would improve?
What would happen if you DON"t have the posterior repair?
J

Hi J, I'm interested in having my rectum tacked back up into place as the prolapse is uncomfortable. I also pass gas too easily, and sometimes, if I don't watch what I eat, have some fecal incontinence. (Dietary fiber supplements have helped that a lot.) I'm not sure what you mean by "what are you weighing that against?" And with regard to your third question, I believe I've read that after a hyst, there is increased chance of rectocele. That's my main reason for wanting to have it done at the time of hyst. Thanks for helping me try to sort this out from an objective point of view.

Hi Laurie -
I asked about what you are weighing up, because identifying that is a way to gather the information in order to make your decision. I'm only guessing what you are weighing up based on the little bit of information you provided -

The problem NOW - describe in your own terms and check with Dr what s/he believes would be changed by the surgery. They should be able to give you % of good results of surgery based on research. In your case, you already know that you have more risk than most of being among the poorer outcomes.

If you have the surgery - what is the best outcome
- what is the worst outcome

If you don't have the surgery -what is the best outcome
- what is the worst outcome

This is more easily explained with flow diagrams than simple text. Sorry if it is not useful.

My information was that the faecal incontinence won't be necessarily helped by rectocoele repair and although I'm just 6 weeks post-op, I don't think mine has. Urogynaecologist sugggested giving it 3 mths to make the final judgement on that. He is willing to refer me for further surgical advice on that problem, but warned that there is just a 50 -60% chance of a good outcome from surgery to repair the anal sphincter. Dietary management, as you said, is the best bet. In my case, the faecal incontinence is dealt with by avoiding wheat, as I have an intolerance, and I also aim for a generally healthy diet, (mostly).

Good luck. It is not an easy decision.
J

Hi, I can only give you my own experience. I had a TVH with a rectocele, cystocele, vaginal vault suspension, and a bladder sling done on 6/29. I had two surgeons who worked for about 3 hours together. My ob/gyn referred me to a urogynecologist who was an expert in his field. They work together. Both of them recommended that all of my prolapse problems be fixed at the same time to avoid, if possible another surgery. I am glad I did. I do have pain in the rear and i do still have cramping but its only been less than 3 weeks since my surgery so i'm hoping things will heal in time. I felt very comfortable with both of my doctors. They each had performed hundreds of these kinds of surgeries. If you are still unsure, maybe you should get a second opinion from someone who has had experience with your kind of history. Good luck.