23 replies to this topic

[LeviM]

Hey guys and gals, For about a year and a half now I've had issues with prolapsed rectum and have got mixed batches of information from health care professionals who in the long run don't think anything of it. Is this a side effect of SCI? How many others have a problem with this? I have no Bladder or bowel control and do a pretty standard B&B routine. I have found this to be an issue not only while doing my Bp but also when moving around from my bed to chair and pushing myself around the house. It is usually pretty easy to remedy the issue by lubing up and shoving stuff back up where it belongs but this has caused a couple AD flare ups.

My biggest concern is that there's going to be a prolapsed section of the rectum and I not realize it before the tissue gets damaged form lack of blood flow to the area. My doctor doesn't really seem to be alarmed by it, but he has never examined me in that area either. He writes it off as just another side effect of SCI or MS without really investigating it on any level.

I would classify the prolapse pretty significant to be honest. Often it takes a good 5+ minutes to get everything pushed back up where it belongs only for things to push right back out so when that happens we have to literally hold things up in place for another 5-10 minutes to get it to stay.

Anyone else find themselves experience this issue? How did you treat/manage it?

Thanks.

[mellowgator]

it sounds serious to me. i'd try to go to another dr who will listen to your concerns. good luck.

[LeviM]

it sounds serious to me. i'd try to go to another dr who will listen to your concerns. good luck.

I'm gonna be changing doctors in April. I'm going to be switching to the doctor who took care of my girlfriends grandfather who died of terminal cancer a few years ago. My girlfriend says shes an excellent doctor. Unfortunately she won't be taking new patients until then. My current doctor is lazy to say the least. He flat out refuses to fill out the monthly pre authorization paperwork for my protonix, say's it takes too much time and when I was trying to ask him about switching to a medication the insurance wouldn't require a monthly pre authorization for he simply ignored me and changed the subject completely. There's other issues as well so April can't get here fast enough.

[brockit79]

What is your physician's problem?! He is a law unto himself by the sound of it. Roll on April. I do not have problems specifically the same as you but I have had to change my set of specialists which I did as soon as I could when I realised how poor my prev set were.

You should not have to feel neglected and ignored by this so called doctor. What you described needs looking at asap, can you see someone else until April?

Best of luck!

[LeviM]

Hey Brockit, I could technically change doctors before then but I really hate to change to a new doctor for only a couple months. I'll just pick and choose my battles with my current doctor and become a thorn in his side on issues that I feel need to be heard, until he stops and listens.

And I also just remembered something else. I am on a Maryland program called Rare and expensive case management(REM). This program is fee for service so I technically don't need a referral anymore for any type of specialist. I could figure out what specialty this issue falls under and find a doctor in that specialty that accepts my insurance and set up an appointment. I've only been on REM a few months now and am still used to going through my primary care doctor for everything.

So I wonder what specialist would deal with this type of issue? Gonna do some homework and find out... If I haven't figured it out by tomorrow I'll put in a call to the REM case worker and see what she thinks.

[Tetracyclone]

Of course you should be concerned. Stupid doctor.

Here is some info from the web:

Some of thecomplications associated with rectal prolapse include:

• Risk of damage to the rectum, such as ulceration and bleeding
• Incarceration, which means the rectum can't be manually pushed back inside the body
• Strangulation of the rectum, which means the blood supply is reduced
• Death and decay (gangrene) of the strangulated section of rectum.

What is the treatment?<p>Treatment depends on the age of the patient and the severity of the prolapse. The treatment options include:

• Diet and lifestyle changes to treat chronic constipation; for example, more fruit, vegetables and wholegrain foods, increased fluid intake and regular exercise. This option is often all that's needed to successfully treat rectal prolapse in young children.
• In cases of mucosal prolapse, the structures are secured in place with surgical rubber bands.
• Surgery is sometimes used to secure the rectum into place, performed through the abdomen or via the anus. One operation involves tethering the rectum to the central bone of the pelvis (sacrum). Another operation is to remove the prolapsed part of the rectum and to rejoin the bowel to restore near-normal bowel function. While abdominal surgery may give better long-term results, elderly patients may be advised to undergo surgical correction via the anus, since it is easier to recover from this procedure.

One can see Colon and Rectal Surgeons, Gastroenterology (Digestive Specialists), or a proctologist.

[LeviM]

Hey there Tetra, thank you for the info. I'm wondering if the doctor that is taking care of and maintaining my G tube stuff can also deal with this. I'm gonna call and ask before trying to find a proctologist. I'm not sure what lead my doctor to believe it's just another SCI/Ms complication as no one else here seems to have an issue with it. Probably his way of blowing it off.

Anyways thanks again for the info.

[julibugs]

Levi, I have had a prolapse and I don't think you should wait until April, you are risking real damage to your bowel and rectum. Mine was treated as an emergency and I was told in no uncertain terms that any repeat should involve going straight to hospital.

Maybe the next time this happens you should consider presenting at the emergency department!

Julia

[LeviM]

Levi, I have had a prolapse and I don't think you should wait until April, you are risking real damage to your bowel and rectum. Mine was treated as an emergency and I was told in no uncertain terms that any repeat should involve going straight to hospital.

Maybe the next time this happens you should consider presenting at the emergency department!

Julia

Hey Julia, the problem that is the area I live in (Salisbury Maryland). The only local hospital is pretty clueless and has a bad reputation. I've been up there at least two occassions where my blood pressure was through the roof. Not sure if it was AD related or just uncontrolled high blood pressure (I'm on 2 meds for it) It concerned them enough for them to make me stay several hours to try and get it to come down but ultimately they discharged me with blood pressures above 150's/110 both times because they couldn't get it to come down and lab work was normal, because that makes all the sense in the word right? lol Both times I tried to discuss the possibility of it being AD but they got a crappy know it all attitude and dismissed it because they didn't know what I was talking about.

Anyways I'm certain if I went up there with this issue they would shove stuff up where it belonged and send me along my way and tell me to see a specialist. This is one of the biggest down falls to living in a small town. There's a lot of doctors here and even specialist but most of them work together in a large practice. I recently saw an orthopedic and didn't much like his bed side manners and closed mindedness to certain treatment options because of me being in a wheelchair. I asked to see another ortho in his group for a second opinion and they said I couldn't because I had seen the one doctor already, so I had to continue seeing him. So pretty much that made it to where the only options for second opinions were doctors not in that practice which means I would have to go out of town. My REM case worker tells me that I will run into that problem a lot around this city and has advised me to consider driving to Baltimore to be seen at John Hopkins for certain issues requiring a specialist.

I have been very fortunate in finding an excellent physical medicine doctor that works at a local rehabilitation hospital but the rest of the doctors I've seen here have been less then ideal. It will probably take me a while to find specialists willing to take my case on that will actually do their job properly. Chances are I will end up having to take my case workers advice and start making trips to John Hopkins.

I put a call out to my caseworker today to get some feedback on which doctor I should see or if I should bypass all the local options and go straight to John Hopkins. Hopefully she will call me back tomorrow and let me know how I should proceed.

[julibugs]

Levi, I have had a prolapse and I don't think you should wait until April, you are risking real damage to your bowel and rectum. Mine was treated as an emergency and I was told in no uncertain terms that any repeat should involve going straight to hospital.

Maybe the next time this happens you should consider presenting at the emergency department!

Julia

Hey Julia, the problem that is the area I live in (Salisbury Maryland). The only local hospital is pretty clueless and has a bad reputation. I've been up there at least two occassions where my blood pressure was through the roof. Not sure if it was AD related or just uncontrolled high blood pressure (I'm on 2 meds for it) It concerned them enough for them to make me stay several hours to try and get it to come down but ultimately they discharged me with blood pressures above 150's/110 both times because they couldn't get it to come down and lab work was normal, because that makes all the sense in the word right? lol Both times I tried to discuss the possibility of it being AD but they got a crappy know it all attitude and dismissed it because they didn't know what I was talking about.

Anyways I'm certain if I went up there with this issue they would shove stuff up where it belonged and send me along my way and tell me to see a specialist. This is one of the biggest down falls to living in a small town. There's a lot of doctors here and even specialist but most of them work together in a large practice. I recently saw an orthopedic and didn't much like his bed side manners and closed mindedness to certain treatment options because of me being in a wheelchair. I asked to see another ortho in his group for a second opinion and they said I couldn't because I had seen the one doctor already, so I had to continue seeing him. So pretty much that made it to where the only options for second opinions were doctors not in that practice which means I would have to go out of town. My REM case worker tells me that I will run into that problem a lot around this city and has advised me to consider driving to Baltimore to be seen at John Hopkins for certain issues requiring a specialist.

I have been very fortunate in finding an excellent physical medicine doctor that works at a local rehabilitation hospital but the rest of the doctors I've seen here have been less then ideal. It will probably take me a while to find specialists willing to take my case on that will actually do their job properly. Chances are I will end up having to take my case workers advice and start making trips to John Hopkins.

I put a call out to my caseworker today to get some feedback on which doctor I should see or if I should bypass all the local options and go straight to John Hopkins. Hopefully she will call me back tomorrow and let me know how I should proceed.

I do hope you get sorted soon - just because you can't feel it, should'nt mean that its not important.

Keep us posted, I will be thinking about you.

[LeviM]

Thanks Julia,
I'm sure with time all the kinks will get worked out. In the mean time it's just one extra thing that has to be checked on often. How do they treat your prolapse? If it was surgical how long did it take to recover?

[julibugs]

Thanks Julia,
I'm sure with time all the kinks will get worked out. In the mean time it's just one extra thing that has to be checked on often. How do they treat your prolapse? If it was surgical how long did it take to recover?

I had a non surgical repair - possible for women as it involves a ring inside the vagina, unfortunately I now need a surgical repair due for later this year.

[LeviM]

Ahh I gotcha, Hopefully the procedure isn't too hard on ya and the recovery is quick!

[julibugs]

Ahh I gotcha, Hopefully the procedure isn't too hard on ya and the recovery is quick!

If i get my surgery before you get sorted I will keep you posted on the recovery

[LeviM]

Well it's been 3 days now and we have not been able to permanently reduce the prolapse. It just will not stay put. We did pack up and go to the ER last night but all they did was peek at things down that way and say yep you have a prolapse. They said as long as it was reducible it was not an emergency that needed to be tended to right that second. I tried to explain to the doctor that, yes it is reducible but no it never stays for more then 30 minutes. It just went over her head I think. She advised me that the prolapse was indeed at the point that it needed surgical treatment and said she would give me the name of a general surgeon I could contact.

So I then asked "so we should keep doing what we are doing and checking it constantly and try to reduce it as much/often as possible?" She said no you really don't need to check it often, you will know when it is prolapsed enough to require manual reduction. I asked how exactly I would know considering I have no sensation in the area and she was like "oh that's right" and said yeah keep doing what you're doing. My blood pressure was in the 140's/103 when I left the ER last night and earlier today is was 142/100. Still not sure if this is uncontrolled high blood pressure of AD flare. Gonna keep an eye on it.

Anyways the good news is I have an appointment with the general surgeon on Friday morning. Hopefully we can fix the issue without it being a major deal. I've read up on the surgical procedures for it and it sounds like it's gonna suck. I'm considering just having them put in a colostomy bag. Girl friend doesn't like that option much so not sure about that just yet.

[xxm]

Levi,

I was afraid that after 35 years chronic constipation i have anal prolapse and went to see a general surgeon who made an examination. He discovered external haemoroids.
How do you know that you have prolapse but not external haemoroids ?

I completely agree with you that living in a small town for a SCI is very difficult regarding medical services.

Rudy

Edited by xxm, 29 February 2012 - 10:44 AM.

[LeviM]

Levi,

I was afraid that after 35 years chronic constipation i have anal prolapse and went to see a general surgeon who made an examination. He discovered external haemoroids.
How do you know that you have prolapse but not external haemoroids ?

Hey there xxm, I was actually diagnosed with a prolapse about 1.5 years ago by a doctor .Back then I mainly had issues with it during and after my BP was done. Also now, enough of the rectum prolapses to the point of completely blocking the entrance or exit from the anus. It's not just a small or even large piece of flesh near the anus it is a large circular section of flesh that completely covers the anus and until recently could be pushed back inside and it would stay for a long period of time. Now no matter how often we reduce it and try and hold it up in place it simply refuses to stay put for very long.

[Tetracyclone]

Levi. GF can get used to a colostomy bag if that is what you want. Some love this option if BP has been a horror.

[LeviM]

Levi. GF can get used to a colostomy bag if that is what you want. Some love this option if BP has been a horror.

Hey Tetra, I'm sure she could get used to it if that's what I decided to do. I have a G tube (feeding tube) surgically put in to the upper left hand side of my belly button and she can't stand it lol. I don't really blame her as it can be gross at times. I'm willing to not go the colostomy route if it makes her feel better. I can see the pro's from having it but it isn't really worth it to have yet another external attachment she ends up hating, all for a mostly quality of life improvement for me. I try to take her desires into consideration seeing as in the long run as I continue to lose function she is going to be having to deal with a lot of these things. I have no doubt she would deal with the whole colostomy thing or anything else for that matter if it was deemed medically necessary.

I still don't know why she fell for such a messed up man lol. I guess I should stop second guessing that stuff and enjoy her.

[greybeard]

I guess I should stop second guessing that stuff and enjoy her.

Sounds like a plan.

[LeviM]

I saw the general surgeon this morning. We are considering two options. 1. the repair done through the bum to try and repair the problem and 2. Having a colostomy done and they will end up fixing that problem too.. The problem with option number one is it has a high rate of reoccurrence and having a SCI, the BP and other issues related it only increases the rate of reoccurance. I haven't decided what to do just yet. My girl friend has done a 180 after speaking with the surgeon and seems to be pro colostomy now.

I requested time to make the decision and am supposed to call the office back once I have decided. Option number 1 is outpatient surgery. Option number 2 would mean 4-7 days inpatient. Hmmm

Edited by LeviM, 02 March 2012 - 07:23 PM.

[Tetracyclone]

My girl friend has done a 180 after speaking with the surgeon and seems to be pro colostomy now.

She sounds like a keeper!

[julibugs]

Levi,

whichever option you go for at least your problem will be dealt with, don't forget you might be one of the lucky ones and a surgical repair might work permanently. Good luck whatever you decide but do keep us posted on your progress.

Julia

[LeviM]

My girl friend has done a 180 after speaking with the surgeon and seems to be pro colostomy now.

She sounds like a keeper!

She definitely is, I'm lucky to have her!

Levi,

whichever option you go for at least your problem will be dealt with, don't forget you might be one of the lucky ones and a surgical repair might work permanently. Good luck whatever you decide but do keep us posted on your progress.

Julia

Thanks Julia! It's gonna be a hard decision, but like you said, either choice will work