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Rectal pain after TVH, no bleeding, taking Advil and Tylenol, CT scan normal

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May 2013
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Had TVH 5 wks ago. Immediately after and on-going since then has been persistent pain in rectum through to vaginal cuff area. Sitting and/or driving is the worst! Constipation has never been a problem, before or after surgery. No bleeding before or after surgery (except minor post-op vaginal bleeding). Pain meds (Advil, Tylenil) only mask pain for ~ 1-2 hrs. When walking, before surgery & post-surgery, there is also tugging or pain "behind" where left ovary was/used to be. I'm thinking these are 2 separate things going on: 1 before TVH and one that definitely started immediately after surgery. Had 2 different UTIs post-surgery, 2nd round of antibiotics seemed to have cleared those up. CT Scan didn't show anything 2 wks ago to explain rectum pain. And pains are not spasms. Pain is there 24/7 except when masked by Advil/Tylenol.
Posted Sat, 28 Jul 2012 in Women's Health
 
 
Answered by Dr. Sree Gouri SR 2 hours later
hi,
Thanks for the query.

the possible causes of your pain are,

-when sacrospinous ligament suspension was done during surgery sometimes it can lead to pain in the buttocks and rectum etc,
-levator ani syndrome: it occurs due to tension or pain of the muscles of pelvic floor surrounding rectum, sitting often increases the pain,
-ovarian remnant syndrome: it occurs due to ovarian tissue that is inadvertently left after oopherectomy, it also presents with pelvic pain,
-formation of granulation tissue at the wound area of vault or cellulitis of vault etc.

usually the pain will subside soon, if not with your doctor’s advice you can follow measures like,
hot baths,
levator muscle massage,
postural adjustments,
electrical stimulation etc

you can go for estimation of levels of FSH to rule out ovarian remnant syndrome,
with these measures possibly you will get relieved of pain.

Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Rectal pain after TVH, no bleeding, taking Advil and Tylenol, CT scan normal 1 hour later
Thank you, Dr. Gouri, for your response. However, none of the bullet points you suggested make sense:

Sac. Lug. Suspension would only make sense if that procedure was done. It was not.

Levator symptoms don't apply. Pain started directly after surgery done was done, there has been no constipation, there is no burning when having a bowel movement, no worse pressure or pain related to bowel movements, and pressure/pain is between rectum and vagina, not solely in the rectum. Pain is constant since surgery.

Ovarian Remnant Syndrome: only references I could find said this occurs when hysterectomies were done laproscopically. Mine was done vaginally.

Last one doesn't match at all.

So, thinking differently, any other suggestions that actually match my history/symptoms?

Thanks, XXXXXXX
 
 
Answered by Dr. Sree Gouri SR 17 hours later
hi XXXXXXX

As you told that already you have undergone examination and CT scan by your doctor I am mentioning rare causes,
The other possible causes for your pain are,

-Pudendal nerve entrapment that may be occurred because of position kept for vaginal hysterectomy for prolonged periods or during procedure,
Other symptoms can like bladder and bowel disturbances also can occur with this as described in books and net but it can only present with chronic pelvic pain sometimes.

-Adhesions between vagina and rectum can occur sometimes because of surgery these can also lead to pain,

-During vaginal hysterectomy sometimes if needed doctors will do pelvic floor repair also, if that was done tightly that can present with pain at the perineal body means in between vagina and rectum,

So you better discuss these options with your doctor and follow her advice to get relif from pain.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Rectal pain after TVH, no bleeding, taking Advil and Tylenol, CT scan normal 3 hours later
Thank you, Dr. Gouri, and I will follow up with my doctor regarding these last suggestions.

Much appreciated, XXXXXXX Wolf
 
 
Answered by Dr. Sree Gouri SR 1 hour later
hi XXXXXXX

thank you,
Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
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