# defecography/evacuation proctography



## kc99 (Jun 7, 2007)

Hello all,

I know several people have commented on defecography in the past, but I am having some difficulty finding any kind of detailed explanation of what the experience is like. I can of course find all manner of patient information sheets, and I have a general sense of what the procedure entails. I just thought I'd see if anyone was game for describing their experiences in more detail, so I have a better sense of what to expect (although I am sure that the procedure varies by location somewhat, and in ways that depend on the patient's condition).


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## annie7 (Aug 16, 2002)

i had a defogram last january at the university of michigan hospital. it was all handled very professionally and efficiently and the two women assisting me were very understanding and sensitive to my needs and concerns.

i had a lot of worry about the whole thing since i have had a long standing need for privacy when having a bm--have to have a private bathroom with a closed door etc etc plus i always use a footstool and no footstool there---lol...anyway i was a bit of a basket case with all this--having to "go" in front of people-- but as i said the staff was very helpful, caring, and understanding. the room was large and quite dim---no glaring lights, which helped--and also they gave me two gowns to wear if i wanted so i would be completely covered--no gaps in the back. and i wasn't directly in front of people--they were further back behind a glass window.

i've heard/read of many people who've taken this test and had absolutely no problem with it. hope this helps..it's definitely a very good test to have--an excellent diagnostic tool-- and well worth it.


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## kc99 (Jun 7, 2007)

Hi Annie, Glad to hear it was handled well. And thanks very much for the info -- this is helpful! I also highly sympathize with all the needs you mentioned above (privacy, etc). Honestly a question in my mind is what happens if the barium just, well, doesn't go anywhere. It seems like surely that must be precedented.

One area of uncertainty that remains for me involves what all needs to get "labeled" (so to speak) by the barium. Obviously, it's going to be administered intrarectally. Aside from that, however, the procedure descriptions vary in where else they say the barium is destined to go (other pelvic regions, either internally or externally, or in some cases it seems like it has to be consumed orally as well...).

So, this is getting into the gory details of what is already an awkward, sensitive procedure, so I understand if no one is eager to share this. Just thought I'd see. I know the best source of this information will be the hospital where the procedure is to be done, but any advance information might help me figure out which questions it would make the most sense for me to ask.


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## AIRPLANE (Mar 15, 2004)

I've never heard of any barium for a defecography test- just the paste that they put into the rectum. I've only had anything like that put into my system with a CT scan.

Like Annie, I also need privacy when doing my business. However, in this case, I had no problem with the presence of medical people. I figured it could only be to my benefit if they could actually SEE what a difficult time I have with this rather than just taking my word for it. Also, nobody was right in the room with me during the test. The test was pretty rushed because they were running way behind schedule and I did have to wait quite awhile in a cold hall wearing only a thin gown before having it done. I did feel rushed during it but the test did reveal a small rectocele. They asked me afterwards if I always had that much difficulty evacuating and I told them that yes, I usually did.

I was diagnosed with the small rectocele and non-relaxing muscles. They didn't want to discuss the rectocele but did want me to go through 2 weeks of physical therapy- biofeedback for the pelvic floor. Unfortunately my insurance wouldn't cover it and it is pretty expensive and also doesn't have the best track record from what I've read from other patients who've done it. Still, I was willing to try it. I had that test 6 years ago and went back for other tests last year when they again recommended biofeedback but my insurance still wouldn't cover it. So I did get some information from having the test but no solutions that I could use.


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## annie7 (Aug 16, 2002)

kc99--i had to drink barium about an hour before the actual test was preformed. and then when i was in the room one of the women inserted barium into my vagina and rectum. i've read that some places will let you do the vaginal insertion yourself.

i was so scared--petrified, actually-- about having to "perform" in front of others that i totally froze up , could not "go" , and so they finally told me to strain to get the barium out. so what they got was a picture of me straining which is not a true picture of how i go at all--i learned 40 years ago straining doesn't work so i don't do it. but anyway, that's how i got the barium out--straining because they told me to.

and because they told me to strain, the test showed pfd (well of course it would because of them telling me to strain--lol--no surprise there) as well as a moderate rectocele and a vaginal prolapse.

i also have colonic inertia. when i go at home, i'm always relaxed, use a footstool and a breathing technique that helps. with me, the big problem for me is slow transit and getting stool to the rectum to begin with. if i can get it to the rectum, i can get it out.

good luck to you--wishing you all the best.


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## annie7 (Aug 16, 2002)

airplane--and yes, me too--because of my defogram showing that i was straining, the doc who was in there interpreting the test came out and told me the test showed pfd and that i should enroll in their bowel control program for pfd/bio training. and i tried to explain that i froze up due to the nature of the test--having to go in front of others etc. he did make a notation of what i said in his written summary of the test results. thankfully my gastro listened to me when i told him about all that and he did seem to understand.

the colo rectal surgeon i recently saw told me that because of the defogram results, i should go through the u/m bowel control program anyway and yes i'm willing to try it of course--i'll do anything--lol--as long as insurance covers it. i still have that hmo--blue care network--and i called them once again to see if they'd cover it and they said that now they do depending on what the codes are of course. the surgeon's office told me in order to get a dx code i'd have to go see a u/m gastro doc first and he'd dx me.


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## kc99 (Jun 7, 2007)

Thanks so much again for the comments -- really, this is all very helpful to me.

Actually, I'm learning that my first procedure is going to be anorectal manometry, and defecography will be scheduled for some day subsequent to that.

Again, this is another situation in which I have a general sense of what that procedure entails, but am very unclear on several specifics. So, if anyone has any personal insight on this one, I'd again be interested to hear about it.


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## AIRPLANE (Mar 15, 2004)

kc- I also had an anal manometry around the same time as the defecography. They put a balloon into the anus and then filled it with air. I can't remember all of it, but I know that for part of it when they started inflating the balloon they told me to let them know when I felt an extreme urge to evacuate. What I recall happening in my case was that very quickly I got severely crampy but didn't say anything right away. Then as they kept inflating it the pain went away and I felt no more pain or urges. They inflated it to the limit. Again, they seemed to be in a rush and I never got around to telling them that I had felt a very severe cramp initially but it went away. They wanted to do all of the talking and I didn't get to give my full input.

That's what gets me about so many of these tests. With my colonoscopy last year, the doctor didn't even have me back for a follow-up and I only had one previous appointment with him. Even with insurance I have to pay quite a bit out-of-pocket for these tests and feel that I should be given more 'face' time for more in-depth discussions. I can't find any gastroenterologist who is willing to work with me on a long-term basis.


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## annie7 (Aug 16, 2002)

kc--no, i've not had the anal manometry yet...hope it goes well for you.

airplane--oh yes i definitely agree. you should have been given much more time both during the tests themselves--rushing a patient through tests is never good--i would think it would skew the test results especially with tests such as these. and you should have been given more time afterwards with a proper follow up and discussion with the doc-- everything explained and all your questions answered. and you had these tests--or most of them-- done at mayo, right? i always read how they claim they're the best. well shame on them...that's no way to treat a patient.


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## PoopiePalace (Oct 12, 2012)

Hi kc99,

I have had both of your upcoming procedures and they weren't bad at all. It is all in your frame of mind. As for the defocography, I went into the procedure laughing to myself thinking, I can barely poop in private let alone on camera so this should be a hoot. Well it was. I had a great doctor do the procedure who was an absolute riot. Professional, caring and with just the right amount of humor. And he was standing right next me as I pooped on camera. He was on my right and the camera was on my left. I had very little room to move while sitting up high on this plastic commode. I had to initally drink barium and then a hour later he inserted barium in my rectum. The most difficult part was holding it in. I couldn't wait for him to finally say "Okay, now push it out." And he would cheer me on to help me go. It was quick and easy. After it all done he showed me exactly what it my insides looked liked as I was relieving myself and explained the physiology of it all. I ended of having a prolapsed rectum, it was completely detached from my sacrum, a rectocele and entrocele, so I was a hot mess. Needless to say I have had major surgery since then. The other exam anal manometry was just as easy and not invasive. A balloon is inserted in your rectum and air is used to inflate it while you are asked to say when you can feel it, etc. I guess the experience all depends on who is doing the procedures. I was fortunate because where I go to be treated, all the tests are done directly by the doctors and not by any technicians. My best advice is keep a sense of humor, I seriously who else gets to poop on camera. P.S. My daughter wanted to know if I was going to get a DVD copy of it for later viewing.


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## kc99 (Jun 7, 2007)

Thanks so much again, everyone -- especially now that I've put you to work at explaining two procedures. This is all really very helpful.


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## Arleneeene (Mar 5, 2013)

Is there a place on this website that actually explains what types of structural defects a persons intestinal system can have? The thought is pretty new to me, that something inside could just be wrong.


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## annie7 (Aug 16, 2002)

i can give you links to some websites that explain it well---and of course there are other sites as well.

this first one --from the university of michigan bowel control program has a number of different links (on the left) to different problems, tests, treatments and there are videos too.:

http://www.med.umich.edu/bowelcontrol/patient/pelvicprolapse.shtml

also--info and links here:

http://ibs.about.com/od/causesofibs/a/What-Is-Pelvic-Floor-Dysfunction.htm

http://my.clevelandclinic.org/disorders/pelvic_disorders/hic_pelvic_floor_dysfunction.aspx


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## kc99 (Jun 7, 2007)

Hi again all,

So, as a follow up, the anorectal manometry wasn't too bad, in case that information is helpful to anyone else.

I am learning more about the details of the particular defecography procedure I can expect. Did anyone else have a catheter placed as part of this?


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## annie7 (Aug 16, 2002)

Hi kc. glad to hear the manometry went ok.

and no, they didn't catheterize me...will you be getting one? if so, i wonder why...must be a special type of defecography procedure.


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## kc99 (Jun 7, 2007)

Hm, so, I think I may have been incorrect to use the word "placed". My understanding (again, apologies for the detail) is that the catheter is used to administer the intravaginal barium. So, my guess is that this means that it is just a delivery device that would be removed after it's done being used for that purpose (but, again, just a guess -- I don't really know). I think I'm getting the standard procedure, and it's just that they're very comprehensive about everything (they do the oral barium too).


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## annie7 (Aug 16, 2002)

yes, that explanation makes sense. and yes they are being very thorough in explaining everything--that's always good.

good luck with it!


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