Perineorraphy repair recovery

Women's health
1

Hello, some of you may know that I had a posterior repair last April that did not fail as such but reoccurred lower down. After re-reeferral by the GP and visits, tests, joint colo-rectal'urogynae clinics. pelvic physio. Saw the urogynae surgeon in May who said "You've had enough, come in in July, we need to get this done sooner rather than later." 

So in on the 3rd July. I did agree that they could do another posterior repair if they felt it necessary otherwise it was just for the perinorraphy. I did think that I may have ended up with   another posterior repair. Woke up after surgery and had just had the perinorraphy. She said that as soon as she went in she could see the problem which I was pleased about in a strange way - as I've been going on for this last year since the last repair  that things weren't right - so pleased that she felt there was a problem. ​She signed me off for 4 weeks - originally she said 2 - 3 weeks, the pre-op nurse said 6 weeks. Recovery has been ok. I was not sure I would ever wear trousers again and sex is still something I can't even think about  - though that has been banned for 6 weeks anyway! The first week I found it much more comfortable to wear no knickers - it was the very hot weather and the sweat plus general 'drips' was not good. Felt like I was wiping myself with sandpaper after going to the loo - suoer sensitive and sore - I was on twice or 3 x daily baths - I checked and they were allowed. Just this last few days I can tell things are healing better and I am not so sensitive and sore. 

​Sitting an standing were an issue in the early days - semi prone on the sofa with legs slightly apart to let air round in commando style was best. I had very little bleeding - only a spot on the first day so that was good as didn't have to wear pads.

​I did go to the GP after two weeks to ask if I could go back to work on a graduated return - there were a couple of visits I would have liked to have done - not involving lifting etc. He catagorically refused to let me go back. His words were "No, no, no and no again. It's not just the lifting  for you it's also the getting up and down off the floor. If you rip this lot of stitches there's not a surgeon who can repair you so no, no ,no. Lift nothing over 10kg for 6 months." So I was well and truly told. 

​Then last weekend had my son, daughter in law and child down - in a tent in the garden (!) and it was a bit much. (DIL was down the whole week - but staying at her sister's - the sister's husband was ill and she was down to help with work. We had our grandson in the evenings - while they were working. Then at the weekend they were at ours.) Also went out on Monday night for a colleagues retirement and that was a bit too far. The sitting upright and, although I was very careful over the weekend, just did a bit much. So by the time I got home Monday night I was whacked out. Had a couple of very quiet days last week. Went into the town on Friday, walked for about an hour and had enough so came home. Feeling better now - think I can see the light and things will get better!

​I am going to be very, very careful though, back to work next week, then have leave for a week. Summer is a bit easier for work - not as pressured but still plenty to do! But I cannot risk another repair. Starting to feel good about this one. I was prescribed movicol and lactulose for 10 days post op. The colorectal surgeon said to take dulcolax everyday anyway when I saw him. I have taken some - probably about every other day to make sure things keep moving! I am careful that my diet has lots of water and veg and fruit in it so never normally a problem but don't want to risk anything.

​This repair was not as bad as the last one, the recovery time is less, but need to be just as careful. I have a post op appointment on October 3rd - she said she wanted to give plenty of time to heal and see if things were really better  - a post op at 6 weeks would only tell her if the wound had healed well not if the issues had been sorted. I haven't really had a feel around as don't want to touch healing tissues. Sometimes I have felt a bulge  - daren't look or press around - but certainly no obstructive defecation which was why they agreed to the op as it was interfering with my life too  much. 

So we shall see. 

​Although I have had to go back I am still pleased I had both repairs done - if they now work it will make life better. Recovery is certainly a long haul - the GP said six months and he is right - the last repair took that long really. 

​Hoping for a restful last week before returning to work - though the bricklayers are in today! Still as I was in a tent in the garden - major building work - till the Friday before my op on the Monday things are better. (the builder was under oath to get me a bedroom back before I came out of hospital!) Trouble is I keep looking at the disaster that is my house and wanting to get things done - being back at work will be easier as I won't have to look at the mess around me!!

 

2

Hi thank you for all your information on your surgery and recovery, I hope you continue to recover well x I just wonder if I am having a similar problem to you - I hope you don't mind me telling you! I had a posterior repair and enterocele repair last December, after the initial surgery swelling I never felt good as it still felt I had a bulge but to me it didn't seem like where it was before just slightly further back as in the perineum. I had a post op appointment at 6 weeks and the urogynaecologist said the stitches were still in place even though I was convinced the op had failed. I was off work for 14 weeks as I do a physical job and I made no improvement in fact I felt worse than before the op. Gp wasn't helpful, got a private appointment with a colorectal surgeon at 12 weeks post op and through examination he said I had a small rectocele! He advised me to wait a little longer then go to see another colorectal surgeon who that specialises in the pelvic floor. Saw him and he wanted me to have a colonoscopy and Mri proctogram, the Mri was a disaster as I had no urge to push as I was laying in a scanner with a huge pad and disposable underwear so nothing was expelled so to check other things couldn't be seen! He now wants me to have biofeedback. I just want to ask your advice I don't really know what to do - I am going to do the biofeedback but I'm sure things are not right. I take things to go to the loo but it feels like there is something there all the time and this different bulge, could it be similar to you? Do you think I should of gone back to see the urogynaecologist? I'm in so much pain down my left hand side - si joint, hip, back, leg also. It's really getting me down and I don't know. Any advice from you would be appreciated, did they say what was wrong and why you needed another surgery? Thank you again sorry for the long post!

3

Hello.

​I had a rectocele repair last April - 2016. After 3 weeks I was convinced it had failed - felt the dreaded bulge again.

Although had a 'good' op - healed well - long process but little pain, little bleeding. Pressure on standing, pain on left side near ovary. Plunged into menopause immedialtley post op - GP reckons it was because they might have clipped a blood vessel  - but anyway I'm 54 so was going to happen sooner or later. 

​Went to post op appt at 9 weeks and allowed myself to be fobbed off - I knew things weren't right. Saw the original surgeon - the one I was going to have but then didn't - so not the one who did the oop (he has subsequently retired so I have the new lady all the time now.) He just said it's all healing well - which it was - he examined me on my back so there was no way he could really tell. He referred me to pelvic ohysio for the stress incontinence issues.

​I have posted about my disaster appointments to pelvic physio - I won't repeat here. Anyway Iknew all was not well, was back to the bulge and splinting again but much lower down - all in the perineum. (I think I have posted about this also) So back to the GP and back to consultant. Saw the man who has now retured - he  felt all was ok but referred me for a proctogram - not an mri one - an xray(?) one. Had that and came back with paradoxical muscle contraction - so instead of releasing the muscles tightened up. I had only expelled 50% of the paste stuff. So then to joint colo-rectal/urogynae clininc - though not with my urogynae. This was really a pointless waste of time. Both of them had hands up my nether regions - though not at the same time! Uro'gynae said the septum in the posterior repair was sound - well that was never in dispute - and he also examined me lying on my back so was never going to get an accurate result. Colo-rectal man said I did have this paradoxical muscle thing - which the pelvic physio said I did not have - (though I couldn't abide this Missy Physio - fortunately she went on maternity leave and I saw another one) They then referred me to bio feedback. They did refer me for an mri protogram but I think that got lost somewhere and I never had it in the end

​Well I have to say I thought this was a bit pointless too.  It is a machine with a probe thing that goes in the vagina (or rectum) and you then do pelvic floor exercises and it measures the response when tensing and when relaxing. I had to do them standing and lying down everyday. When I went back the physio - this one was ok - said "that's ok , it shows you can release enough, the muscle release is good enough." I asked what it would be like if the paradoxical muscle was there and she said the difference woul dbe form, say, 28 when tensing then only down to 19 when relaxing. Mine went from 28-32 when tensing to 7 - 9 when relaxing so a good difference. 

​My case was discussed at the joint clinic (MDT) meetings. I had a final appt in May with the consultant and pelvic physio and that was when they had decided to operate again. 

​It took from last August till the May to jump through all their hoops but I got there in the end. They would no thave opersted if the paradoxical muscle contraction had not got better - the pelvic physio exercises and techniques did help - though mine was not bad anyway - the colo-rectal man said it would have been easy for the pelvic physio to miss. Also it was having an effect on my life. The obstructive defecation was greater than 50% of the time and some days were worse than others - that feeling of needing the loo for a bm but then not being able to go. The bulge was quite bad. They did ask about when the bulge was there - how it releated to types of stools. Well I got a bulge even when I had a very loose stool so they said that was bad - had I been constipated with hard stools they would have expected a bulge on defecation with the lax perineum, but as I had it all the time that was another factor to decide in favour of another op.

​I was off work for 13 weeks the first time - 12 weeks sick then one week's leave. I too do a physical job. I don't think the first op failed as such, it just reoccurred lower down.

​The many appointments did get me down. I had a major hissy fit with the awful pelvic physio - who then wrote to the urogynae requesting an urgent follow up!  I'm no  tsure of the point of the joint physio and urogynae appt I had last time. I just went in and they said they would operate.

​The stress incontinence issues seem to have got lost in all this - I shall ask about this at my post op in October

​It was very difficult to find any good info on just a perineorraphy - it seems it is commonly done with a posterior repair.

​So I think it was worth persevering. I do feel better and am more cautiously optimistic. The key was how much of my life was being taken over by the obstructive defecation - how many times I was having to splint to go to the loo, the bio feedback told them that the paradoxical muscle contraction was not that bad. (they wouldn't have rpeaired if it was as it would have just caused the problem to reoccur again) And the proctogram was just something to get through as was various people's hand up various places! I was tempted to take a picture of the bulge - I was going to call it a velfie! - to show. The pelvic physio thought this wouldbe a good idea. I never got round to it. My phne is also synced to my tablet so I wuld have had to have been careful with my delete button!

 

4

Thank you for your reply and all of what has happened to you. Your symptoms do sound extremely like mine. I will give the biofeedback a try, I know I've got to wait for my first appointment and then I've got up to six other appointments which will probably take six months fitting them in around work and travelling to them (not nearby!) but I shall go back and ask to see a urogynaecologist again and I shall remember your information! I too don't think it is muscle related as when I had physio pre op she said I had strong pelvic floor. I have had horrendous appointments the last three years also I have always had lying down appointments also. I just think back to when the urogynaecologist come to see me the morning after surgery I asked how it went as at the time I didn't know what I'd had done as I'd signed to other things if she deemed necessary as in hysterectomy etc all she said was 'I was close to alot of blood vessels' I didn't realise what she meant by that??? Please keep me and everyone else informed of your recovery as the stories especially the good outcome recoveries are vital for a light at the end of a tunnel. Take care and continued success x

5

Hi sorry me again, was just looking at the colorectal surgeon's letter to me he said I could have possible anismus which I've searched is like what you said the paradoxical muscle is contraction. I've not seen anywhere that it causes a bulge feeling in the perineum. I think my symptoms are very similar to yours.

6

The colorectal man did a physical examination and said I did have the paradoxicl muscle contraction but it was not bad - which was why he felt th ephysio had not picked it up. The biofeedback will show whether you do. The proctogram all agreed gave  - to a degree - false readings as it's an unnatural situation and an unnatural way to go to the loo - so can be not as helpful as it could. I did all these biofeedback exercises for a month - went back tp pelvic physio who took about a minute to look at the results - they can read them off the machine and said - shows what I thought. So it wasn't really necessary but did show I had a degree of release that was ok I suppose. They did say the bulge in the perineum was not helped by the muscle contraction  - after all the stuff has to go somewhere! I think that was why they were not going to be willing to operate if the muscle contraction was bad - it wouldn't cure the problem and would just reoccur. As I said I can  - I think  - still feel a little bulge - but don't want to check this out too much just yet. 

7

What is a perrinoraphy?