Jan, I need your expertise and advise. If you go back and read my previous posts reagarding my surgery for a rectocele and rv fistula you should have a general idea of my surgery and what it entailed. I have been having air coming thru the vagina and a burning irritation in the area where the flap was done. The air and burning is bcoming more frequent. I can't sit,it feels like I am sitting on a ball and my bm's are getting hung up on something. it just pulls in that area and feels like something is in the rectum pushing on the back of the vagina irritating it. My gyne sent me to a pelvic floor department at the local women's hospital and the doctor told me that a lot of women have air coming thru their vagina, and that is normal. Is it? I mentioned the irritation and burning in the vagina and she prescribed premerin vaginal cream for me to use. It just makes the burning and itching worse. could this be from the flap? could it be scar tissue? I never had this until the flap procedure was done. She told me it was a muscular problem, spasms, and levator ani syndrome. My three options were womens rehab, botox injections in the area or pain management. I told her I wasn't going to any of those. I went to rehab for 9 mos after the surgery and it didnt help. something is not right down there. could it be from the second surgery being done 10 days apart from the first and maybe the tissues were pulled too tight and this is causing the problem. My regular gyne said that I shouldn't be in the pain that I am in. Do you have any suggestions?

I always frown when doctors tell patients that they should not be experiencing the pain they are feeling. What they really should be saying is that they can't figure out what is causing the pain or how to deal with it because everything they know or have learned tells them that there is nothing "wrong." Of course, you are the one living with your body. Sure, there are chronic pain syndromes that happen after surgery or other trauma, but I'd want to be 100% sure that there was not something that could be treated before "settling" with that diagnosis. That said, going to a pain management specialist can be a very good idea to get some relief while you continue to try to sort this out. Levitator ani syndrome does happen.

Maybe you and the doc at the local women's hospital are not on the same page. First of all, you need to make sure you are both talking about the same symptom. For lack of a better term, I'll call it a vaginal fart. OK, yes it is not uncommon for air to become trapped in the vagina and cause these vaginal farts. Usually it is associated with positioning and similar things. But, vaginal air that is generated from the vagina is associated with RV fistula, particularly when you have other signs and symptoms, such as pain, unusual drainage, signs of infection, etc.

I am sure that you know that RV fistulas have a pretty high recurrence rate, regardless of the type of treatment used. I think you need to seek another expert opinion, not just someone who is an OB/GYN. You need someone who has a great deal of surgical experience with RV fistulas. What diagnostic imaging have you had? A CT or MRI at this point seems warranted to see what is going on. A scoping is also in order, if you have not been scoped. Have you been seeing the surgeon who did your original repair following the rectocele repair?

Jan

Jan,

Thanks for your advise. As far as tests, I have had a colonoscopy , EUA and a vaginogram. Everything was negative. I do have diverticulosis and there was some scar tissue from the surgery that the doctor mentioned in his report. He did remove some of the scar tissue. I don't like the fact that the air is constantly coming thru the vagina and the burning, irritating sensation in the vagina where the fistula repair was done. What could be causing the burning sensation? Is it possible for me to feel the flap that was put in? It also feels like I have the Wall Street Journal down there. If women do have air, where and why does it get trapped? Do you think that the second surgery might have caused this being done so soon after the first?

I have not been back to the original doctor that did the surgery, When I was going to her before and after the surgery until she released me, she made comments that I just carry my stress in my butt. I'm sure she would be upset if this was happening to her. When I tried calling her office when I had questions, she would never get back to me.

I would just like my quality of life back again.

Thanks for listening and your feedback.

Elaine

The trapped air I am referring to is just air that goes in the vagina and gets trapped, sort of like a whoopee cushion. But this would not be a constant or frequent thing. I would be concerned that the burning sensation you are feeling is due to the return of the fistula. Are you having unusual vaginal discharge that would further indicate the return of the fistula?

I suppose it is possible to be able to feel the flap and maybe it is pulling. Adhesions can cause this too. I doubt that having the surgeries back to back made much of a difference one way or the other.

I think you just need to make an appointment with your surgeon, see her face to face, and get to the bottom of this. It seems like you are getting the royal runaround.

Jan

Jan,

I don't have any unusual drainage. It just seems moist down there at times. Even tho I had a vaginogram done and was told I don't have a fistula, could I possible have one?

Elaine

Yes. Fistula tracts can be notoriously difficult to find. They might have better luck finding the opening from inside the rectum rather than from the vagina. The fact that you do not have vaginal infections or discharge is encouraging that there is no new fistula, or if there is, it is extremely small.

Jan

Jan,

Last year when I went to the doctor and complained about the air thru the vagina, I did have some type of dye(bright green) put into the rectum and it did come out thru the vagina, not immediately, but later that day. that too was brushed off. If I do have a very small fistula, could it be causing all these issues that I am complaining about? burning etc. If so what are my options as far as having it corrected?

Elaine

The dye should not have been coming through the vagina, even later in the day and yes, I do think that even a small fistula can cause a lot of symptoms. Granted, they should be less with a very small fistula, but what if there is and abscess brewing or something? Honestly, there isn't too much to do that is not surgical. They have fistula plugs that could be tried (I think they are made of fibrin and are supposed to be an improvement over the fibrin glue that doesn't have such a good success rate). When a flap procedure fails, sometimes a redo can fix it. Sometimes not. Any chance of getting a second opinion by a different surgeon? A CT scan would help rule out an abscess or fluid pocket, or similar.

You may want to post a "shout out" in the women's forum, asking for recommendations for surgeons in your area that might help. There are quite a few here with fistulas, although most of them are IBD patients. However, that really shouldn't matter as far as surgical repair goes (IBD just worsens the prognosis for a cure).

Sorry I can't put a more positive spin on this, but I don't want to give you false hopes, just some hope.

Jan

Jan, I have just a few more ?? for you.

If the flap would have to be redone, where would they get the tissue to redo it? what would happen to the original one?

I really appeciate your help in this matter, and I know from reading other posts that other people appreciate your expertise and knowledge too.

Once I get the answers to my questions, I am going to make some phone calls and get another opinion. Idid get a few names of doctors in this area from others on this site.

Thanks again for your help.

Elaine

I really don't know too much about it. But, there are a variety of procedures they can do and it all depends on the findings once they get in there.

Here are some links to more info:

http://www.fascrs.org/physicians/education/core_subject...ulas_and_rectoceles/

http://www.springerlink.com/content/3nb85nftey8k1p5d/

http://www.ingentaconnect.com/content/klu/384/2008/0000...0000413?crawler=true

Jan