Cervical Issues: Persistent Bowel Urgency After Surgery

Cervical issues

Hello Dr.
Wu, I would like to ask you about my condition.
Since I had hemorrhoid surgery last December, I have been experiencing a constant urge to have a bowel movement, but I don't always succeed.
Sometimes I may go 3-4 times a day, and I have to strain to pass stool, although the stool is not hard.
I have also noticed that my stool has become thinner.
I have consulted two colorectal specialists (including the surgeon) and one gastroenterologist, all of whom said that the hemorrhoid surgery went well and there are no issues with narrowing.
I had a colonoscopy in June of this year, which was normal.
One colorectal specialist mentioned that during a digital rectal exam, they felt something that might be related to the uterus or ovaries and advised me to see a gynecologist.
Another colorectal surgeon said that what was felt during the rectal exam was the cervix, which is in a normal position, even if slightly low.
Since there are no issues with the colon, I am still troubled by the persistent urge to have a bowel movement.

I have seen four gynecologists; one suggested that it might be endometriosis and recommended a laparoscopy.
I am concerned that having a laparoscopy after a previous cesarean section might lead to more adhesions in my intestines, so I hesitated to proceed.
The second doctor said that the cervix is not a major concern, but when I mentioned the constant urge to defecate, they suggested monitoring it.
The third and fourth doctors performed vaginal ultrasounds and reported normal results, but I am still suffering from this urge to have a bowel movement.

I want to ask Dr.
Wu, since I previously had severe hemorrhoids, I would often push them back in and never felt anything unusual.
However, since late pregnancy, I have had this constant urge.
When I push back, it feels like I am pressing against something, but I didn't think much of it at the time.
I assumed it was due to the hemorrhoids, which led me to have the surgery.
Afterward, I realized that when I perform a self-exam, I can only reach a small knuckle before feeling something.
It is more pronounced when squatting.
Is the position of the cervix truly normal? What kind of examinations should I undergo? I am really troubled and feel that the low position of the cervix is pressing on the rectum, causing this urge to defecate.
I hope Dr.
Wu has some good advice.
Thank you.

Eva, 40~49 year old female. Ask Date: 2020/07/07

Dr. Wu Xianghui reply Obstetrics and Gynecology

It is necessary to rule out pelvic organ prolapse (commonly including cystocele, uterine prolapse, and rectocele).
It is recommended to visit an outpatient clinic for evaluation by a specialist in obstetrics and gynecology.

Reply Date: 2020/07/07

More Info

Persistent bowel urgency after surgery, particularly following hemorrhoid surgery, can be a complex issue that may arise from various factors. It is understandable that you are feeling concerned and frustrated, especially after consulting multiple specialists without receiving a definitive answer. Let’s break down the potential causes and considerations regarding your symptoms.

Understanding Your Symptoms
1. Bowel Urgency and Frequency: The sensation of needing to have a bowel movement frequently, even when the stool is not hard or formed, can be indicative of several underlying issues. This could be related to changes in bowel habits post-surgery, nerve sensitivity, or even psychological factors such as anxiety about bowel movements.

2. Changes in Stool Characteristics: The fact that your stool has become thinner may suggest a change in the way your intestines are functioning. This could be due to a variety of reasons, including dietary changes, the effects of surgery, or even the presence of scar tissue that might be affecting bowel motility.

3. Pelvic Organ Positioning: The concern regarding the position of your uterus or cervix is valid, especially since pelvic organ prolapse can lead to symptoms that mimic gastrointestinal issues. If the uterus is positioned lower than normal, it could potentially exert pressure on the rectum, leading to a sensation of urgency.

Potential Causes
- Post-Surgical Changes: After any abdominal or pelvic surgery, including hemorrhoidectomy, there can be changes in the anatomy and function of the pelvic organs. This can lead to altered bowel habits or sensations.

- Nerve Sensitivity: Surgery can sometimes lead to increased sensitivity of the nerves in the pelvic area, which may cause a heightened sensation of needing to have a bowel movement.

- Pelvic Floor Dysfunction: Weakness or dysfunction in the pelvic floor muscles can lead to issues with bowel control and sensation. This can be exacerbated by previous surgeries or childbirth.

- Endometriosis: As suggested by one of the gynecologists, endometriosis can cause pelvic pain and bowel symptoms. If endometrial tissue is present outside the uterus, it can lead to inflammation and changes in bowel habits.

Recommendations
1. Further Evaluation: Given your ongoing symptoms, it may be beneficial to undergo further evaluation. A pelvic ultrasound or MRI could provide more insight into the positioning of your pelvic organs and help identify any abnormalities.

2. Consult a Pelvic Floor Specialist: A specialist in pelvic floor disorders can assess your symptoms more comprehensively. They may recommend pelvic floor physical therapy, which can help strengthen the muscles and improve function.

3. Dietary Adjustments: Consider evaluating your diet to ensure you are consuming adequate fiber and hydration, which can help regulate bowel movements and reduce urgency.

4. Psychological Support: If anxiety or stress is contributing to your symptoms, speaking with a mental health professional may be beneficial. They can provide strategies to manage anxiety related to bowel movements.

5. Monitoring Symptoms: Keep a detailed diary of your bowel habits, dietary intake, and any other symptoms. This information can be invaluable for your healthcare providers in determining the best course of action.

Conclusion
Persistent bowel urgency can be distressing, especially when it affects your quality of life. While your previous evaluations have ruled out significant issues, it is essential to continue seeking answers. Engaging with specialists who focus on pelvic health and considering a multidisciplinary approach may provide you with the relief and clarity you need. Remember, your symptoms are valid, and it is important to advocate for your health until you find a resolution.

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