# Saw a colorectal surgeon today



## oceannir (Mar 6, 2012)

SO i've been waiting for a while to see a colorectal surgeon. I was sent there for a prolapse which strangely the colorectal surgeon couldn't see in her examination "it doesn't mean its not there" is what she said, but she was certain if it was there it was something quite minor, because as they advance they become more evident.It was also the first time i've felt a doctor was actually genuinely interested in looking into my problems, rather than just labeling me IBS and getting me out the door with a new script. She didn't actually say the word IBS once in the whole time I was there.Shes set me up with a few tests to 'cover the field' being a defecography (which I am not looking forward to, it sounds rather unpleasant!) and following this I have to do a transit study test, and she is going to do a colonoscopy following this just to make sure everything still looks normal considering its been so long since my last one (6 years).I was impressed with the fact I didnt have to ask for any of this, she was just being super proactive about it all and said following this she will reassess what they can do based on the results of these tests. Unfortunately I know that even if they find abnormalities, there is not alot they can do.The tests will no doubt be very unpleasant, but I am happy in a way with the level of finality about it. I feel this type of examination should have been completed when I was 16/17 rather than left to now. If there is anyone out there who is putting up with terrible GI's, do yourself a favor and see the surgeon. She stated to me that she would in no way recommend surgery for my condition, but just wanted to know 100% of the information to help divice a treatment plan that may actually help me, rather than one that is ineffective at best.Now I have to wait for these tests which won't be completed until September with a colonoscopy. But atleast there is some balls in motion.


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## annie7 (Aug 16, 2002)

congratulations on finding a good doc. sounds like she is being very thorough--good to hear she's having you take all the necessary tests. wishing you all the best--stay strong--stay positive! some of the tests may sound unpleasant to you but believe me, having been through them myself--they are most definitely worth it!


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## Sean (Feb 8, 1999)

All of this is great news. Congratulations on finally finding a physician who is interested in getting to the heart of the problem. I wasn't able to do that until I was about 25 (and had been suffering for 9 years). However, knowing what you are dealing with is a big help in treating it. The defography and colonoscopy are not fun, but I have endured things far worse. The defography and the transit time studies are critical for diagnosis. Otherwise, the doctor cannot do much more than vaguely label your symptoms as IBS-C. Feel free to PM me for my experiences with these tests.


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## oceannir (Mar 6, 2012)

Guys im just curious.Did your tests show normal for the defeography? I'm well versed on whats involved, it sounds absolutely awful but i'm at the point i'll try anything. Also if they find I have slow transit which seems likely to me is there anything they can actually do to help? That is the question. It sounds like i'm already at the max remedies they can help in the normal sphere.But I am very thankful i'm not going through this alone... it makes me feel somewhat more normal like this.


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## annie7 (Aug 16, 2002)

my defogram showed i have a vaginal prolapse and a moderate sized rectocele. that's what it showed in my case. it can also reveal other problems such as pelvic floor dysfuntion, rectal prolapse, enterocele...it's a very good test to have. as sean said, both the defogram and the sitz marker studies are critical for diagnosis. very well said, sean!


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## TheOutlookChild (Sep 2, 2011)

WOW. YOU ARE SO LUCKY. I hope I eventually find someone who will run those tests.


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## oceannir (Mar 6, 2012)

Cas, look up a colorectal surgeon local to you. They all do these types of tests.


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## TheOutlookChild (Sep 2, 2011)

I know, but I cannot just go see one, I have to have my doctor refer me to one which will never happen.


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## annie7 (Aug 16, 2002)

yes, that's similar to my situation as well. my insurance won't just pay for a visit to a colo rectal surgeon unless my primary care doc--based on my gastro's advice--refers me to one. and for the present time at least, the gastro doesn't think a colo rectal doc is necessary. and i can't afford to pay out of pocket.although fortunately for me, my gastro was the doc who had me take the defogram and the sitz marker test--actually, i specifically asked to have the sitz done and thankfully he agreed, otherwise it wouldn't have happened. i know it works differently in other countries depending on how the healthcare and insurance systems are set up and i do understand what you mean, outlook child--wish you could find a doc that is more proactive and willing to help you--which can be hard to do, isn't it.


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## oceannir (Mar 6, 2012)

annie7 said:


> yes, that's similar to my situation as well. my insurance won't just pay for a visit to a colo rectal surgeon unless my primary care doc--based on my gastro's advice--refers me to one. and for the present time at least, the gastro doesn't think a colo rectal doc is necessary. and i can't afford to pay out of pocket.although fortunately for me, my gastro was the doc who had me take the defogram and the sitz marker test--actually, i specifically asked to have the sitz done and thankfully he agreed, otherwise it wouldn't have happened. i know it works differently in other countries depending on how the healthcare and insurance systems are set up and i do understand what you mean, outlook child--wish you could find a doc that is more proactive and willing to help you--which can be hard to do, isn't it.


the problem is with these specialists is, what can they really do that gastero doc's cant?I mean if they find I have slow transit, there is no other real remedies for it is there? Just the same thing as there has always been?


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## annie7 (Aug 16, 2002)

sorry--i personally don't have anything more to add to this since we've already discussed it







...and i sent you the link to that medscape article about chronic constipation--the one with the flow chart--there's a lot of good info in there.i do think it's always good to see a specialist who is up to date and proactive.and i do find that it always helps to keep an open mind, stay positive, stay strong and never ever give up...wishing you all the best.


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## oceannir (Mar 6, 2012)

annie7 said:


> sorry--i personally don't have anything more to add to this since we've already discussed it
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oh im more just thinking outloud







Im just kind of justifying, I do understand why they dont bother to run the tests sometimes, as the ultimate conclusion kind of ends up being the same with their treatment options.But I do agree, once you have the diagnosis they can help you alot better and atleast give you the 'higher' level medicines.Is there any information about what causes slow transit constipation? Or its just one of those things that happens and people dont know the cause of.


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## annie7 (Aug 16, 2002)

i don't really know a lot about what causes slow transit c. what i do know is that low thyroid levels--hypothyroidism--can cause slow motility. thyroid meds can help with that.certain medications---like opiods, anticholinergics, etc--can slow things down. not permanently, though--just while you're on the med.so can certain diseases--parkinson's, ms--i'm sure there are others. in my case i have mitochondrial disease-my cells don't make enough energy. in particular i have a genetic variant that causes slow motility as well as pain in the gi tract.and i've read that genetics in general can play a part in it..can run in families, even without mito.an abnormally long or twisted colon can slow things down.and a lot of people just experience a general slowing down of colonic motility as they age or become less active, etc. mine sure got worse after menopause--lol. even though i'm very active.or like you said, it could be just one of those things in some people..


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## Sean (Feb 8, 1999)

oceannir said:


> oh im more just thinking outloud
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I have never had a doctor even speculate about what causes slow-transit constipation. I do not think anyone knows for certain. I have read some research pappers that theorize that may have to do with misfiring neurotransmitters that activate the colonic muscles to contract. There is really no sure fire "cure" for slow-transit constipation. If it gets resistant to standard therapy (laxatives, etc.) a subtotal colectomy is the only option. I am definitely not ready for that. The key for me has been learning to manage it with laxatives, etc. You may find that eventually the only thing that works is stimulant laxatives. That is where I am right now. Fortunately, dulcolax does not seem to be losing its effectiveness. I have had a very uncomfortable weekend. I was uber busy this week and did not attend to my bowel issues. Yesterday (Saturday), I was in a lot of discomfort with bloating, gas and cramps. I realized that I had not had a movement since last Sunday. Kind of scary. I decided to cancel most of what I was going to do today and took four Dulcolax at bedtime. It started cleaning me out first thing this morning. The cramping was only mild, and I feel so much better now. I can't believe that I went an entire week with nothing happening. It is not like I wasn't eating. In fact, I was eating more than normal because of business commitments. It is crazy when you think about it.


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## annie7 (Aug 16, 2002)

omg, sean! glad the dulcolax worked for you.i could never get by without going for that long a time. i get a lot of pain, cramping, bloating and nausea if i don't go for more than two days. after that point i start retaining urine. when i took the sitz marker test, i developed an impaction by the end of day three and had to go to the ER the evening of day four because the urinary retention and pain was so extreme. they pumped a liter and a half of urine out of me. besides being slow transit, i have a rectocele--i think that may have had something to do with the urinary retention and the backing up, blockage of stool.glad you're feeling better!


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## Sean (Feb 8, 1999)

annie7 said:


> omg, sean! glad the dulcolax worked for you.i could never get by without going for that long a time. i get a lot of pain, cramping, bloating and nausea if i don't go for more than two days. after that point i start retaining urine. when i took the sitz marker test, i developed an impaction by the end of day three and had to go to the ER the evening of day four because the urinary retention and pain was so extreme. they pumped a liter and a half of urine out of me. besides being slow transit, i have a rectocele--i think that may have had something to do with the urinary retention and the backing up, blockage of stool.glad you're feeling better!


Thanks, Annie. I have never had an issue with urinary retention. I drink a lot of water and I think that helps. I can only imagine how much worse it must make the impaction issues. My sitzmark test was a miserable time. They had me stop taking anything for constipation (laxatives, etc.) three days before swallowing the markers. At that time, I had probably already gone a day or two without a movement. Then, I couldn't take anything for the five days after swallowing the markers. When I finally had the abdominal x-ray, I had not gone to the bathroom in something like nine days. I was completely miserable. As I was getting dressed in the outpatient area of the hospital, the x-ray tech came in and told me the doctor wanted to see me. The doctor showed me the abdominal x-ray, which showed all of the markers still in me, and my colon distended with stool up to and under the rib cage. He then sent me to the colonoscopy prep area where they gave me an enema. Another x-ray revealed that the enema had helped but that I was still impacted. So they sent me home with a colonoscopy prep kit that had the nasty gallon of stuff that you have to drink.


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## Sean (Feb 8, 1999)

oceannir said:


> Guys im just curious.Did your tests show normal for the defeography? I'm well versed on whats involved, it sounds absolutely awful but i'm at the point i'll try anything. Also if they find I have slow transit which seems likely to me is there anything they can actually do to help? That is the question. It sounds like i'm already at the max remedies they can help in the normal sphere.But I am very thankful i'm not going through this alone... it makes me feel somewhat more normal like this.


Oceannir, my defogram showed that I had some issues expelling the paste, but the doctor said I was within normal range, whatever that means.


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## Kathleen M. (Nov 16, 1999)

What that means is not every "normal" human is "perfect". There is usually a range in which standard issue healthy people used to develop a test end up in. And usually another range that people diagnosed with something end up in.So you don't have to have perfect functioning to in the range they see in healthy people. A certain degree of things not working quite right is expected in any given population of healthy people. If you did enough medical tests on the healthiest person you would find a few things that aren't quite up to spec without being a disease or disorder. Basically there is a typical range of abnormal you expect to see if you do the test on enough people. Sounds like you are in that part of the spectrum of every possible abnormality they could see (the part where healthy people end up). Rather than being in the "that just ain't right" part of the spectrum of every possible abnormality. So normally abnormal rather than pathologically abnormal.Usually for a lot of tests you set the boundary where only about 95% of normal healthy control people are in the normal range. There are always a few "outliers" in any large population so a lot of times on medical testing you may be out of the normal range but not in the diseased range so they'll just wait and see. A lot of people can get pretty freaked out when they are just outside of the normal range, but it is expected that 5% of the time people will be "close to normal range" but not in the normal range.Hope that clears things up.


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## annie7 (Aug 16, 2002)

sean--oh yes i drink lots of water, too--all the time and especially during the sitz. after all, that's what the nurse said when i called in on day three and told them i was impacted--she said to be sure and "stay hydrated"---lot of good that did--lol...and yes, like you said about yours--it was a miserable time. but it was so well worth it in the long run. it finally convinced the gastro to take me seriously--nothing like a good ol ER visit to do that....and not passing any markers, too, of course.


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## Sean (Feb 8, 1999)

annie7 said:


> sean--oh yes i drink lots of water, too--all the time and especially during the sitz. after all, that's what the nurse said when i called in on day three and told them i was impacted--she said to be sure and "stay hydrated"---lot of good that did--lol...and yes, like you said about yours--it was a miserable time. but it was so well worth it in the long run. it finally convinced the gastro to take me seriously--nothing like a good ol ER visit to do that....and not passing any markers, too, of course.


The first sitzmark test was definitely the turning point for me in getting a grip on what was wrong with me and how to treat it. The gastroenterologist at the time was at a top teaching hospital here at the Texas Medical Center. He definitely "got it" after he saw the test results, especially the abdominal x-ray, and took me very seriously after that. I got my first referral to a colon and rectal surgeon from him. Mind you it took 9 years (from age 16 to age 25) to get to that point. Before that it was just "eat more fiber" or "men don't get constipated."


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## annie7 (Aug 16, 2002)

omg--"men don't get constipated" that doc should have his license revoked.yes i got the fiber water exercise mantra too---from the early 70's when i saw my first doc til about five years ago when i finally found a gastro (now retired) who was more up to date and proactive about treating constipation.


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## TheOutlookChild (Sep 2, 2011)

Wow...everybody has been through so much hell. Glad things are somewhat working for y'all.


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## oceannir (Mar 6, 2012)

Sean said:


> The first sitzmark test was definitely the turning point for me in getting a grip on what was wrong with me and how to treat it. The gastroenterologist at the time was at a top teaching hospital here at the Texas Medical Center. He definitely "got it" after he saw the test results, especially the abdominal x-ray, and took me very seriously after that. I got my first referral to a colon and rectal surgeon from him. Mind you it took 9 years (from age 16 to age 25) to get to that point. Before that it was just "eat more fiber" or "men don't get constipated."


You mention yours started around age 16 (around the same age I began to get issues)Did you have trouble prior to this?My bowel seemed to be great until I was around 16, than it was slightly iritable but still worked until I was 20, than overnight it just stopped working completely pretty much and became reliant on osmotic laxatives to pass anything.


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## Sean (Feb 8, 1999)

oceannir said:


> You mention yours started around age 16 (around the same age I began to get issues)Did you have trouble prior to this?My bowel seemed to be great until I was around 16, than it was slightly iritable but still worked until I was 20, than overnight it just stopped working completely pretty much and became reliant on osmotic laxatives to pass anything.


I did have some trouble prior to age 16, but it wasn't chronic. I know that I did get Castoria and Milk of Magnesia on occasion as a kid to help me "go." I was never super regular. I started having more trouble around 11 or 12. I would not use public restrooms, especially at school. The summer when I was 11, I went to Boy Scout camp for the first time. The toilet facilites were beyond disgusting, so I "held it" for an entire week. Same thing later that summer when I went on a 10 day family vacation. I ended up virtually impacted both times. It was stupid, I know, but kids often do stupid things. I am sure that the withholding did not help. I also started to have a lot of stomach aches (usually from constipation) when I started middle school. Sometimes it would be so bad that the school nurse would send me home. I guess what I am trying to say is that there were signs that I had issues as early as age 11, but the severe chronic constipation didn't start until I was about 16 and in high school.


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## oceannir (Mar 6, 2012)

Sean said:


> I did have some trouble prior to age 16, but it wasn't chronic. I know that I did get Castoria and Milk of Magnesia on occasion as a kid to help me "go." I was never super regular. I started having more trouble around 11 or 12. I would not use public restrooms, especially at school. The summer when I was 11, I went to Boy Scout camp for the first time. The toilet facilites were beyond disgusting, so I "held it" for an entire week. Same thing later that summer when I went on a 10 day family vacation. I ended up virtually impacted both times. It was stupid, I know, but kids often do stupid things. I am sure that the withholding did not help. I also started to have a lot of stomach aches (usually from constipation) when I started middle school. Sometimes it would be so bad that the school nurse would send me home. I guess what I am trying to say is that there were signs that I had issues as early as age 11, but the severe chronic constipation didn't start until I was about 16 and in high school.


Mine was much the same, I remember asking mum for laxatives when I was younger, and I also remember having alot of trouble with incomplete evacuation, but like you it all really started at around 16. Strange really.


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## annie7 (Aug 16, 2002)

sean--i had much the same thing going on with me. as a kid it always took me a long time to have a bm. then when i was ten my parents started sending me to girl scout camp for two weeks every year--this went on till i was 18. and oh yes the facilities were, just as you put it, way beyond disgusting! only one outhouse --a two seater outhouse-- serving a large number of girls. i was totally unable to "go" in there because of the stench and also because of having another girl sitting right next to me. plus the other girls would start banging on the door if you took too long. utter hell. so i would hold it for two weeks. and my parents were angry at me when i came home all backed up like that. miserable situation. and ever since i have not been able to have a bm in public restrooms or even when staying overnight in other people's homes-unless i take a lot of laxatives to force it out.the whole camp situation certainly did not help my c problems any. it all got slowly and progressively worse after that.


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## oceannir (Mar 6, 2012)

Funny how so many of these issues are linked to mental situations such as that.The one true amazement of the entire situation for me was that the symptoms all but disappeared for a year after suffering for years and than for no obvious reason came back twice as bad as they were. I still find this a peculiar element of the 'IBS'.


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## annie7 (Aug 16, 2002)

in re the mental situation...do you think maybe your c problems came back as you said at least in part due to to the stressfull new job situation that you described in your very first post in march ...and that it's now--for whatever reason-- taking a while to get out of the whole thing...if my reasoning--or explanation of it-- makes any sense--lol... i'm pretty scattered sometimes.i'm just remembering all you said in your very first post in march (" a new job practically killed me") when you talked about the demands of your new job and that it was then that your "bowel almost instantly stopped working effectively". of course, the question is how to get it all working again...and many other questions too, of course. hopfully your upcoming tests will provide answers and your doc will have the solution and a treatment plan that works well for you.


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## oceannir (Mar 6, 2012)

annie7 said:


> in re the mental situation...do you think maybe your c problems came back as you said at least in part due to to the stressfull new job situation that you described in your very first post in march ...and that it's now--for whatever reason-- taking a while to get out of the whole thing...if my reasoning--or explanation of it-- makes any sense--lol... i'm pretty scattered sometimes.i'm just remembering all you said in your very first post in march (" a new job practically killed me") when you talked about the demands of your new job and that it was then that your "bowel almost instantly stopped working effectively". of course, the question is how to get it all working again...and many other questions too, of course. hopfully your upcoming tests will provide answers and your doc will have the solution and a treatment plan that works well for you.


ah they've been problematic for a few years now.But for whatever reason when i was around 20 years in age, they just disappeared for a year. I didn't have to sit around in the morning waiting to go, I didn't have to run to get a BM, I was just regular and normal. I thought the IBS-C had left me, I stopped taking all supplements and my body was fine. Than one night I got a bit of food poisening and my bowel just shut down, it has never been the same again.And for me it is 100% stress based. If i'm in a great mood my bowel is far better. But these days it is still reliant on lactulose to help it go. Years ago before it just 'stopped' that random night it was managable, painful but manageable. Obviously all the doctors have no idea why I could go from perfect one night to it just randomly stopping, but I think that is the nature of IBS in many ways.I kind of wish I never got put into researching it, but if I hope to ever work a 9-5 job effectively I need a better sollution, unfortunately researching it has just uncovered all of the bad advice doctors have given me over the years and makes me wonder if I should have pushed for more. Alas its too late now. It was really hard for me (as sean mentioned above) as when your a kid its all very confusing, if it came about in my mid 20's i'm sure I would be far better at managing it. Its all very scary when you are 16 and no doctor seems willing to help.I think thats why so many people see IBS as such a huge problem and often result to taking laxatives long term... no doctor just seems interested in giving them advice. They say there is no problem, or blame it on stress/being in your head. For most of this we deal with it from a very young age too in which case we are rather 'bad' at explaining things to the doctors and parents to get us better help.


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## Sean (Feb 8, 1999)

annie7 said:


> sean--i had much the same thing going on with me. as a kid it always took me a long time to have a bm. then when i was ten my parents started sending me to girl scout camp for two weeks every year--this went on till i was 18. and oh yes the facilities were, just as you put it, way beyond disgusting! only one outhouse --a two seater outhouse-- serving a large number of girls. i was totally unable to "go" in there because of the stench and also because of having another girl sitting right next to me. plus the other girls would start banging on the door if you took too long. utter hell. so i would hold it for two weeks. and my parents were angry at me when i came home all backed up like that. miserable situation. and ever since i have not been able to have a bm in public restrooms or even when staying overnight in other people's homes-unless i take a lot of laxatives to force it out.the whole camp situation certainly did not help my c problems any. it all got slowly and progressively worse after that.


OMG, I can laugh about it all of these years later. We had the two-hole outhouses at boy scout camp, too. They had no doors, so boys would just randomly wander in and out. There were no toilet seats, just holes in the boards. Wasps would build nests under the boards to create an added hazard. Add the 95+ degree Texas heat and it was simply intolerable. My first and only visit was short-lived. I know that other kids were having the same issue. About 5 days into the camp, the camp nurse came to our campsite to lecture us about the dangers of not going to the bathroom regularly and tell us to make sure we notified her if we were having those kinds of problems. I think most of us figured that the cure would be worse than the problem so we kept quiet. One kid did go to the nurse's cabin for what he said were stomach aches. He refused to tell anyone what happened to him there. That only fueled speculation among the campers that it couldn't be good.


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## Sean (Feb 8, 1999)

oceannir said:


> Funny how so many of these issues are linked to mental situations such as that.The one true amazement of the entire situation for me was that the symptoms all but disappeared for a year after suffering for years and than for no obvious reason came back twice as bad as they were. I still find this a peculiar element of the 'IBS'.


I know that stress played a role in mine getting worse. I started having really bad stomach aches in middle school. I started middle school when I was 11 and entering 6th grade. Some of the 8th graders were 13 and 14 and many of the boys were well on their way to being men. As 6th graders, we were pretty much the victims of the older kids. Plus, middle school was much more like high school than elementary school. Much more was expected academically and in athletics. I was totally terrified. To make matters worse, my family was very-achievement oriented, so grades and extracurricular activities were very important. I was the type of kid who tried to please everyone and I ended up being a nervous wreck. No wonder that my bowel issues were really starting to show up by the time I turned 12.


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## annie7 (Aug 16, 2002)

sean--omg is right--no doors! yikes! at least we had doors--lol--course they were badly warped and didn't close properly and were always a bit ajar...and oh yes, the heat, the stench and the wasps nests..fond memories of camp.i remember one girl screamimg in one of the "stalls". the counselor explained to us terrified bystanders that she was having "some problems" and was going to see the nurse.and yes i think you're right--under those abysmal conditions, the cure might well have been worse than the problems.


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## DECIE (Jul 10, 2012)

As everyone here said, YOU ARE SO LUCKY to find one, ESP. a colorectal surgeon who is interested in the problem and NOT THE SURGERY. I went to two, I have a slow moving colon and they said a rectocele, the gyn said a cystocele. But, they had no options, no tests, no anything JUST SURGERYL They didn't want to discuss anything else except to REMOVE my entire colon and fix the rectocele if they could. Before you have any surgery, if God forbid it comes to that, find a PELVIC FLOOR PHYSICAL THERAPIST, mine is wonderful and the 'cystocele' is fixed, up and tucked where it should be. From biofeedback and exercises. I still have a lot of issues, that doesn't fix the IBS symptoms but it is better and easier, for the most part. I am just trying to stay out of surgery until a last resort.Good luck to you. I hope it goes well.


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