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Bowel Disorders Message Board


Bowel Disorders Board Index


Hi all,

My repair was of both internal and external sphincters. The next morning, my surgeon was so optimistic about the repair and believed that it would be very successful. My appt is tomorrow; I hope there is something he can do for me.

Lisa, ask your dr about how he will get to the internal sphincter. My dr drew me a simplified little picture to show what he would do during surgery. You asked about my diet; it is a regular diet with emphasis on getting 25 g fiber daily. I am small, so it sometimes seems that I am eating so much food to hit that goal. Although there isn't anything that I am not allowed to eat, I find that I often have to forego some things that I really want, so that I have room for the high fiber stuff. For example, I usually cook big breakfasts for the family on the weekend, but I have to go for the high fiber cereal; no room for waffles or eggs. I'd really like to eat a croissant, but instead have to choose the high fiber bread. It's not the worst fate in the world, but right now, it doesn't even seem to be helping, so what's the point? I am absolutely sticking with this high fiber diet for now, though. I'm sure you are anxious, who wouldn't/hasn't been? You've done your homework and made your plans. Have a cocktail and relax.

I used a lot of gauze, and perhaps that did speed up the wound healing after it dehisced (sp?). I could never have rubbed my wound (still can't), but packed it with clean gauze ~10 times a day. Although the incision opened along almost the entire length, my surgeon said it was "superficial" and that the underlying muscle was intact. The deepest opening was just at the back of my vagina, and that area is still not quite completely healed. It's not really open or draining, but red and fragile and so very tender. The rest of the incision looks really good, though, and there is not as much scar tissue all the way down the perineum as I feared earlier. I know I never over exerted myself and I haven't been constipated, so I can't imagine that I could have caused any damage internally. I'll let you know what the dr says. Thank you so much for your supportive responses. I did talk again to another former surgical patient, but she did not have any of these issues after her surgery.

Take care,
JJ
Hi all, I hope everyone is doing well. There are so many of us now who have had the surgery and are posting that I have quite lost track of who is experiencing what and when your surgeries were. My own surgery was 9-10 weeks ago, and I feel very normal as far as the incision site (still a bit sore sometimes and one small tender, fragile area-I think by around 7 weeks is when I felt like the healing was nearing completion) and ability to control any urges when out and about (I first ventured out around week 4, and felt comfortable with it around week 6.) I leak after every bm, just as I did before the surgery, and I also have a hard time controlling gas. Like someone else said, I can often control it if I stand very still (and clench my butt), but if I make any movements, I lose it. I have 3 young children, so there really isn't a lot of standing still. It embarasses me and the kids, too, but I don't know what to do to stop it. I have been on a high fiber diet since week 4, and though the gas varies, I could not honestly say that it has decreased since getting used to the diet. I went for 2 biofeedback sessions before the surgery and 1 just last week. They are expensive and not covered by (my) insurance; but the cost & coverage likely varies. Each session lasts about an hour and consists of mild electrical stimulation via a probe that is inserted into the rectum. It isn't painful. After about 10 minutes of stim, the nurse leads me through a series of exercises (contract your sphincter, bear down, relax, etc) while we watch a computer screen which shows how the muscle is working. In addition to managing my diet and doing kegels, I am also supposed to be working on a sort of bowel training regimen, where I train myself to have a bm early each morning. I have never seen any discernible benefit from the biofeedback, but robyns has mentioned having better results. My newly attached muscles are very weak, and I have never been able to squeeze the sphincter in isolation. When doing kegels, I end up squeezing my cheeks, thighs, everything. It's the only way I can contract anything. I am going to continue for at least one more session because I don't know what else to try to correct my problem.

One thing that you all might try is blowing out very hard (like inflating a balloon) several times when you are having a bm. It helps the muscles in your pelvic floor to relax or contract or something to expel the stool. It hasn't prevented my leaking afterward, but it has definitely helped me to evacuate more fully than I previously could.

Kelley, you have mentioned several times about being in the bathroom for hours. Is that because of inability to pass hard stool or soft stool? If you don't mind me asking, what are you doing for that length of time? Relaxing, pushing, waiting? I ask because I am still trying to find something, anything to help me improve my ability to get it all out and stop the leaking!

Take care, JJ
Hi Lisa, so good to hear from you. I am a week ahead of you on recovery, so maybe I can give you some insights too, as Kelley and Mindy did. I agree that you might have a UTI - get it checked out. Also, it's almost impossible to urinate when you have an impaction, soft or hard. Before my impaction was diagnosed, I went 24 hrs without urinating and that can be dangerous. (I finally could urinate standing up in a warm shower! seemed to relieve the pressure). I had a soft impaction and it was nothing I could clear by myself. It felt like everything was swollen inside my whole abdomen, and I could only squeeze out 1" soft pieces of BM and that was with much difficulty. Had it been hard, I would have been back in the hospital. It surely made me feel depressed and discouraged too. The Dr. had me do this routine: Two Rx enemas of cottonseed oil and liquid Colace, each retained for 30 mins. Then 6oz. citrate of magnesia by mouth, 8oz water, and finally a Fleet enema. What an afternoon, but I virtually exploded the blockage out and I had diarrhea for 12 hrs afterwards but it was worth it to get rid of the impaction without having to be hospitalized. I hope by now you have passed some of it; if not, please call your doctor again. Let us know your progress! How wonderful you can have your mother there, and a helpful husband.

Kelley, JJ & all, yes I think we have become experts at toilet acrobatics and gymnastics! For me, leaning forward for a few mins and then going upright or a little backwards helps sometimes. Also deep breathing, and sometimes pressing gently on the cheeks near the anus helps - but be careful not to stretch or put pressure on the incision(s).

Kelley, I also have an autoimmune disorder - Polymyalgia Rheumatica and Giant Cell Arteritis, but I didn't have a flare, thank goodness. Good luck with keeping yours in check. Prednisone helps with inflammation, but also delays healing. I'm down to 3mg now. Has adding the stool softener and more fiber & water helped you get softer stools?

JJ - re the Kegels... my Dr had me start them at week 2, trying to isolate the anal sphincter (not primarily the muscles around the urethra). I find it's easy to do them just when I wake up in the a.m. and just before I fall asleep. I'm in bed, totally relaxed, and for me I can contract and hold the muscle without engaging too much of the cheeks or abdomen. During the day, all the other muscles want to be in on the action! I don't know why. Suzan, how are you doing with your Kegels? I agree every Dr. has a different approach. Mine says slowly contract 5 secs, hold 5 secs, slowly relax 3 secs. 20 reps 5x a day.

Well, this is too long already, but I have time to respond today, so I did! Actually I'm trying a new method: typing this into a word processing program while looking at your posts, then copying & pasting into quick reply box. Hope it works!
... Mary
Lisa, I hope you are a little better by the time you read this post. You have been in my thoughts. That horrid opening of the incision is really scary, I know, but it does eventually heal. Pack the gauze all the way deep into the opening. So many of us can relate to what you are experiencing. This very early stage of recovery is the hardest, and it will get better. I was very nauseated for about a week, dry heaves, etc; keep drinking, even if you have no appetite for food. I have had so many UTI’s in the past (not associated with this surgery). The clincher is if there is burning when you go and a constant feeling of needing to go. If you are going with normal frequency and feeling relieved afterward, you may just be irritated. I had to really relax and concentrate to urinate at first, but there was no UTI. If that is the case, use a soft squeeze bottle with very warm water and squirt a stream over yourself while you try to pee. Also, the warm sitz baths seemed to help me relax in that area some. If you feel the urge while you’re in the sitz bath, just go ahead and relieve yourself there. You can easily dump the pan and start over if you have to. I am so sorry that you are depressed. I was too for a bit; felt so sorry for myself. You will undoubtedly start to feel better when you get that 1st bm over. You probably want to stay away from the narcotic pain killers as much as possible to prevent more constipation, but don’t be shy about taking the ibuprofen, because being in pain will only make you more depressed. I hope you are eating or drinking milk with the ibuprofen so that you don’t have more nausea/vomiting. I am very impressed that you drove home 7 hours and did ok. You clearly have weathered the worst and can only start feeling better now. I hope it is soon!

Mindy and Mitzee, Thanks for sharing what toilet gymnastics work for you. I will try all of them! Sometimes, the technique of having a finger just behind the sphincter seems to help get the stool out. My morning and evening kegel routine (with biofeedback sensor in place) is contract & hold for 10 seconds. 6 reps, rest, repeat the sets twice. Mindy, my perinealplasty has resulted in a kind of muscular wall or dam just in front of the sphincter. It actually is a physical divider whereas before, the sphincter and vaginal opening were just so close with very little space between.

Robinlake, Welcome to the discussion. Was your original sphincteroplasty at the time of child birth? How and when did you know that the first one did not hold? I am still having some problems following my sphincteroplasty and am questioning everything that I have done or am doing and whether or not there is any reason to think that I can still improve. I wish you all the best making your decision about what to do. It is very hard to know what is best.

Sorry for the long post, ladies. Take care, JJ
Suzan, I went for 2 biofeedback sessions before the surgery and 1 since. Each session lasts about an hour and consists of mild electrical stimulation via a probe that is inserted into the rectum. It isn't painful. After about 10 minutes of stim, a nurse leads me through a series of exercises (contract your sphincter, bear down, relax, etc) while we watch a computer screen which shows how the muscle is working. In addition to managing my diet and doing kegels, I am also supposed to be working on a sort of bowel training regimen, where I train myself to have a bm early each morning. I have never seen any discernible benefit from the biofeedback, but robyns has mentioned having better results. I am going to continue for at least one more session because I don't know what else to try to correct my problem. The nurse is very supportive and full of tips and observations, so I do feel the meetings have some value even though they have not been a miracle answer.

Linds, Welcome to the discussion. I’m sorry that you are having this problem. You will get most or all of the questions you raised answered by reading through the entire thread. It’s worth taking the time. I had a sphincteroplasty, perinealplasty, levatorplasty (& rectocele repair) in March. The surgery took 3 hours and I was in the hospital for 8 days. I was first out and about on a limited basis at 4 weeks. My incision had opened around day 10 which made sitting a near impossibility. If your surgery is less extensive and/or your incision doesn’t open, your recovery should be shorter. You should not lift anything over about 8 pounds for at least 5-6 weeks. My kids and I did a lot of cuddling in the bed as a substitute. The way you describe not being able to wipe completely and needing to change your undies frequently sounds as if you ARE leaking after bm’s. This was also my problem (along with incontinence of gas). When you read the thread, you’ll see that most of the women might leak initially after surgery but not after they have recovered . I wish that I didn’t, but I have the same post bm leaking problem. My dr said that the most common complication with this surgery was wound infection (which includes the wound opening). I feared needing a colostomy, too, but as I understand it, that is never or almost never indicated. My dr was very optimistic about the surgery helping me with the leakage but not the incontinence of gas. As you read through the thread, you will hear a lot of us talking about having trouble controlling gas. I am now about 10-11 weeks post op, and I feel normal most of the time, but my perineum is still sore. Other women on this board and that I have spoken to say that it could be 6 mos to a year to realize a complete and full return to “normal”. We will try to answer your questions. My recovery has been so helped by this board and knowing that I am not alone in this ordeal. Good luck.

JJ





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