Re: Recurrent rectocele
From: Bernard Cristalli (bcrist@club-internet.fr)
Thu Nov 30 01:36:56 2006
Anal sex has something to do with stool incontinence, not with trans
vaginal rectocele. This rectocele can be repaired vaginally if needed.
The repair should be a bit higher than the previous one. No penis, no
tennis for one month, she'll have to stick to oral sex (unencombered by
datas).
Bernard
Elrod, Darryl G Maj 48 MDOS/SGOBO a écrit :
>
> I figured I’d change the tone of the conversation to something along
> the clinical lines.
>
> 35 yo G4P4 with TVH/abdominal paravaginal repair/Burch/McCalls and a
> posterior repair with perineorrhaphy about a year ago presents back
> for recurrent rectocele symptoms. Although not as bad as before
> surgery, she still feels the need to splint with bowel movements and
> has increased pressure rectally.
>
> On exam there is still a significant bulge in the posterior vagina. On
> rectal exam, the sphincter feels intact, the posterior vaginal wall
> can be brought nearly to the hymen (better than before her last
> surgery when I could bring it past the hymen). The anterior vagina and
> the cuff are well suspended. I don’t feel anything that would make me
> concerned for an enterocele and the upper half of the vagina there
> feels to be good support.
>
> Endoanal ultrasound shows a normal internal and external sphincter.
>
> Under normal circumstances I wouldn’t be to concerned about either
> tackling this repair myself or sending her to a urogyn to repair.
> However, I got one of those turn the head, get red with embarrassment
> looks from her. I questioned what that was for and got ‘do you think
> this might have something to do with liking anal sex???’ Turns out,
> she likes it enough to not really want to be without it for any
> lengthy period of time.
>
> Oddly enough, I can’t seem to find much literature at all on
> management of recurrent rectocele and none on risk of recurrent
> rectocele with anal sex.
>
> Any thoughts on a) if this would be enough to undo a perfectly good
> posterior repair (probably) b) if you repaired it again, how long
> would you prescribe nil per anus (6 months???) c) would you tackle
> this yourself or refer?
>
> Thanks,
>
> Glen
>
> //SIGNED//
>
> D. Glen Elrod, Maj., USAF, MC
>
> Obstetrician/Gynecologist
>
> Chief of Obstetrics
>
> 48 MDOS/SGOBO
>
> RAF Lakenheath, England
>
> Telephone DSN: 314-226-8130
>
> Comm: +44 (0) 1638 52 8130
>
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