# occult rectal intussusception



## Mary2001 (Aug 25, 2006)

Hi All. Its been sometime since I posted on the boards. I've found out that my problem is occult rectal intussussception, and the only treatment is either surgery which is not successful or a colostomy which I do not want, so if anyone knows of anything else to treat or manage this condition, then all info greatly appreciated. I have posted on the boards in the past as been diagnosed with ibs C, but now been told its rectal intussception. Its horrible as I have constant trapped wind feeling between the front and back passages which I cannot expel all day, everyday, and its not any foods is the cause just the prolapsed lining of the bowel is causing it, and I find it so hard to live with. Tried so many things. Anyone any more ideas? There is a few of us have this problem and seeking help. Thanks for reading my post. Mary.


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## cherrypie09 (Jan 20, 2009)

I have this as well, it is very uncomfortable all day every day, feels like you are sitting with a golf ball in your bottom(sorry if too much). The wind is embarrassing. You never know if you need a bm or if its just wind or its the rectal lining prolapse causing the discomfort, only doing pelvic floor exercises 3-4 times a day every day can help it getting worse and not straining on the toilet, as mary said surgery is not realy given as not very successful. I also have IBS-D. Any help and advice greatly appreciated.


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## Kathleen M. (Nov 16, 1999)

Unfortunately anatomical problems like that usually aren't something you can take a few herbs for or a vitamin or two and have it go back to normal. I do not know if any pelvic floor exercises would help with something like that, so other than keeping the stool soft enough to get past there easily I'm not sure what you can do as self care.


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## idkwia (Feb 26, 2009)

As some regular posters will know I know quite a lot about this condition. I have previously stated that I am certain that many people who have been diagnosed with IBS do in fact have a rectal intussusception (otherwise known as an internal prolapse). A rectal intussuscpetion is where the colon prolapses, which means it become loose from its moorings and telescopes inside itself particularly when having a BM and more so on straining. This creates difficulty in evacuation and often gives a feeling of something stuck in the rectum. It can also cause constipation which can then overflow into seemingly diarrhea. Two surgeons I met said that some patients with this condition also have acid reflux. It can also create thin flat stools. lt should not be confused with a mucosal prolapse of the colon which just involves the telescoping of the lining of the colon although I do believe they can cause similar symptoms. It should also not be confused with a full prolapse of the colon where the colon actually descends out of the anus, but again has very similar symptoms. This condition can also me combined in women with a rectocele which is where the colon sort of herniates into the back of the vagina causing faeces to become stuck there also. All of these conditions are more common in women especially those that have had children althought the exact cause is not known.Surgery *can certainly correct* this problem see *http://www.dailymail.co.uk/health/article-1207203/Me-operation-Doctors-said-I-IBS--fact-Id-suffered-prolapse.html*I have met the surgeon who did the above operation.It is not guaranteed that surgery will work but in the above operation they state an 80 - 90% chance of success depending on the starting point. The most important thing is to choose the right surgeon and the right procedure as there are a number of different procedures. It is also important that the surgeon chooses the right patient and condition for the right procedure and this is why the choice of surgeon is so important.Most good surgeons will recommend trying bio-feeback before surgery as this can sometimes manage the problem however, if the prolapse is deep then surgery is probably the best option.In the meantime it is a good idea to take a non-stimulant laxative such as Movicol (Miralax in the US) and drink plenty of water to keep stools bulked and soft and then when having a BM not to strain, just try to let things happen.I am in the UK so if anyone wants any help choosing as surgeon then just let me know. If anyone wants any other advice then either post here or send me a PM.Good luck!


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## strawdog (Jan 28, 2009)

I wonder how any of the people with this condition got diagnosed. I've suspected for a while that there might be rectal issue for me as there is a strange chronic pain there and feel as though it could be the cause for backing things up (tho possibly just from fissures/piles which I've also have). My doc didn't seem to engage with the idea when I suggested it. Did you come up with this possibility as a suggestion yourself after research? or did the doc find it after extensive tests/exclusions? or was there a symptom or give away sign that lead you to this conclusion? It seems hard to know if it could be a root cause of problems as l imagine its likely a lot of people will develop anatomical problems after extended periods with elimination issues.


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## idkwia (Feb 26, 2009)

Strawdog - you need a defecating proctogram for diagnosis. This is where they put barium meal into your rectum then take X rays whilst you are having a BM. Sounds horrid but really isn't at all, trust me. Also, a good surgeon will be able to see it sometimes by using a finger or with a sigmoidcsope. I saw several GI docs before one suggested that I have this test. However, when I met the doctor who did the test as soon as I told him my symptoms he told what I had even before the test! It really depends on how good your doctor is and believe me it is scary how much they vary.


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## cherrypie09 (Jan 20, 2009)

Mine is actually the rectal mucosal lining telescoping on itself, the rectal surgeon i saw diagnosed it with examination and a proctoscope. He said surgery isnt successfull and he wouldnt do it, I have biofeedback and am told to do pelvic floor exercises and dont strain when going to the toilet, this should prevent it from getting any worse.


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## Mary2001 (Aug 25, 2006)

Hi Idkwia. Thanks for your reply, and all the information, and I'm glad your operation was a success and things worked out for you. I think in my case and my friend's case, it is rectal lining prolapse. I had a proctogram done which said there was no evidence of intussussception, but what appeared to be rectal lining prolapse. Then I had a digital examination by a surgeon, and a polyp removed, and he sent me for pelvic floor physio and stated in the letter to the physio that there was evidence of an occult rectal intussusception. I am presuming that is the same thing as rectal lining prolapse as my physio has said its like putting on a coat with the lining coming down in the sleeve. The trapped wind is what drives me crazy and can't get anything to help with it as its constant everyday and the lining and not foods is the cause of it. Thanks for you info and help. My surgeon is reluctant to do surgery as he says its not successful and only other thing I could get is colostomy which I definitely do not want. If I could get help for the trapped gas discomfort I would be fairly happy, but nothing seems to work for it. Thanks to all who replied also, and if anyone else has any more suggestions it would be greatly appreciated. As you said there may be a lot of people diagnosed with ibs who have a prolapse of the lining as symptoms are a bit similar in ways. Mary.


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## Naomi889 (Sep 11, 2005)

Where are you all situated? Are any of you in the UK?The reason I ask is that I was discussing this with Idkwia and it seemed to me that I'd got quite different advice to him from the surgeon I'd seen about my rectocele and from the guy who did the proctogram diagnosing the rectocele. I'm trying to figure the general current medical view on the whole thing out. Idkwia points out that there are different types of rectocele (prolapses) although I am a bit confused about these differences as there is conflicting info on this on the web. All I was told was that I had an "anterior rectocele". The guy who did the protogram said "You have a significant rectocele, but 70% of all women have a rectocele". If that's true I don't see how they can distinguish who has a rectocele which is causing symptoms and who has one that isn't. I saw a surgeon about this but she had never removed a rectocele to treat bowel symptoms in a women who had not given birth and was really quite dismissive of the idea. She also told me there was a major risk of permanent pain during sex in women who get this done.I remember that you are Scottish like me, Mary. I live in Glasgow but am being treated in Edinburgh - the proctogram I got and the surgeon I saw were both in Edinburgh. Were yours done in Glasgow?


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## cherrypie09 (Jan 20, 2009)

Naomi889.The anterior prolapse you refer to is where the rectum is prolapsing and causing to come down and press on the back part of the vaginal walls, I had a operation to pull up the vaginal wall and insert mesh to strengthen the back wall of the vagina, they wont do it to those who have not had children as it makes the vagina smaller, where they have to cut it and pull it up and then in turn can cause pain on intercourse, but if you are sexually active, as i was they take that into account and dont cut and pull up so much. This is very different to a rectal mucosal lining prolapse. Hope that helps


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## strawdog (Jan 28, 2009)

Mary, the cause of my condition is still undiagnosed, this is still just one of a few different lines of investigation for me, but just in case you haven't tried this, I get relief from trapped wind from whats called the knee-elbow position. I posted about it yesterday here:http://www.ibsgroup.org/forums/index.php?showtopic=109847I'm not sure why it works for me, one possibility among many is that the changed position opens up a constriction in the back passage. idkwia, thanks for the info, i know what you mean about doctors, really seems to need large degree of pot luck. If you don't get that luck (ie a knowledgable doctor with an open mind) then I find you have to be very firm and well researched to get a proper hearing and avoid being fobbed off. I changed doctor a couple of times and fared little better so have settled back on my original doc who at least listens once you show him who's boss!Could I ask, what where the symptoms in particular that lead the doctor to be able to make a diagnosis before the test. Don't want to kick up too much fuss if I'm barking up the wrong tree!


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## King Of The Small Room (Aug 13, 2009)

As Idkwia knows (he's given me some really useful advice on this subject via PM's) the rectal prolapse angle is something I intend to pursue in the coming weeks and months, beginning with my GP on Thursday.The advice about not straining is obviously good, especially as it will almost inevitably make the prolapse itself more pronounced as you actually do the straining. But it's very hard advice to stick to. If I didn't strain I think I'd be sat on the toilet for the entire day.One thing that's to my advantage is the fact that ever since I've had the problem (a very long time) I've always passed D. It'a almost as if my body has found it's own way of coping with this, though it's more likely to be down to the SIBO that I also strongly suspect I have. If I was constipated in the traditional sense with hard stools, I'd be worried I'd never go to the toilet again, or end up like the girl featured in Idkwia's link, needing hospital admissions and strong enemas.Anyway, I'm getting ahead of myself. I need to get it officially diagnosed first which may not be that straightforward and, will probably be much further down the line.Good luck Mary btw, and all those similarly affected.


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## sirjohn (Sep 29, 2009)

I really feel for all the people with this problem. Having constipation problems has almost driven me insane. I have a exterior prolapse, my doctor said he didn't think it was to bad, and that it would probably take care of itself.I have endless gas some days. And can't seem to pass most stools without straining even if they are soft. Unless I take a really strong laxative like go lytle, something enough to turn my stool to diarriah.I would have blood in my stools most of the time from straining. I had crones disease with diarriah for 30 years (before the IBS constipation). And I use to love to sit on the tolite and read, and strain for long periods of time. I'd strain to try and get all the diarriah to come out, so I wouldn't have to go back in the bathroom so quickly. (Dumb me huh?....)I've found that enema's are the only thing that seem to really work for me. And that I have little or no blood in my stools with taking a daily enema. And my prolapse does seem to be improving.I still take mirilax everyday to keep the stooles soft. And I do still foolishly strain some, on the small amount of stool I have inbetween the enamas. But my bottom feels much better, as I had trouble even sitting for periods of time previously.


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## rocketiz (Jan 1, 2005)

Thanks Idkwia,I may investigate this as well. This sounds suspiciously what could be a diagnosis that makes sense for me. I also have some rear-end discomfort. I often have the flat stools. It feels that I have trapped gas or incomplete evacuation with something always in the rectal area. The thing is to find a physician who would consider this instead of dismissing it all as IBS (which may still be a contributor).


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## cherrypie09 (Jan 20, 2009)

I only became constipated by taking too many imodium because i have ibs-d, but now(damage done) i have the ibs-d manageable, but still passing loose stools, i do sit and strain, its as if i can not completely go, which sounds weird, as i am usualy loose, but because of the prolapse the surgeon told me i could get stool left behind making it not easy to go to the toilet. But definately dont strain. I was refered for biofeedback and told to do pelvic floor exercises. I was sent to the rectal surgeon because my doctor thought i had haemerrhoids, it was discovered that it wasnt and was the rectal mucosal lining telescoping down, luckily not a complete rectal prolapse.


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## King Of The Small Room (Aug 13, 2009)

It seems the colo-rectal surgeons of Britain and the U.S. could be seing an awful lot of business heading their way.All thanks to Idkwia.Hope they appreciate it mate.


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## cherrypie09 (Jan 20, 2009)

strawdog.It varies from person to person the symptoms, which would then determine the severity of the prolapse. Some people get constipated and cant pass stool and it feels like they have a constant pressure like swelling in the rectum, also trapped wind in the bottom. It depends on the severity of your symptoms as to how bad a prolapse you might have, it could be a full rectal prolapse or just a mucosal lining prolapse. Surgeons seem to operate more in people with complete rectal prolapses than those only with rectal mucosal lining prolapses, both are extremely uncomfortable and frustrating, the symptoms are sometimes the same for both, also you can get incomplete evacuation. My gp didnt detect anything, it was when i saw a rectal surgeon for what i thought was haemerrhoids that he found i had the mucosal lining prolapse and not haemerrhoids.Good luck with getting the help you seek.


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## idkwia (Feb 26, 2009)

Hello to all of you.As previously stated, I have done a lot of research on this subject.Prolapses of the colon in their different forms are very common. However, in many people they don't cause any symptoms and if they do they are often mild. However, if it is a large prolapse or an external prolapse or just happen to be in the wrong place then they can cause very uncomfortable symptoms. As for me, I had a large internal full prolapse otherwise known as a rectal intussusception. It stands to reason that it didn't just suddenly become large and no doubt increased over many years. For many years it was asymptomatic (no symptoms) but then suddenly started to cause problems.For those of you who are in discomfort which isn't managed adequately by bio-feedback (pelvic floor training and good toileting procedure) and have been told by a surgeon that surgery isn't effective then I would strongly suggest that you go and get a second opinion. I saw 8 different surgeons (yes, 8!) and the difference of opinion was almost frightening. In addition I spoke by phone to other surgeons who referred me to other surgeons because this problem was outside their expertise. Let us be clear, this is not an easy condition to correct and success is not guaranteed however one surgeon explained the correct operation should at least put a person in a better starting position than before the operation.For those of you with a mucosal lining prolapse I would suggest you look at this: http://www.springerlink.com/content/2p1f91yk4l2l9ay3/ This surgeon treats patients with this problem in order to correct it. I don't have a lining prolapse so I didn't look into it any further but considering what other people's surgeons on this board have said it just illustrates my point about vastly differing opinions.For others who have a rectal intussesception or a full thickness external prolapse I would suggest (if you haven't done already) look at http://www.bristolsurgery.com/SectionConte...x?sectionid=209 and http://www.obstructed-defaecation.com/Firstly you need to be sure if you have a prolapse, and then which type and its extent and location. The gold standard way of doing this is to have a defecating proctogram together will full anal manometry tests (they are not in the least bit painful, just maybe a little embarrassing, although not for me!). Then you need to do some research and inform yourself and then find the best surgeon you can - all have emails so send them an email or a letter and ask them if they are experienced in this field of colo-rectal surgery. Then you can decide whether you want to go and see them. Often they will suggest another surgeon which is an excellent way of finding the best ones.Having seen one surgeon then get at least one other opinion (unless of course you are very happy with the first). All of the surgeons you see will examine you with their finger and a sigmoidscope (again not painful) and together with your other test results will give you their advice, which may or may not include surgery and/or bio-feedback. You could try bio-feedback whilst you are arranging and waiting for the tests becuase if you are having difficulty in evacuating it can only make things better no matter what your condition.My strong view is that if you are in discomfort and a doctor or surgeon says that they can't help, then go and find one that maybe can.Good luck to all of you. If you need more help then write here or send me an PM.


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## Naomi889 (Sep 11, 2005)

Wow, threads like this are fantastic. I've thought for years that the most useful function of these boards is when there is scientific discussion of the likely physiological causes of our symptoms - because at the moment there is such a dearth of concentrated research into the physiology of so called "IBS", and because it's such a poorly understood disorder, the discussions we have with each other often turn out to be far more insightful that meetings with doctors - even gastorenterologists! It is outrageous, really. Thanks so much for all the info Idkwia! One long thread on this board on the symptom of incomplete evacuation turns up as one of the first links when you Google "incomplete evacuation" - to me that just says it all about how little talked about and how poorly understood this symptom is by the medical profession.Idkwia, in your last PM to me you said you'd had had the operation but surgeon said it will take 5 - 6 weeks before you would know whether it was successful. Have your symptoms improved at all yet?


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## Naomi889 (Sep 11, 2005)

This older thread might be relevant to this discussion too.http://www.ibsgroup.org/forums/index.php?s...mp;#entry702755


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## cherrypie09 (Jan 20, 2009)

IdkwiaIts all well and good suggesting people seek more opinions to see different surgeons, but this costs money and alot of us dont have that sort of money to spend, that why we dont seek more opinions.But thank you for all your tips and help.


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## sirjohn (Sep 29, 2009)

Yes I'd like to thank Idkwia also for answering my PM's and being very knowledgeable.But I'm on medicade, to sick to work, I live with my parents. The only place I can go for medical help, is the University of iowa. And that's a 165 mile drive from my home. They have 1 colorectal surgeon there. And the GI doctor there said he didn't think my prolapse was that bad.I had consultation and a colonoscopy from my home town GI Doc, because I was scared I was going to die. My parents paid for it. I had the colonoscopy, as I had a bad reaction to Pentasa, and the local GI told me it was an emergency and I needed colonoscopy right away.


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## Amity (Nov 25, 2008)

Is this what causes the urgency feeling all the time and feeling like you need to have a BM all the time?


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## cherrypie09 (Jan 20, 2009)

It depends, in some it does, others are constipated, but it can all be signs of just ibs and not prolapse.


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## sirjohn (Sep 29, 2009)

How often does everyone here have a Bowel movement?Do you use enemas? If you do how well do they work for you?I have to use an enema everyday, to get cleaned out. 2 doses of miralax a day keep my stools soft, but I don't really ever have an urge to go. And I don't get much out even with straining, until I use an enema.


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## Mary2001 (Aug 25, 2006)

Hi All. Thank you for all the replies and information about seeing different surgeons etc. I have been told by the surgeon that the operation for prolapse is not very successful and that is why I have not pursued it any further. I have not had a chance to reply all day to all the posts because I had an awful day with trapped wind and when I get that somedays it hurts to even bend, and I cannot sit at my computer. I would love to get something to cure the trapped wind but nothing seems to work and its constant every day which is torture. Thank you to all who replied and offered suggestions and input. I really think the medical profession should have something to help with this if surgery is not successful, or do some research into it because it is soul destroying living with it everyday, and I feel grinded down trying things every day and getting my hopes up that there might even be the remotest chance of it working, only to be back at square one again. I do check in on the ibs board from time to time in the hope that someone out there might have something that works so thank you all once again, and as long as I still have some hope I beleive something might turn up. I'm not having a good day today. Mary.


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## idkwia (Feb 26, 2009)

*Naomi889* - I had an operation 6 weeks ago to try and repair a large rectal intussusception. During the operation the surgeon found that I also had a psuedo rectocele as well as some diverticular (pouches in the colon). I say "psuedo" because men cannot have rectoceles because they don't have vaginas (at least I didn't have one when I last looked!), however, I had something that resembled a rectocele - apparantley slim, tall-ish men can be prone to this - the surgeon mentioned this before the operation having seen my defecating proctogram. Anyway, there are many procedures designed to correct this problem. I had a laparascopic ventral mesh rectopexy. I had also considered a STARR procedure and was not sure which one to go for so I saw three surgeons who do both and two suggested the ventral mesh rectopexy and one said STARR. I have discovered it is essential that the surgeon chooses the right procedure for the right patient depending on symptoms and test results etc to ensure a greater and better success rate.I am due to go back and see the surgeon for the first time in 3 week's time. He told me that it would take about 6 to 9 weeks before the full outcome would be known. At the moment, the feeling of having a golf ball stuck in my rectum has gone. I am evacuating better and more easier than before. My stools are significantly fatter but still flat. My worst issue was nausea, however most of the surgeons thought this was unrelated but one or two thought that maybe it was related. At the moment the nausea is improved but is not resolved. Does my bowel feel completely normal? The answer to that is "no" but thus far it is significantly better. However, I always knew that my prolapse was large and it may take another procedure to correct it further (maybe a STARR) but I can't comment as I have yet to see the surgeon again.Am I pleased that I had the surgery? The answer to that is "yes" as bio-feedback did not help me enough and I didn't want to be faced with giving myself enemas and/or colonic irrigation everyday and I certainly wanted to get rid of the feeling that I had a golf ball stuck in my bottom for 50% of the time.I was told that there was no guarantee of success and that if things were improved they may not make me 100% normal again. Considering how things were before, I was grateful for any improvement. I am still hopeful that things can be made even better. I should also say that no matter what happens to me I know for a fact that many people get a very high level of improvement from these procedures.On a slightly side issue, I mentioned that the surgeon found some diverticular which even though they are not inflammed can also cause symptoms that mimic IBS. This was interesting because they didn't show on the colonoscopy I had or the CT scan - or maybe the testers missed them! (I have lost a lot of faith in the medical profession). Anyway, when I see the surgeon this is an area to be explored as maybe this could be removed by re-section. I should point out that I don't relish surgery, I just want to get back to normal if I can and will do whatever it takes.PS - if anyone tells anyone here not to go for the STARR procedure, then you may like to talk to me before you make the decision. If anyone tells any of you to go for the Express procedure or anything else then please also feel free to talk to me. I say this because I think that it makes sense to be armed with as much information as possible in order to make the best choice you can, because at the end of the day it is your bottom!(Sorry about the length of my posts on this thread but I am trying to help as much as I can because I went through a lot of anxiety in making my decision and if I can help someone else in the same postion, even just a little bit, it would be worth it).


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## idkwia (Feb 26, 2009)

cherrypie09 said:


> IdkwiaIts all well and good suggesting people seek more opinions to see different surgeons, but this costs money and alot of us dont have that sort of money to spend, that why we dont seek more opinions.But thank you for all your tips and help.


*Hi Cherrypie09* - I understand what you say but........this of course only applies to us in the UK, you are perfectly entitled to a second opinion and see other surgeons under the NHS, particularly under the new Choices scheme. You pick a surgeon and then ask your GP to refer you.I have seen surgeons under both the NHS and privately. Part of the reason why I am writing such long posts here is because I have seen and spoken to so many surgeons I am trying to pass on the information I have gleaned.You are in Gloucester, why don't you go and see Mr Purdey or Mr Dixon in Bristol or Mr I Lindesy in Oxford. It is only an opinion, it doesn't mean that you have to take it. But if there is a way in which you can get some relief then perhaps it is worth it unless of course your symptoms are only mild and you are happy to live with them. For me, I had to try and get some relief as my quality of life was nil.Either way, I wish you luck!


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## idkwia (Feb 26, 2009)

Amity said:


> Is this what causes the urgency feeling all the time and feeling like you need to have a BM all the time?


It certainly can do *Amity*, but the only way to really know is to have the test or be examined by a surgeon or a very able gastroenterologist. Good luck!


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## idkwia (Feb 26, 2009)

Mary2001 said:


> Hi All. Thank you for all the replies and information about seeing different surgeons etc. I have been told by the surgeon that the operation for prolapse is not very successful and that is why I have not pursued it any further. I have not had a chance to reply all day to all the posts because I had an awful day with trapped wind and when I get that somedays it hurts to even bend, and I cannot sit at my computer. I would love to get something to cure the trapped wind but nothing seems to work and its constant every day which is torture. Thank you to all who replied and offered suggestions and input. I really think the medical profession should have something to help with this if surgery is not successful, or do some research into it because it is soul destroying living with it everyday, and I feel grinded down trying things every day and getting my hopes up that there might even be the remotest chance of it working, only to be back at square one again. I do check in on the ibs board from time to time in the hope that someone out there might have something that works so thank you all once again, and as long as I still have some hope I beleive something might turn up. I'm not having a good day today. Mary.


Hi *Mary2001* - firstly, in an earlier post you said that you have an "occult rectal prolapse" which you think is a mucosal prolapse. I don't think this is correct, I think this is an internal prolapse otherwise known as a rectal intussusception. To illustrate this I have copied the following....._"*A complete rectal prolapse occurs when the rectum protrudes through the anus. If rectal prolapse is present, but the rectum does not protrude through the anus, it is called occult rectal prolapse, or rectal intussusception*"_ You can see this at http://209.85.229.132/search?q=cache:UHkLG...clnk&gl=uk#You say that your surgeon says that the operation for this is not very successful. I am sorry but your surgeon is wrong. He may have been right 20 years ago but not now. It is true to say that success is not guaranteed but there are many people (including me) that have been greatly helped by surgery, including one lady who evacuated her poop for 20 years with a spoon! Not all surgeons are the same and this is why you need to get a second opinion - try David Jayne at Leeds Infirmary as he operated on the lady with the spoon. You say that you are faced with a colostomy or continued horrible discomfort, surely a second opinion is therefore at least worth trying.Before I go please let me make it clear that I am not wishing for one second to push anyone into surgery, it is your choice. I am merely making it clear that I have found that all surgeons and doctors are not the same. As in any profession there are some who have different areas of exeprtise and experience. Some are old school and perhaps stuck in the past and some have embraced more modern approaches.I wish you the very best of luck and hope that whatever happens you find some relief.


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## cherrypie09 (Jan 20, 2009)

idkwiaMy doctor is not one easily persuaded to refer for 2nd opinions, especially as i have been seen by a rectal surgeon already and have been examind and told that it is the mucosal lining telescoping down on itself, and that if i do pelvic floor exercises and dont strain, it should not get any worse. Yes it is uncomfortable, and it feels like i am sitting on a golf ball at times. I am not very often constipated, I have ibs-D. I have been told its not easy to pull back up mucosal lining or stitch it up in place, as when you go to the toilet after you would be putting pressure on it pushing out stool, so surely wouldnt heal properley and stay in place.


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## Mary2001 (Aug 25, 2006)

Idwika Thanks for your reply and all the info. I presumed rectal lining prolapse and occult rectal intussusception were the same. I had a proctogram done in 2007 which states "quote" the rectal emptying is rather poor during defecation. There is a prolapse of what appears to be mainly rectal mucosa outside the anus. There is no obivous evidence of intussusception, rectocele or perineal descent."Unquote" When I had the protogram there was something inserted into my back passage like mashed potato mix and I was told to sit on a fake toilet and empty it while they took an x-ray. How embarrasing. I did not feel any desire to even go to the loo or feel like I needed it even though they put this mix in, so I did not manage to empty any of it atal hence the report stating the rectal emptying is rather poor during defecation. But it could be embarrasment maybe that caused it - hard to know why I couldnt empty any. Then a year later I had an internal examination which revealed a polyp which I had removed under anasethic. The surgeon who examined me and discovered the polyp said in his report "quote" there is a polyp and a suggestion of occult rectal intussusception. "unquote" He told me that that it the surgery to repair a rolapse was major and not successful and that he would have to go in through my abdomen to do it. He referred me for pelvic floor physio and the letter he wrote to the phsyio says there is evidence of occult intussusception, and the phsyiotherapist said that is a condition like the lining on the sleeve of a coat would be coming down. Idwika what sort of test did you have to diagnose your rectal intussception, and do you know if it can be diagnosed from a rectal exam, as I dont know if the surgeon was going by the report of the proctogram in 2007, when he stated there was a suggestion of occult rectal intussusception or if he actually detected it when he did the internal before the polyp removal. The report of 2007 says there is no obvious evidence of intussusception, rectocele or perineal descent, that is why I think rectal mucosa prolapse must be the same thing. Thanks for your help and support. At this stage I am not sure yet about having surgery and would need to be guaranteed that it would be succesful. Thanks for your research and help. Mary.


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## idkwia (Feb 26, 2009)

Mary2001 said:


> Idwika Thanks for your reply and all the info. I presumed rectal lining prolapse and occult rectal intussusception were the same. I had a proctogram done in 2007 which states "quote" the rectal emptying is rather poor during defecation. There is a prolapse of what appears to be mainly rectal mucosa outside the anus. There is no obivous evidence of intussusception, rectocele or perineal descent."Unquote" When I had the protogram there was something inserted into my back passage like mashed potato mix and I was told to sit on a fake toilet and empty it while they took an x-ray. How embarrasing. I did not feel any desire to even go to the loo or feel like I needed it even though they put this mix in, so I did not manage to empty any of it atal hence the report stating the rectal emptying is rather poor during defecation. But it could be embarrasment maybe that caused it - hard to know why I couldnt empty any. Then a year later I had an internal examination which revealed a polyp which I had removed under anasethic. The surgeon who examined me and discovered the polyp said in his report "quote" there is a polyp and a suggestion of occult rectal intussusception. "unquote" He told me that that it the surgery to repair a rolapse was major and not successful and that he would have to go in through my abdomen to do it. He referred me for pelvic floor physio and the letter he wrote to the phsyio says there is evidence of occult intussusception, and the phsyiotherapist said that is a condition like the lining on the sleeve of a coat would be coming down. Idwika what sort of test did you have to diagnose your rectal intussception, and do you know if it can be diagnosed from a rectal exam, as I dont know if the surgeon was going by the report of the proctogram in 2007, when he stated there was a suggestion of occult rectal intussusception or if he actually detected it when he did the internal before the polyp removal. The report of 2007 says there is no obvious evidence of intussusception, rectocele or perineal descent, that is why I think rectal mucosa prolapse must be the same thing. Thanks for your help and support. At this stage I am not sure yet about having surgery and would need to be guaranteed that it would be succesful. Thanks for your research and help. Mary.


Hi *Mary2001*, you mention "prolapse of what appears to be mainly rectal mucosa outside the anus" which is a full prolapse of the lining that descends down outside the anus. You also said that you had a proctogram but didn't manage to expel any of the baruim (this is the mashed potato) so I am wondering how they can tell what your condition was if you didn't have any urge to go and didn't go. Presumably you must have evacuated the barium at some point.As I have said before there are different procedures to correct these tpyes of problems. Some are done by open surgery through the abdomen and some laparascopically (keyhole surgery, much less invasive) through the abdomen. Some like STARR, are done through the anus. Maybe the physio was wrong, after all he/she is a physio and not a surgeon.There seems to be a difference of opinion as to what your condition is. Would it not make sense to perhaps go and get re-examined and maybe re-tested to determine exactly what is wrong so that you and your surgeon can decide on the best course of action?In answer to your question: I had a defecating proctogram which showed I had a rectal intussusception as well as a psuedo rectocele. Immediately beforehand I had other tests to test for the strength of the sphincter muscles in the anus and a test to see if I got the correct and sufficient urge to go to the loo which of course is essential. They also did some other tests in the same area. I was then seen by 8 surgeons who all examined me with a finger and a sigmoidscope and all could see the intussusception.Good luck!


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## idkwia (Feb 26, 2009)

cherrypie09 said:


> idkwiaMy doctor is not one easily persuaded to refer for 2nd opinions, especially as i have been seen by a rectal surgeon already and have been examind and told that it is the mucosal lining telescoping down on itself, and that if i do pelvic floor exercises and dont strain, it should not get any worse. Yes it is uncomfortable, and it feels like i am sitting on a golf ball at times. I am not very often constipated, I have ibs-D. I have been told its not easy to pull back up mucosal lining or stitch it up in place, as when you go to the toilet after you would be putting pressure on it pushing out stool, so surely wouldnt heal properley and stay in place.


OK *Cherrypie09* I understand. I was just trying to point out what you are legally entitled to as I am certain your condition can be corrected. At the end of the day you are the one that has to live with the symptoms - not me or your doctor.Personally I was fed up with sitting on that bloody golf ball..............even though I like golf!Good luck!


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