My First Diagnosis - Factors that contributed to Obstructive Defecation

Last January 2016 I underwent major surgery to correct pelvic organ prolapses in order to improve symptoms of ‘Obstructive Defecation’. An MRI Proctogram Scan MRI, which is a video imaging used to assess bowel elimination using a radio-opaque gel for clarity. The results of this MRI Proctogram showed a radically different outcome to the Proctogram I had in 2012, which showed muscle dissynergy. This scan reported the following category of errors:

MRI Defecating Proctogram Scan – Hospital 6-3-15:

MRI demonstrates a normal anorectal angle at rest. On defecation there is moderate distension of the rectum to 8cm below the pubococcygeal line. There is also a cystocele with bladder descent of 3cm below the pubococcygeal line and a small bowel entrocele. There is a moderate degree of recto intussusception, and a small anterior rectocele, both the rectal ampulla and the anterior rectocele empty completely. (Incidental note is made of sigmoid diverticula).

I’d initially been booked for a laparoscopic Ventropexy Mesh repair to essentially ‘hitch’ all my organs into the correct position in December 2015, only recently prior to that I’d had an admission for diverticulitis at a different hospital and the surgeons had not been informed. Instead they ended up using that laparoscopy diagnostically and in addition to the Proctogram findings they also found pelvic adhesions which they removed, and also a large redundant sigmoidocele – a large amount of sigmoid colon which was superfluous and excessive loopy bowel. They deferred me for urgent surgery to remove approximately 8 inches of my sigmoid colon and resect the bowel lifting the rectum so as to put my rectum and bowel into the correct anatomical position and correcting many of the defects reported in the Proctogram scan. This happened in another hospital to the one where I’d had the diagnostic laparoscopy, but part of the same hospital trust.

My colorectal surgeon couldn’t believe this new catalogue of problems. It was wondered whether I had a vaginal prolapse and the impact of the cystocele (bladder prolapse) questioned. I was sent to Urogynecology for their opinion, but they concluded that no action be required at this time for the cystocele, or anterior vaginal prolapse at this stage, other than women’s health physiotherapy, as recommended for this type of problem, and that it would be up to colorectal team to consider repairing the other catalogue of prolapses.