# update on my problem



## Mary2001 (Aug 25, 2006)

Hi to everyone, Its been a while since I posted on the ibs forums, and on the women's issue forums so my latest update is I am seeing a pelvic floor physiotherapist and doing pelvic floor exercises. My problem seems to be a pelvic floor problem i.e. that my back passage is pushing up against my front passage and causing a feeling of fullness, pressure and bulges, and problems emptying my bowel and knowing when its properly empty. The lining in my back passage is prolapsing also. This pressure is very uncomfortable and my physio has said that it is a difficult one to handle and even if I would have surgery that its not always successful. The way I was handling this problem for the past few years was that I kept going to the toilet all the time to try and keep emptying my bowel and ease all that discomfort as I never knew when my bowel was empty and felt I could not tail off a bowel movement properly and unable to empty my bowel properly. Now I think that the pressure was coming from the prolapse lining and not a need atal to keep emptying my bowel (it just felt that way) That is still my situation, but I am doing pelvic floor exercises now to see if I can pull everything back up again, and it will probably take 3 to 6 months of exercises to see any changes (I sincerely hope this works as I am so tired of this problem) My question is if anyone out there has this sort of problem i.e. back passage pushing up against vagina, and a vaginal bulge, and feeling full down in the groin area, then if you found anything to releive or help with the discomfort then I would be grateful for any tips or help you an offer. I have tried so many things to help but nothing works, and the only way I can soothe this discomfot is when I would have felt that I emptied everything out of my bowel, and then I would have no more pressure feeling. Anyone? Thanks for reading my post and any help offered.


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## MollyB (May 3, 2009)

Hi Mary,Sounds like we might share some symptoms. I had rectocele surgery in the past and thought after the surgery everything would be back to normal; however, I am still experiencing problems related to pelvic floor. I can NEVER completely evacuate when having a BM and have been told when I push that part of my intestines comes out. I never feel empty and make many many trips to the bathroom everyday. It feels like stool just won't move, and if I push, it locks up the muscles making it almost impossible to pass stool. I've been through the phys therapy three different times over the past six years. It helped a bit, but it's not a cure. I currently am taking 2 capfuls of Miralax daily to make it easier to pass stool. How's your emotional state? I feel so defeated by this problem that I have problems with anxiety and depression.Molly


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## cherrypie09 (Jan 20, 2009)

Hi mollyMy bms are getting worse, I get up in the morning and strain to go, then about 1 hour later it feels like there is more there to go but its soft and sticky and i cant push it out, (sorry if tmi). As you know i am having the same test as you, but when i do muscle pull ups it gives me the feeling like i need to have a bm even more, i want to strengthen the muscles to help me go without straining, but by pulling the muscles up to strengthen, makes the feeling of wanting a bm worse, i go enough times now without any more. How can the toning the muscle axercises work for helping with constipation and diarrhoea, as it makes you want to go more. i am confused.


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## MollyB (May 3, 2009)

That sounds exactly like what I go through each day, so no it is not tmi for me. I am using 2 capfuls of Miralax daily and lots of water to make stool so thin that I don't have to strain. I know what you mean about pooping all day.....it's so tiresome, but this Miralax has helped a bit to get it out faster and I'm not in the bathroom quite as much during the day. I also have to use glycerin suppositories to get it a push. The kegal exercises are helping your muscle to relax, and that's probably why you feel like you have to go when you do those exercises. I have the same issue. Also my phys therapist says when I lie down, the rectum will realign, so that may be part of it, too, because I lie down to do the kegals. You may have multiple things wrong like I do. My phys therapist reminded me that I have intussecption, which is a condition where the rectum moves downward when having BM, and in my case, comes out slightly when I push down. I've been told its like a telescope that collapses, so that's why stool gets thinner and can't move out. I've been diagnosed with so many things that I forgot about intussecption (I'm not spelling it correctly), so I've now contacted a general surgeon to see if he can help with this condition. I've also just been diagnosed with non-relaxing puborectalis muscle, which also causes constipation. When pushing down to have a BM the muscle tightens and pulls the intestine out of alignment. With both of these issues, I don't have a chance of complete evacuation. Have you had defacography? Intussecption can be diagnosed with that test. It's terribly embarrassing, but I've been through it 3 times, and if it's needed to get me properly diagnosed and the problem corrected, then I'll do ANYTHING!Molly


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## cherrypie09 (Jan 20, 2009)

. Hi MollyWhat is this test that you have had. whats it for.(Have you had defacography? Intussecption can be diagnosed with that test. )I always feel as though i have got to go more when i have a bm, if i pull up my muscles, it makes me feel like i want to go more, but i cant get bm to come out easily, doesnt matter wether i am constipated or have loose bms.


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## MollyB (May 3, 2009)

Yes, that's exactly how I feel, too, Cherrypie. The test was I had was defacography. I've had three tests actually. One showed another small rectocele and intussesception, then the next test a few months later didn't show either of those. That's why my surgeon has not operated. I am so frustrated because I KNOW there is a physical abnormality along with the IBS, but that last test didn't show anything physically wrong. I've also had an MRI which showed only a slight muscle problem. Seems like everytime I go to the doctor that I'm having a good day and the problems go away. Then the next day it's HELL all over again, but there is no doctor around to witness it.


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## Mary2001 (Aug 25, 2006)

Hi Molly and Cherrie. Thank you very much for your replies, and sorry I did not get back to you both sooner, as there was a problem with my omputer. (not very good at the technical side of things) What types of physiotherapy did you have and the intussusseption is what I have as well. The co-rectal surgeon did say that there was evidence of internal instussessception, so Im wondering if I wil ever get any better. What I do everyday is go to the toilet a few times in the morning and empty out (I never seem to know when I'm empty properly) so I just go everytime I feel theres something there. You asked how is my emotional state, well it is depressing to say the least, and I'm trying to hold down a part time job which can be nerve wrecking when you think you need to "go" just as your walking out the door to work. I do not think my surgeon is eager to do any surgery for this problem, so I am sort of pinning my hopes on the pelvic floor exercises being of some value when I finish doing them in a few more months. I dont know at this stage what sort of physiotherapy they do for that. Do either of you know, or did you find the physiotherapy helpful. I wished to God there was something for this problem. You mentioned your intestine coming out, I always think too that there is a loop or something up there that is misplaced as when I feel a pressure downwards and think its the toilet I need, it turns out I am pushing "something" which feels like a bowel movement, but I think when nothing comes out that it must be something else, but I cannot tell the difference if its a bm or that "other thing thats pushing down" However with this problem I think I am not able to "fully" empty my bowel whenever I go, and that it all builds up and up and then I am overloaded after a few days. Well thats my symptoms anyway, and I do not know what else to try. I take movicol (a laxative) every second day to try and keep me from feeling discomfort, but it is not a great help and I have discomfort every day. I am grateful and thankful to you both for replying to my post, and for your support, and if theres anything else that you find helpful it would be great. Please keep in touch and let me know how things going for you. Thanks again for replies and help. Mary.


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## Mary2001 (Aug 25, 2006)

Molly That is strange that your defecography test showed a rectocele and intussussectpion and then another time it did not show those conditons. I had a proctogram done in Dec. 2007 which is something like a defecograpy, where you just sit on a fake loo and try to empty paste mixture out while they take an x-ray. Last year I had that proctogram, and the result was a rectal lining prolapse, with no evidence of intussusseption or rectocele, so then I had an internal exam done by a co rectal surgeon while I was under anesthetic last October, to remove a polyp, and he said there was evidence of internal intussessecption and sent me for phsyiotherapy. I do not know why I got two different answers either as to what is causing the problem, as I wonder which test actually would tell if there was internal intussusseption. The physio whom I saw recently put me sitting on a fake loo and saw a bulge coming out at the front and back, and it was evident worse on pushing down, so I am being referred back to the corectal surgeon again. I am living in Scotland, and I don't know if they do the same tests here as over in USA, but its a puzzler why theres two different diagnosis, and I feel if only I knew what exacxtly is wrong then I might feel a bit better about it at least. I wondered what age group you are. I am in mid fifties and am putting this problem down to some pelvic floor weakening due to age, but again I dont know. I never feel comfortable unless my whole intestines is cleared out, and then I feel ok for a while and it all starts again. The discomfort is like a feeling of needing to go versus needing to get gas released, and when I can't do neither its so uncomfortable, and also I feel like the contents in my stomach have stopped moving along, so I think that is something that is prolapsed and not anything to do with the bowel, but again I dont know. If I had one wish in the whole world it would be to get rid of this problem. The only help I can offer you is that when I feel discomfort, I lie down and listen to music on a small radio at a very low volume right beside my ear, and it makes the contents in my gut move on a bit and releases some pressure sometimes. That only works sometimes though and I do not know anything else that helps except extreme patience and hope that maybe someday it will cease. Thank you for your support. Mary.


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## cherrypie09 (Jan 20, 2009)

Hi Mary And MollyWhat is a intusseception and a Rectocele. ?,I know what you mean about wanting a bm, but it feels like you need to go but there is nothing there, i always feel uncomfortable in the rectum, like a bulging feeling. I have had a camera up my bottom and everything came back normal, i have had the doctors put their fingers up there and examine me, they say everything feels ok. so i dont know why i feel like i do. I am having a probe and balloon put up my bottom to test the muscles inside and may need physio depending what they find. I live in Gloucester.


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## Cathy in CA (Feb 5, 2009)

Oops, that'll teach me... I answered your first post before I noticed this update one. I'm just going to copy what I wrote there and paste it here. I think Molly and CherryPie have more experience but maybe you'll get something out of my reply. Good luck to you all. IBS is bad enough all by itself. I will learn from you by checking this posting though because after 20yrs diarrhea from ulcerative colitis then 20yrs from IBS, I may end up with weakness too. Here's what I replied to your first post, asking what it is...Rectal prolapse is when the outer wall of the rectum protrudes from the anus. I think that like rectocele, where the roof of the vagina caves in so rectum above that sort of falls down into the vagina, it is commonly seen in the elderly who have weakening of ligaments and muscles. It can also gradually occur from prolonged diarrhea and constipation and childbirth. It's all about weakness so I guess we should all be doing Kegal exercises and taking fiber. I think there is surgery for it too, but I don't have any experience with this or even know anyone who has gone through it. I imagine surgery is reserved for more severe cases or those whose function is badly compromised because of it. What does your doctor say?Cathy


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## MollyB (May 3, 2009)

Hi to all who have replied to the posts,I don't know where to begin in responding because I can relate to everything that everyone has written. I'm 60 and have suffered with all my pelvic and intestinal problems for 10 years now. It all started when I picked up a heavy object and felt a "pop" in my pelvic area. I had just started going through menopause at that same time, so I didn't think about the pop being related to the constipation and gas problems. Now, I think the pop was the rectocele, but for 5 years, all the gastroenterologists I saw (and there were many) told me that I had IBS. By the time the rectocele was diagnosed by a urogynecologist, I really had developed IBS issues because of my anxiety and depression caused by the embarrassment of smelling bad from all the gas I had. (Rectoceles cause you to be very gassy). Neither the surgery to repair the rectocele nor the phys therapy (sometimes called biofeedback) were the cure I was seeking. I recently saw a new urogynecologist who disgnosed non-relaxing puborectalis muscle, so that problem, along with intusseception that was diagnosed about a year or so ago, probably means I will never feel normal again. I never feel like the bm is complete, and I'm in the bathroom for a minimum of 3 hours straight every morning (literally) and multiple times during the day while at work. Just as you said Mary, as soon as I head out the door to go to work, I get that feeling that I have to go again, and I'm stuck on the toilet for another hour or so. Every time I push, it seems stool is just stuck and won't move out. It gets thinner as the day progresses which I guess is caused by either the intusseception or the non-relaxing pubo muscle or both. The more I push, the more anxious I become because I know its not going to do any good. The only thing I can pass is gas, and I have a lot of that from all the trapped stool. At some point during the day, I've pushed so much that I feel like there is a hugh knot in my vagina or that all my intestines have fallen into the perineal area. Plus when I'm sitting, which I have to do at work, I can't tell that I have to go to the bathroom. When the gas starts or I start to feel my intestinal muscles go into spasm, I realize that I probably have to go. Needless to say, I'm not a very popular gal at my office. The 2 capfuls of Miralax daily have helped some because stool is liquid enough that it passes more easily, but I can't take laxatives the rest of my life. Mary, you mentioned having to lie down and listen to music in order to feel better. My phys therapist told me its good to lie down after a bm because the rectum can realign itself. I soak in the tub every morning while doing my kegals which helps some.Thanks to all of you for your comments. It helps to know I am not alone and my symptoms are real. Over the years, doctors have made me feel like I was crazy and that my symptoms could be cured by increasing my fiber intake. Fiber is not always the answer to intestinal problems.Molly


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## cherrypie09 (Jan 20, 2009)

HiThats what im having biofeedback next week with the probe and baloon for the muscles control of the anus. 2 years ago i had a front and back vaginal repair, so my bowel has not come down into vagina, as i saw gyny back in march and he said everything was still fine there. I find that when i want a bm i sit for ages and strain, it starts to come then i struggle to get the rest of the bm out(sorry if tmi). What is intersusseception. ?We seem to all have something similar, i dont know which is worse, having loose bms or hard ones, i cant go properley with either, i have a job to get them out anyway.


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## MollyB (May 3, 2009)

Hi Cherrypie,Biofeedback here in US is when the physical therapist places sensors on the buttocks and stomach to gauge the strength of the muscles. She then teaches kegal exercises to retrain the muscles. I've mentioned before that I'm going through PT for the third time in the past 4 years. It didn't work before, and I don't expect it will work this time either. Yes, it helped a little, but not enough for all the expense. I want a cure, not something that just helps a little. You asked about intussesception - it's where the intestines collapse upon themselves. Think of a telescope with the narrow end pointed downward and think about how it collapses from the the large end to the narrow end. That's what the intestines do and that's what makes the stool thin. Sometimes mine is very thin - smaller than a pencil, but I still can't pass it. With the non-relaxing puborectalis muscle, any push causes the muscle to pull the intestine out of alignment, so stool can't pass normally. When this new doctor diagnosed the pubo problem and explained how the the intestine is pulled forward, then I understood why I have the sensation of stool being pushed against the wall of the intestine rather than downward. With both the intussesception and pubo problem, I'm afraid there will be no cure for me.I know exactly what you mean about not being able to pass loose or hard stool. Sometimes it feels like a piece of stool gets stuck about four or five inches up inside me, and if I'm finally able to pass it, it is never bigger than a grain of rice. Doesn't seem right that something that small should get stuck.I was wondering if you have had defecography (possibly proctogram in UK). If you've had previous vaginal repair, there may still be a problem that the proctogram would detect. Try a gynecologist who specializes in pelvic floor problems. I had to find a new gynecologist to diagnose the pubo problem because the gynecologist who had done my surgery kept telling me there was nothing wrong.


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## Mary2001 (Aug 25, 2006)

Hi all. Thanks for replies, and it looks like we are stuck with these problems with no workable solution. I was hoping that maybe physiotherapy might help in some way. I have also being diagnosed for a long time with ibs (had the camera up) and all the other tests, and I am angry now, because they did not find out the proper reason for my symptoms and didnt find anything in the camera test, then they automatically assumed it was ibs. I really do not think I have ibs atal, and that all my problems are stemming from this pressure and bulge feeling (when the bulge comes out it feels like I need a BM) very frustrating trying to figure out if its the bulge causing pressure or if I really need a BM, as the two sensations are the same. I have now tried not pushing so hard as its not stool I am pushing half the time when I think I need to go, so what I do is blow air with my mouth into my fingers , ie, (imagine if you felt cold and blew into your fingers to warm them up) while gently pushing to see if I can get stool out. This does help a bit, and like you Molly I feel my intestines are sitting right down on the perinium too, and that if I had some sort of support to hold it up a bit that it might help. You said you felt a pop one time after heavy lifting. Well I heard what sounded like a pop or tear a few years ago while straining to have a BM, and I also think maybe I did some sort of damage then. I never mentioned this to any GI doctors or physiotherapists, but wonder if theres anything they could do even I did, like find out what exactly popped. Don't know over here in UK if there is any repair op for the likes of that, some mesh or something to support it. Again I don't know if that op is successful either. Did you have your pelvic floor tested Molly? The only other thing I find a bit helpful is lying down and taking deep breaths and being aware of each breath in and out. It feels like that does move the contents along in my gut, and it doesnt feel so knotted then, as I feel if things are not balanced properly in there that it tends to feel lopsided like a clock sitting off balance, and that the contents are not moving along properly Hope this helps someone, but I have no other solutions to this problem . Thanks again for all replies and support, and it is good to know that we do not suffer alone. Still I really wish there was some help available for these problems as they are a nightmare to live with. Mary.


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## pattygk (May 27, 2009)

Hi, I have rectal prolapse. I am pretty sure it is from the IBS. All the things you mentioned sounds like mine but the vagina is not buldging yet. My doctor told me the excersize I would of been able to do would of had to of been done within 3 months of giving birth, so these excersizes sounds interesting. I have had a complete prolapse surgery in 1996 and another prolapse last Oct. they say it is not for ever, may last 5 years or not. The pressure that comes from this does make you feel you have to go to the bathroom all the time. It sucks!! I kept going back to the doctor thinking that the prolapse was falling only to find out I have IBS so I am thinking about going to a gastroenterologist to see what they say. Being a female with the rectal problem and the IBS makes it very hard to do much of anything, including sex. I just joined this forum in hopes to find people that are going thru the same things I am. I can not find any support groups around here. Well good luck! Thanks Patty


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## cherrypie09 (Jan 20, 2009)

When i had the anal mametry yesterday and the biofeedback, they put probes attached to the computor and put a baloon up my bum and gradually put more and more air into it and i had to say when it felt like i needed a bm and then at what stage did it feel like i couldnt hold on. The nurse that did it said it feels like the mucosal lining in the rectum comes down slightly when i push for a bm, hope its not too worrying, i dont want a operation, as i would be so frightened to go have a bm afterwards in case i damaged it again.Ive had a vaginal prolapse repair done, where they took some tissue away from the front and back of the vagina and put a support mesh in at the back where the bowel comes down to help strengthen it. I had this done about 18 months ago. But since ive had trouble with getting my bms out and doing a bit of straining, i feel like im bulging in there again, but saw gyny and he said everything felt fine, but i get a definate bulging feeling when i think i need a bm, sometimes i go, sometimes i cant, if i strain my stomach hurts and my piles bulge out, (yes another problem with straing for the loo).When i need a bm it always feels like some has got stuck somewhere and i have to push my bottom cheeks together and down to try and push the bm out.This is so horrible, its bad enough having IBS-D without this, I also suffer from anxiety, which makes everything seem worse.I live in england too.


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## cherrypie09 (Jan 20, 2009)

Hi MollyWhat is a proctogram, what do they do and what can they tell is wrong.Good luck today at the hospital, i will be thinking of you.


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## MollyB (May 3, 2009)

I believe it's called proctogram in England, but it's called defocography here in USA. The patient drinks a barium liquid and then a barium paste is inserted into the rectum. You are placed on a toilet-like device and x-rayed while pushing out the paste. The test detects pelvic hernia and intusseception, which is like what you described with the mucousal lining coming out.


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## cherrypie09 (Jan 20, 2009)

Hi MollyI dont like the sound of that, i hope i dont have to have that done, the lining hasnt actually come out yet, the nurse yesterday said it felt a bit loose.


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## Mary2001 (Aug 25, 2006)

Hi Cherriepie, and Molly . Thanks for posting. What you are saying about rectal lining coming down is what I am supposed to have. It was detected with an xray of me sitting on a fake toilet. I did not have barium or any liquid, it was some sort of paste "like mashed potato mix" to quote from them!! that they inserted into my back passage, and asked me to try and empty it. Anyway I could not empty it out, atal, and felt extremely embarrased, so that is how my rectal lining prolapse was detected, by viewing on the xray what was happening. They said I do not have a rectocele or any evidence of intussusseption, so I am now wondering how is intussessuption actually detected? My corectal surgeon said there is evidence of intussesseption (he is going by an internal exam he done) so its two different opinions, as the protogram said theres no evidence of intussesption. I always feel that I've not completed a bowel movement properly and if I kept trying to dooms day it would still be the same sensation of incomplete emptying or sort of a loose feeling like something did not close back up properly, and that I need to empty more. Now I think that maybe my whole problem i.e. that my back passage somewhere internally is not closing properly while having a bm, and it just gives a "sensation of needing to keep emptying". It causes a lot of discomfort low down in my pelvis like pocket of wind trapped there somewhere and I cannot release it. Does that sound anything like what you are experiencing with the lining coming down. Molly how was your intussusption detected. What test? I am most thankful to you both for your input on the boards, and its good to exchange ideas. Mary


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