Rectal Compression: Causes, Symptoms, and Surgical Options

Rectal pressure questions 2?

Dear Doctor: I previously inquired about rectal pressure issues, and now I have a few more questions.
For instance, I have a severely retroverted uterus, which does not cause any discomfort, but the prolapse is what compresses the rectum, leading to a sensation of urgency and heaviness.
After many years, I have considered the possible causes of the problem and underwent a uterine suspension surgery.
However, I have experienced compression for over a decade, and it is neither a uterine fibroid nor an internal uterine issue.
When I refer to the deformation of the rectum or colon, I mean the long-term pressure it has endured.
Although the compressing organ has been ruled out, is it possible that the rectum and colon cannot return to their original shape? If this is a possibility, could that segment of the rectum or colon be surgically removed? Therefore, I previously asked what kind of examinations could reveal this.
(As long as I can have smooth bowel movements, I am willing to try any surgery.) Thank you sincerely for your response!

yoyo, 40~49 year old female. Ask Date: 2014/03/17

Dr. Ke Fangxu reply Surgery

The rectum and colon are delicate organs that do not deform under pressure.
If you still experience a sensation of urgency and incomplete evacuation after undergoing a uterine suspension surgery, it may be necessary to consider that the suspension effect from the surgery is inadequate.
If there are no longer any concerns regarding fertility, a hysterectomy may be a viable option to consider; however, it is essential to have a thorough evaluation by a gynecologist.

Reply Date: 2014/03/17

More Info

Understanding rectal compression and its implications is crucial for addressing the symptoms and potential surgical options available. Rectal compression can arise from various causes, including anatomical abnormalities, tumors, or conditions such as uterine prolapse, which you mentioned. In your case, it seems that the significant retroversion of the uterus has led to compression of the rectum, resulting in the sensation of urgency and heaviness.

Causes of Rectal Compression
1. Uterine Positioning: A retroverted uterus can press against the rectum, especially if it is also prolapsed. This can lead to discomfort and changes in bowel habits.

2. Pelvic Floor Disorders: Conditions such as pelvic organ prolapse can contribute to rectal compression. The pelvic floor muscles and connective tissues support the pelvic organs, and any weakening can lead to displacement.

3. Tumors or Masses: Benign or malignant growths in the pelvic area can exert pressure on the rectum, causing symptoms.

4. Chronic Constipation: Long-standing constipation can lead to rectal distension and changes in the rectal wall, which may contribute to a sensation of pressure.

Symptoms of Rectal Compression
- Urgency: A feeling of needing to have a bowel movement frequently.

- Heaviness: A sensation of fullness or pressure in the rectal area.

- Difficulty with Bowel Movements: This may include straining or incomplete evacuation.

- Pain or Discomfort: Discomfort during bowel movements or a general sense of pelvic pressure.

Surgical Options
Given your history of uterine suspension surgery and ongoing symptoms, it is essential to evaluate the structural changes in the rectum and colon. Here are some surgical options that may be considered:
1. Resection: If there is significant deformity or damage to the rectum or colon due to prolonged compression, surgical resection of the affected segment may be necessary. This involves removing the deformed portion of the bowel and reattaching the healthy ends.

2. Colostomy: In severe cases where rectal function is significantly compromised, a colostomy may be performed. This involves creating an opening in the abdominal wall for waste to exit the body, bypassing the rectum entirely.

3. Pelvic Floor Reconstruction: If pelvic floor dysfunction is contributing to your symptoms, reconstructive surgery may help restore normal anatomy and function.

Diagnostic Tests
To determine the extent of rectal or colonic deformation and to evaluate the best surgical approach, several diagnostic tests may be recommended:
1. Colonoscopy: This allows direct visualization of the colon and rectum, helping to identify any abnormalities or lesions.

2. MRI or CT Scan: Imaging studies can provide detailed information about the pelvic anatomy, including the position of the uterus and any potential compressive lesions.

3. Defecography: This specialized X-ray study assesses how well the rectum and pelvic floor function during bowel movements.

4. Manometry: This test measures the pressures and function of the rectal and anal sphincters, providing insight into any functional issues.

Conclusion
It is indeed possible for prolonged compression to lead to structural changes in the rectum and colon, which may not revert to normal even after the compressive factor is removed. Surgical options exist to alleviate symptoms and restore bowel function, but the specific approach will depend on the findings from diagnostic evaluations. It is essential to work closely with a colorectal surgeon who can assess your individual situation and recommend the most appropriate treatment plan. Your willingness to explore surgical options for improved bowel function is commendable, and with the right evaluation and intervention, there is hope for significant relief from your symptoms.

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