So, You Need Defecography Testing for Bowel Issues? Dispelling the Top 5 Myths
pelic-A common scenario: You have constipation, but the cause is unknown (and may have several underlying factors). What if your physician orders a “DEFECOGRAM?”
This is actually quite a common test, but if you search the internet, it will likely leave you with questions and fears. Dr. Vikas Shah, guest blogger and UK consultant radiologist specializing in gastrointestinal and colorectal imaging, shares information to dispel to the myths about defecograms.
What is a defecogram?
A defecating proctogram, also known as a defecography or a defagram, is used for functional imaging of the muscles and tubular structures used in defecation. It is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction, or a rectocele. These symptoms can be constipation, incomplete evacuation, incontinence, mucous discharge, or perineal pain.
By Dr.Shah
Defecograms are tests surrounded by a lot of confusion. I am going to bust 5 common myths about defecograms:1. I have to have an enema before my defecogram.
In my practice, and most other centres in the UK doing this test, there is no need to have an enema before the test. You can certainly go to the toilet before the test. What you will end up evacuating will be the barium paste that is used for the test. It really doesn’t matter if in addition to this, a little bit of your normal stool comes out too. I don’t use a caulk gun, the whole idea sounds horrible! I simply use two 50 ml bladder syringes which have nozzles just the right size for easy insertion into the anal canal, and the whole thing is far cleaner as they are simply disposed afterward.2. The barium drink is useless, as my problem is with opening my bowels.
Radiologists will have varying practice on this; in my clinic, all women are offered a barium drink to take half an hour before the defecogram. The drink shows up the small bowel. This is usually located in the center of the abdomen, but in some cases, particularly where a woman has had a hysterectomy, the small bowel drops down into the pelvis and presses on the rectum. This is known as an enterocele or small bowel prolapse. So although drink doesn’t show up the rectum, it is important to identify one of the causes of problems with opening of the bowels. People worry that the drink will make them constipated; if you make sure you drink plenty of water for a day or two after the test, it will pass through with no problem. Please note that men aren’t offered the drink as enteroceles are very rare in men due to differences in anatomy.3. I’ll need a catheter in my bladder for my defecogram
Very few centers will also put contrast (xray dye) in the bladder and vagina to show up bladder or vaginal prolapses, as this is considered too invasive. So you will be highly unlikely to need a catheter in your bladder for contrast. If your doctor wants to look for bladder, vaginal or uterine prolapses, it would be better for you to have a dynamic pelvic MRI.4. I can’t pee during my defecogram.
The aim of the defecogram is to simulate what you do at home when you go to the toilet. So if you pee while you poop at home, go for it!5. I find it hard to go toilet so my defecogram won’t show anything.
It doesn’t matter if none of the barium paste comes out. Most women are having the test because they find it hard to go, so its hardly surprising that they can’t go in a hospital xray room. The most important thing is that you try your best, and the xray images will show how things are moving and whether you have problems such as rectoceles or enteroceles. Is a defecogram always the best test? What about dynamic pelvic MRI (MRI procogram) and anal ultrasound?Test basics: The Chair
Defocogram Chair
What the images look like:
Rectocele
prolapse and enterocele
Reblogged this on Healthy Solutions.
I have a rectal prolapse have had alkmeirs procedure and it hasnt worked now waiting to go for prochogram and dreading it
Don’t worry I had one the other day I like you was nervous but I came out thinking it wasn’t that bad and it was a lot quicker than I thought please don’t worry. X
I had a defecography test to evaluate constipation and incomplete emptying. I have MS. The barium emptied before the images could be taken. The barium was inserted a second time and even though I tried to hold it, the same thing happened. Now I don’t know what my specific problems are (rectocele, etc)
What can be done for me????
See if there’s a way to get the dynamic pelvic MRI. That doesn’t require barium. Just an ultrasound gel (and then you are lying down instead if sitting). The information is in this article too. Good luck, Lori. Let me know if you have more questions.
I have been sick since last November, have always been constipated but got much worse after a barium test. Had a CT scan which showed a recurrence of a herniated bladder, and a colon which is in terrible shape. Terrible back pain and abdominal pain and some kind of prolapse in vagina(had hysterectomy). I am having a Defecating Proctogram end of month and I am very worried about it. The gastro Dr has suggested I think about a bag, I think I need a second opinion before such a drastic surgery. Thank you
It is now Nov 2017 and Ihave seen 8 specialists. I have IBS with constipation and a rectocele and have been in major abdominal pain with terrible pressure in my rectum. The surgeon now says he wants me to go to Biofeedback therapy which is not covered by by insurance and is expensive. My family doctor tells me I am getting the run around. Any advice Thanks
Hi
I have a proctogram and it showed a small RECTOCELES. It showed I managed to get rid of most but not all the paste and this is my problem. Poop stops moving once it reaches the last curve of the bowel/top of the rectum and I’m worse than ever(had the test two years ago) poop gets stuck at this same point every time. I was also told my pelvic floor drops severely if I try to stain. Any advise on further tests/what you might think is wrong or how I can get this sorted. My life is hell I’ve been like this for 14 years and its getting worse.
Many thanks
Hi Michelle,
When the pelvic floor is weak, it often balloons when people strain. This means that the effort you put into straining doesn’t help push the poop out easily, as a lot of the straining just makes the pelvic floor balloon downwards. There is no simple solution, but there are a few measures that can be taken to improve your symptoms. It would be best to chat with a qualified pelvic floor specialist about muscular exercises, bowel habit, diet and medications.
Vikas Shah
Thank you for your input on this Dr. Shah, it was very informative. I bucked up and had it done two weeks ago. It was very painful, very disgusting and very embaressing. You couldn’t pay me a million dollars to ever do this again!!!
Hi,
Well done for having the courage to take the huge step to go and have this test – I hope it helps you on your journey. I am sorry to hear that it wasn’t comfortable for you – this is such an important aspect to get right to make sure that patients leave feeling satisfied and with their dignity intact.
Vikas Shah
serialmom12
Hi serialmom12, you’re saying what was very painful….& you wouldn’t ever do it again? Is it the defecography test you are referring to or a surgical procedure do you had?
Thank You,
*Very nervous in NJ!!*
Hi doctor, I am having problems having a bowl movements. I had a hystorectomy in Dec.My doctor said it can be from this. He is sending me for a dyfecography. If there is something wrong will I need surgery? The doctor kept saying,”Let’s take one thing at a time.” I need to know what might need to be done to fix this.
Hi Gerri,
I am not sure if we can that these problems are due to the hysterectomy, but a defecogram is a good step to take. I would however agree with your doctor that it is best to take one step at a time. The range of options of what can be done will depend very much on what is seen on the test. Please be reassured that whatever it shows, there are many options available to help you – ranging from simple lifestyle measures to complex surgery – but you should definitely wait to see what the test shows before thinking about this.
Vikas Shah
Dear Dr. Shah,
I had underwent two spine surgeries MLD in year 2010 and TLIF surgery 2014. Still I have a lots of lower back pain, recently i visited gastroentrologist for chronic constipation problem and GI Dr. advice me colonoscopy and ARM. The biopsy report of colonoscopy and ARM report say.
1. Colonoscopy Impression: Adenomatous polyp (Tubulor adenoma)
ARM: comments: Normal basal sphincter pressure with adequate squeeze pressure but not well sustained duration.
RAIR is present.
On straining there is simultanious increase in rectal as well as sphincter pressure.
Balloon expulsion test: pt didn’t expel balloon out in one minute.
Above f/s/o defecatory disorder.
So Dr. I just want to ask you which radiology test will be better for me xray defecography or dynamic MR defecography to find the exact cause of OD.
Dear Bhupinder,
There are some signs in these tests that point towards a diagnosis of anismus (anorectal dyssynergy). The test to have will depend on whether you are male or female – if you are male, I would recommend an xray defecogram as we wouldn’t really be worried about examining the anterior and middle compartments. If you are female, I would recommend MRI so that you have a global pelvic floor test to check out any subtle but clinically difficult to detect prolapse of the bladder or uterus/vagina. In this situtation, I cannot emphasise enough how important it is that the radiologist/rad tech doing your exam understands it fully and makes you feel relaxed and comfortable and calm, otherwise you won’t be able to poop and a “false” diagnosis of anismus can be made.
Vikas Shah
Thank you Dr. Shah for your reply and advise me for x-ray defecography. I am a 34 yrs male. Recently i visited GI office for polypectomy and full colonoscopy and GI Dr find
1.terminal ileum shows small clean based ulcer.
2.caecum shows multiple nodules.
Conclusion: small ileal ulcer and caecal nodules.
Advice: await HP report.
According to you Dr. Shah which diagnosis may be i m suffering? And which medical investigation will help me to find out the cause of OD.
Dear Dr. Shah,
I had underwent two spine surgeries MLD in year 2010 and TLIF surgery 2014. Still I have a lots of lower back pain, recently i visited gastroentrologist for chronic constipation problem and GI Dr. advice me colonoscopy and ARM. The biopsy report of colonoscopy and ARM report say.
1. Colonoscopy Impression: Adenomatous polyp (Tubulor adenoma)
2. ARM: comments: Normal basal sphincter pressure with adequate squeeze pressure but not well sustained duration.
RAIR is present.
On straining there is simultanious increase in rectal as well as sphincter pressure.
Balloon expulsion test: pt didn’t expel balloon out in one minute.
Above f/s/o defecatory disorder.
So Dr. I just want to ask you which radiology test will be better for me xray defecography or dynamic MR defecography to find the exact cause of OD.
Dear Dr. Shah thank you for your reply and advice me for X-ray defecography. Recently i visited GI office for polpyectomy and full colonoscopy. At the time of colonoscopy GI Dr find small ileal ulcer and caecal nodules. And advice await HP report. He told me we need to wait for biopsy report and later will decide what test to perform next. I am 100% sure I have a issue with pelvic muscles but I don’t know which medical investigation test should i perform to rule out the cause of OD problem.
I would highly appreciate if u will advice me some medical investigation test’s to rule out the cause of my chronic lower back pain and OD problem.
Hello Bhupinder,
I think an xray proctogram would be the best test for you. You should discuss the significance of the other findings with your doctor as a lot will depend on the results of the biopsies and histology analysis.
Vikas Shah
I had stage 3 rectal cancer and tx included a hysterectomy and appendectomy and removal of the tumor. I was left with two inches of a normal 6 inch rectum. I had an ileostomy for a year. After the takedown my anal opening had a stricture so I had an anal flap enlargement. At first I suffered from incontinence but now, five years later, I suffer from painful constipation.
had a memectomy test and a barium defeography is suggested to rule out structural abnormalities caused by the various surgeries. Do you think this would be a good test for me or going straight for an MRI?
SO very grateful to have found your site!
Hello Victoria,
I think you may well need both a barium defecogram as well as an MRI scan to evaluate the pelvis. The defecogram will help in evaluating for rectal intussusception or prolapse, although these are usually not painful. An MRI (not a dynamic one, just a straightforward MRI of the pelvis) is important to check that there are no signs of tumour recurrence and for the effects of radiotherapy in the pelvis – these may certainly cause pain.
Best wishes,
Vikas Shah
I’m wondering which test I should have and which doctor to see for the test. Almost two years ago I had pelvic reconstruction (site specific rectocele repair, paravaginal cystocele repair, utetosacral ligament suspension for prolapsed uterus repair, and perineophery). Recovery was hideous. Acute urinary retention for two weeks post op, then, at three weeks post op I had a complete small bowel blockage with acute urinary retention that put me back in the hospital for three days. This horrific blockage caused hemerroids, so I ended up having hem banding, which didn’t work, so then a full hemmerhoidectomy. I had already had a successful PPH (procedure for prolapsed hems) several years prior to my pelvic reconstruction, but the pelvic surgery post op blockage ruined that. Recovery continued to be awful and mysteriously uncommon to doctors. Lots and lots of strange and various pain, lots of physical therapy, and tons of antibiotics. I still have dyspareunia, and a couple of months ago, out of the blue I had a couple of incidences of urinary incontinence and fecal incontinence. They were isolated incidences it seems, but I have chronic large urinary retention, and decreased sensation to urinate or deficate. I always feel the sensation of incomplete emptying. My colorectal surgeon says it’s pelvic floor dysfunction and that biofeedback will cure it. That’s great, but I believe there’s more going on and would like definitive testing before I dedicate another 12 weeks to physical therapy that’s over an hour drive away. I believe I may have a rectocele again, or maybe some other problem. The incomplete emptying, peculiar shaped stool, and the latest, this almost constant ache on the right side of my pelvic floor that’s driving me batty. It’s like a never ending recovery from this pelvic reconstroction.
So, I was thinking a defecogram is what I needed until I read about the dynamic pelvic MRI (is that the correct name?). Which one would be best for me? Also, can my primary physician order this? My colorectal surgeon moved on to a teaching hospital and my urogynecologist is over an hour away. There’s also a gastroenterologist? My primary doc is the easiest and least expensive to see, and at this point I’m exhausted and appreciate easy and straightforward. I appreciate pelvic physical therapy, but at this point I just want some definitive answers as soon as possible so I can know what problem needs addressing. Thank you for listening and for your advice.
Hello Daisy,
Yes, it does sound like a dynamic pelvic floor MRI (also known as an MRI proctogram or MRI defecogram) would be useful to see what is going on. You will have to check if there are radiologists near you who offer this test – I am not based in the USA so unfortunately cannot help you with this. The MRI will be able to assess the remainder of the pelvis too, to see if there are any other problems causing you pain.
Vikas Shah
Thank you for your reply and advice. I consulted with a new urogynecologist last week and in her office I was retaining 1,000 ml of urine. So, I had the dynamic pelvic MRI today. I couldn’t expel one drop of the gel. This worries me and I’m anxious to see what the radiologist and urogynecologist have to say. I’m afraid I’m doomed. I’m so worried that I have irrepairable nerve damage. What do you think? Any chance it could be pelvic floor dysfunction that might be resolved with PT? I also started with a new PT yesterday.
Dear Dr. Shah:
Recently I have done MRI DEFAECOGRAPHY for dyssynergic defecation but no significant abnormality is detected. And still I have lots of low back pain, feeling of anal spasm and difficulty in passing stool. MRI DEFAECOGRAPHY report says:
Observation:
Normal position of anorectal junction at rest.
Mild pelvic floor lift on squeeze.
On straining and defecation, there is mild physiologic desent of the anorectal junction which is located approximately 3 cms below the pubo-coccygeal line. No evidence of rectocele. No evidence of recto-rectal intussusception. There was good rectal evacuation during this study.
No abnormal bladder descent.
No evidence of enterocele.
Impression:
No significant abnormality is detected.
I would highly appreciate if you would let me know which investigestion test and what should i do next to come out from this PFD problem.
Dear Bhupinder,
I think the next step really needs to be a discussion between you and your pelvic floor doctor – when the test results are out of keeping with the symptoms, I always recommend that patients go back and have another discussion with the surgeon to see if there is another cause for the symptoms (pain is not a very common feature of pelvic organ prolapse, so could something else be causing the pain?) or if they feel the test needs to be repeated.
Best wishes.
Dear Dr. Shah.
I would highly appreciate if you would let me know the difference between MRI Defecography & MRI Dynamic Pelvic Floor.
Warm Regards,
Bhupinder Singh.
Dear Dr Shah,
I’ve been experiencing IBS-type symptoms – predominantly constipation and bloating, along with what feels like a spikey blockage in my rectum, which makes it very uncomfortable to sit, as there seems to be some referred pain in my perineum and right buttock. I have not had a ‘proper’ bowel movement for several months and am now dependent on Laxido to have a mushy and rather bad smelling movement (overflow?) a couple of times a day. I had a colonoscopy last month, which was clear. I have now been referred for a defecating proctogram, but am absolutely terrified that I am not going to be able to get the barium out of me after the test, given that I no longer seem to be able to have a solid bowel movement. I’m wondering if I can reject the barium drink and whether or not this test with barium is even advisable given my inability to poo solids. I have not been given the option of an MRI. Is there anything I could take after the test to soften the barium so I will be able to evacuate it? I’m so worried about this aspect of the test that I am considering cancelling it. I would be grateful for any thoughts or advice. Many thanks in advance.
Dear Lizzy,
I completely understand your fears about this, and it is quite a common fear that people have about the test and what will happen in the days afterwards. In my experience, having done approximately 500 proctograms in the past 5 years, there has not been an incident where the barium causes a blockage. It is generally of soft consistency (softer than most people’s stools) and if it doesn’t come out by itself, a gentle suppository may be helpful. You could ask for your barium paste to be made more runny than usual if an MRI with gel is not available. I hope this helps.
Best wishes.
I only clear my bowels like every 4-6 days. Have to admit I don’t drink a lot of water daily. Just cleared my colonoscopy and doc has scheduled me for a defaecating proctogram. Have read that the radiation level is pretty high. Am apprehensive about taking this test. Your advice please ?
I just read that someone had the barium paste come out from under her when she went to the mall after the proctogram. Does this happen ? Should we take more water before and after the test to clear out the barium paste ?
Hello Meng,
The radiation level of an xray proctogram test is not high – many methods are used to keep the dose as low as possible and overall, the benefits of the test far outweigh the small dose of radiation.
Generally, paste leakage happens to people who have an element of faecal soiling or incontinence – we send those people home from the test with pads to help keep their underwear clean on their way home.
Best wishes.
Dear Dr Shah,
A year ago, I had a large tumor on outside of but on the right side of my colon/rectum. The surgeon removed my coccyx in order to remove the tumor. The tumor was benign and quite large so it had been there many years. The surgeon said the tumor had been pushing the rectum off to the left but had not attached itself or invaded the rectum/colon very much so very little of that was removed/affected. I still have a lot of pain when sitting and it’s been a year since surgery. The last MRI I had showed no recurrence of the tumor (thank goodness). I just don’t understand why it seems to feel like I am “sitting on something almost jagged” is the the sensation I have/feel. I have been back to my surgeon – he now wants to schedule a defecogram and maybe another MRI. Do you have any suggestions? Are we on the right track? I was hoping to be pain free when sitting since it has been a year since surgery.
Hi ! M I have to make Defecogfaphy test , but I can’t find hospital that have this service, inm leaving in fair lawn Nj !! Please let me know if anyone know some place not far !
Thank u !
I am having this test done in 3 weeks. Mine says GI Abdomen Defecogracy with UH. What does the UH stand for?
I wasn’t sure… So, I asked the expert and he said that he’s not familiar with that either. Maybe it is specific to your doctor or region.
I have consistent mucus discharge since April of last year, and I’m male. Have you heard of this and if so can this test show something that can be fixed?
That’s a good question. It is not always known as to why someone has increased anal mucus, but this test can be helpful to see if there is an underlying anatomical defect or issue contributing. It may also be good to get a GI work up as well.
I have severe blockage that shows up in a defogram. the only problem is that no dr. has looked at it in real time except a uro gyno dr. that was incuraging me to get my mesh removed. It makes it very hard. Im getting sicker and sicker. I have autoimmune, connective tissue. Also Inguinal Lymphedema. I need someone who can truly look at my problem and know exactly what it is. im a little confused due to my vaginal area has severe pain now. where I never did before. Im afraid I now have an enteroceele again. I have had a prior large intestine partial resection. My rectum also has a bulge on the right side that causes a blockage from the stool going thru this certain area.If you could help me get this problem correctly diagnosed or know of someone sufficient I would greatly apprectiate it. I feel like this is making me sick all over from all of these toxins. I believe either I may have parasites or adhesions that are wrapping around my intestines. I have bumps and filled out areas that show my body has severly changed. If you could help me I would be so thankful. Sincerely, Tamera Pelren. tpelren@sbcglobal.net
What big city do you live near or in?
I will see if there’s someone in your area who can help you. So sorry you are dealing with all of this!
Sir, I have chronic constipation due to long tenure Semen problem after Masturbation. All type of treatment is done including naturopath but coulnot recover the problem. Is MRI defecography suitable for me and this test says positive of weakness of muscles what is the remedy.
i live in Peoria, il. where can i get this test done????
Most colorectal surgeons can refer for this.
I am having a defecogram next month as I have what was thought hemorroids bleeding, and some constipation, dr’s have tried suppositories and cream which costs hundreds of dollars as Medicare doesnt pick it up and they didnt do anything more than Prep H, then a dr said my mucus lining was coming down so he did banding so painful for 2 days, I went for a second opinion and the surgeon I’ve known since my husbands colon cancer surgery said its not hemorroids, but that because I feel pressure in my vagina like I’m having a baby, tailbone pain and some constipation (I take citucel in the a.m. and docolax stool softners and they both seem to help) that I might have rectal Interseption and that I should go for this test.. I’m only concerned with the after since I have a long ride home 2 hrs. and my daughter is kind enough to take me I dont want to have a accident in her car. they say its about 2.5 hrs long the test, and that I dont have to fast before. Can you just give me some information to ease my mind. thanks Judy
I’ll see if I can get Dr. Shah to comment… or others who know that specific information.
Hi Judy,
The test itself usually takes 1 hour from start to finish, that’s starting with drinking the barium drink and then finishing the xrays. I think you will be ok to travel afterwards. You will find it helpful to got to the toilet after your test as some paste may come out, and wear some pads in your underwear as a little may ooze out during your journey.
Regards,
Vikas Shah
I had the test in June in Philadelphia, it did take an hour the drinking of the Barium the test itself only took 10 min. They gave me a pad and lots of wipes when I finished and I was fine getting home. Only problem the barium a month later was seen in my diverticulosis on a Sitz Marker xrays, so I then had to cleanse to try to clean them out hopefully, I’m still in the same place, but eating more fiber apples, prunes spinich salads, etc, and Fage yogart for the live cultures to help my imflamed insides..still very constipated but am taking citucel, docolax stool softners, etc and lots and lots of water. Dont go back to the dr. until the 25th when we will discuss surgery to cut away some bad spots or if better how to deal with this…it took a long time to get to this point so it’s going to take time to get back to normal whatever that is…and staying positive… I love my surgeon Dr. Rolandelli in Morristown NJ he is the ONLY one who has listened to me and tried different things to get to the bottom of this he is head of surgery in Morristown Hospital too. He took my husbands cancer out of his colon 5years ago he is amazing.
I was treated so badly in my last proctogram, I never want to experience that abuse again. Unfortunately my doctors have requested a second proctogram and I am terrified of being tested again. The clinician was so verbally abusive I’m not sure I’m strong enough to deal with the procedure. It has left me totally traumatized.
Oh no! Can you go to a different center or call ahead to talk to a supervisor?
I had the Defecogram last Friday in Philadelphia at Thomas Jefferson Hospital, it went well, everyone was so nice and it wasnt as embarrassing as i thought…the doctor also said that I looked fine and didnt see anything wrong, He said You do not want the operation they take a big piece out of your bowel I said no this is putting in mesh and pulling up the lining and attaching it. He didnt know about that procedure and thought I needed to have more testing to see what was going on in my stomach, intestine and bowel. I was relieved but still confused as to whats wrong with me. Just came across my Birth mothers death cert. she died of Hepatic Failure, Sepsis and Ishemic Colitis, she was in a hospital for weeks I did not know, I have to go to the surgeon tomorrow and will give him this info too and ask for more non invasive test or another colonoscopy before I commit to surgery. Thank you for your help.
My pelvic organ prolapse as well as hernia in bowel.
I can’t even have a bmeeting or pass gas with out actually assisting my self.
I also have something wrong with gallbladder because I keep getting horrible pain in right upper side.
Every time I eat my stomach and abdominal swells like I’m pregnant
Doctors have been doing some test.
What surgery be the best and should I consult a couple different surgeons to see if there’s differ options ?
I’m miserable, I don’t eat much because I no what’s going to happen
Hours in the bathroom hoping to pass gas or if lucky a BMW
As suggestions out there,? I’m all ears!
ST
Dr. Shaw,
First I want to thank you for taking your time to have this website that helps so many people.
I have a concern regarding a defocgraphy that I had been scheduled to take at the facility closest to me which is a 3 1/2 drive by car. The defocgraphy was cancelled and the reason I was given was that ‘the doctor has seen enough data from the other two tests I had been given to make the decision that the defocgraphy wouldn’t be of any benefit to me.’ The doctor did say that if, after having gone first to several sessions of physical therapy to work on my pelvic floor muscles and then to EMG training after the pt sessions were completed and my muscles hopefully in a better condition to be receptive to Biofeedback, if I still am experiencing symptoms then I could go back to the facility for the defocgraphy. My symptoms are severe constipation for the last year, feeling like there is stool that needs to come out even when it turns out that there is nothing there, and also of not being able to push the stool out when it does Finally make its way all the way through my system (this can take a very long time!) without using my thumb pressing through my vaginal wall to help propel it out. It could be several more months of dealing with this constipation and the problems it causes in my health and lifestyle.
The other two tests that were done were a anotectal manometry and EMG Recruitment. Would either of these tests have been able to tell if I have an internal rectal or pelvic floor prolapse or a rectocele? I was told that I have a “small” rectocele but it wasn’t mentioned in the report. Would the defocgraphy have measured the rectocele?
Because of the issues and some others with my health it’s difficult for me to leave my home for long periods of time and this drive is 7 hours round trip. I would prefer not to suffer for several more months just to have to make that drive again and in the winter which is extremely cold where I live. Knowing what my symptoms are, do you think I should request that my referring doctor put in a new order to have this defograohy done in the near future instead of waiting for several months? Even though she initially ordered one done the notes now say that it will be requested if the physical therapy and biofeedback don’t get rid of my symptoms.
Thank you in advance for your time and consideration of this matter.
Louise E.
I am in Canada and have a grade two rectocele, alternately diarrhea, serious bouts of sustained distension inability to pass wind or stool. Abdominal and pelvic ultrasounds and colonscopy normal save for numerous diverticuli. I have NEVER had constipation. Gastroenterologist sent me on my way despite the feeling that the intense pressure in the rectum/lower bowel. He has no clue about this evacuation demography. Neither does the urogynecologist. Who can order this test – perhaps Canadians have never heard of it.
I live in the London Ontario area and had every test, the last one ordered by a Gastroenteroligist. None of the Drs I have seen would address it. I am waiting to see a Pelvic Floor Dr. I have had this pain almost a year now and at my wits end. May I ask how you know you have the rectocele? Who diagnosed it? The test I had was a Defecating Proctogram which showed the Rectocele, now to the pelvic floor dr. Please keep me posted on your case. Thanks Carole
Hello I have had a rectocele prolapse surgery 8 months ago. I thought my problems were over! not so! I start feeling like a pressure or spasm in my rectum mostly at night! I feel like I need to empty my stool so I push and all this clear mucus comes out following very dry stool in which I have to press open my anus to help the stool out! Along with this I have pain on the left side of my spine which I’m not sure it has anything to do with my rectum! It seems like the mucus that helps the stool to travel through the passage way is being separated! After everything is eliminated I feel like I need to pass gas so I keep pushing hoping to release some pressure but instead of releasing gas I get more mucus! My Dr is sending me for a Mr Defactogrm I’m praying for a solution!
I am confused I had a defecating Protogram in June which showed I had a Rectocele, it was a test not a solution. Now cannot find a surgeon to fix it??? (Canada)
Urogynecologists typically do surgery for rectocele.
How is that different from a Uroligist?
Urologists do not do prolapse surgery. Urogynecologists are GYN surgeons trained in rectocele repairs
Thank you
It can also be a GYN minimally invasive surgeon too
Dee the lady above says she had the surgery and now has those symptoms I have those symptoms now. Is the surgery not suppose to fix that? Thanks
Is there anyway to communicate with a person who has posted t
Dr. Shah does check back here and answer, but here’s an email as well. vikasshah99@gmail.com
My text was cut off above. I would like to communicate with another poster on this site. Is that possible?
Yes- just hit reply to their comment
Kate I have posted on here , who is the person you wish to communicate with? Thanks Carole?
I would like to communicate privately with Judy – who posted July 13, 2016 about her experience. I am going to have the same test at the same hospital and wanted to know more, but not necessarily in the public forum. Thanks.
Hi I’m booked for a proctogram soon to see if my colon is leaking after a bowel resection will it be the same as the proctograms described on here?
I had my defecography test done while laying down. I fear the results are not accurate, because I don’t poop everyday while laying down. Should I be concerned about the test being inaccurate?
Sir I am constipated from last 10 years, I have done a lot of test like ct abdomen , ultrasound ,colonoscopy ,andoscopy blood urine…all reports are normal but problem stop with me . Pls suggest me what should I do.
And also suggest me about defecography and pelvic mri …what is better for me.
Thanks
I have a question: can you see diverticula in a defecography? I know that isn’t how they are diagnosed, but I was curious if they could be seen.
Also, I wanted to thank you. This post was very helpful in getting me mentally ready for my defecography. It was still a bit much, I don’t think I will ever be comfortable defecating on command for an audience, but it was manageable and not painful or traumatic. Everyone was very professional and kind and did their best to make it easy for me.
Thank you for a very useful article. I had MRI defecography done and I was unable to pass stool in the supine position.
I had also anal manometry done which showed that the pelvic muscles were not working properly. The name of the ailment is paradoxical relaxation of puborectalis muscle.
There does not seem to be any clear cure for it except pelvic floor physiotherapy and biofeedback which I had done and it did not help much.
I’m just wondering if there is any used to get MRI defecography done in the sitting position as I’m unable to pass stool. But does it really matter? And also if you or any of the people who are putting comments here here are aware of any kind of treatment that would be useful.
Thank you and
Not all pelvic PTs are trained the same way. It may be helpful to see if there is someone else in your area who feels comfortable treating paradoxical muscle issues. To be honest, though, I see a lot of anal manometry readings that say “paradoxical” but the issue is another type of pelvic muscle dysfunction or tightness or lack of coordination.
There isn’t a dynamic pelvic MRI in sitting, but the defecography described here is done with an xray and in sitting. It only shows the back area of the bowel and pelvic floor, not the front. It also depends what your symptoms and goals are in terms of appropriate treatments. Don’t give up. 🙂
I have had a chronic anal pain for 14 months. A pelvic floor PT has confirmed a pain point at the left center of sphincter. Pelvic floor therapy.boi-feedback and examination by two colorectal surgeons confirmed no tightness of pelvic floor muscles. This was confirmed by a defeogram that was. negative. Extennal and Internal sphincter were. also normal. Also had colonoscopy pelvic floor MRI WHICH WERE NEGATIVE. One colorectal surgeon observed the sphincter spasm when pressing to left of sphincter, his diagnosis was an entrapped nerve. On a typical day awaken at 4AM with level 5 pain, and have zero pain at 8 AM . Then usually no pain until after normal BM. Pain ranges from 1-7.. sitting, walking and exercise increase pain. Dissepan, Tramadol and Gabapentin keep pain in lower ranges.. Any suggestion for sphincter spasm/entrapped nerve.?
Hello
I recently had an abnormal anal rectal manometry. The GI is adamant that I also need a defacography as “they go hand in hand”. Is that true? Also during the defacography they are planning to “insert a tampon” which I assume has some contrast on it. Is this necessary? I would like to do without that if I could
Any advice would be appreciated
Thank you
Hi Sandy,
The manometry test and the defacography are different and complementary. It would make sense to have that test as well. The way they can visualize this test is by using the barium and that is inserted. It is typically necessary to make the test effective. Most patients do quite well with this test (once they get over the awkwardness of sitting on a toilet type of contraption for testing). Hope this all goes well for you.
I had these tests and really no big deal.
Medicine needs to a advance in order to preserve the dignity of patients. I am a rape survivor with PTSD and this procedure is more traumatic than my rape. This article shows a nice commode. No, that’s not the choice I was given. I was forced to have a tech use barium gun in both my rectum and vagina, force me to put on an adult diaper, and defecate on the MRI table in front of a live audience. Medicine needs to come further and do a better job preserving the dignity of patients.
This is how a mri defecogram is done. Why a gun?.
would be used I don’t understand . You should have requested a small syringe and told them you would put the contrast in your own vagina. Some practitioners have no concern for the embarrassment and loss of dignity for their patients. Most do feel or show some empathy and try to preserve as much of the patients dignity as they can, giving that this is a gross ,horrible, degrading procedure.. I agree with you Re medical advances and hopefully in the future less embarrassing awful procedures like this will be consigned to the bin of horrible dehumanising medical practices.
52 yr old male. Excellent heath, perfect BMI/weight, no drinking or smoking ever. Born with “imporforate anus” which required surgery to create an opening, therefore my anus is not normal (patulous anus), and my anal canal is extremely short, sub 2 CM’s in length, less than half the normal male length. 2 years ago ago, I started to “prolapse” and bleed. Have had to manually push the prolapse hemmoroids back inside daily. Had colonoscopy, all good, no polyps, bleeding from stage 3 hemorrhoids. Went to see colorectal surgeon who confirmed stage 3 hemorrhoids and wanted to do hemmoroidectomy, but because of my birth defect, small anal canal length, he stated: “it’s high risk surgery, and there’s a good chance on the operating table I decide to call it off. You don’t have a lot of closure with the very short anal canal length so it’s risky removing tissue as it could leave you with incontinence, and I don’t want to make a bad situation, worse”. This made me nervous and I scheduled a 2nd opinion at Mayo Clinic in Rochester, MN this past week. Well the colorectal specialist there told me “this isn’t stage 3 hemorrhoids and you don’t require hemmoroidectomy surgery, but it’s actually more complex, and you do require abdominal surgery as you have a rectal prolapse”. He ordered a battery of tests, including MR Proctogram Defecography, Anorectal Manometry, and wanted to operate this week. I was caught totally off guard, not expecting a completely different diagnosis and surgery. I had to push the tests and surgery off for 5 weeks so I could clear 6 weeks off with my job. My question is: how is it possible the first colorectal surgeon misdiagnosed rectal prolapse for stage 3 hemorrhoids ??? I’m very confused, nervous, and scared. I’m also extremely nervous about all these new invasive tests that I now have to go through. Thank you.
I had cine defecography about 2 years ago. It showed grade 3 enterocele, moderate rectocele, and possible intussisception. Neen to 3 urogynecolgists, 2 colorectal surgeons, GI dr. and they all say something different.
Last urogyn a few weeks ago said i have the following: Stage III rectocele, perineocele, intussusception, Stage II incomplete uterovaginal prolapse and cystocele. She gave me a pessary, sent me for PT (therapist said muscles are not the problem), and told her to let her know if I wanted surgery.
Anal manometry showed good function and strength. Defecography: I emptied 2/3 of barum in 30 seconds and no residual after evacuation. But I do not feel it is a good representation of my bowels on a daily basis where stool gets stuck in the rectum and I have to often strain and use perineal pressure to get it out. The defecography was fine but I stopped once on the way home for bm, then could not hold it in on the way home and went in my pants. I had a pad but should have asked for a pullup, though I’m not sure that would have contained it all. When I got home and was on the porch opening the door all of it broke loose and filled my pants and ran down my legs.
Do you think it would benefit me to have an MRI defecography? Colorectal surgeons say surgery may not help my bowel issues. I am in a quandry as to what to do.
This is the perfect blog for anyone who hopes to understand this topic. You realize so much its almost tough to argue with you (not that I personally would want to…HaHa). You definitely put a fresh spin on a subject that has been discussed for ages. Great stuff, just wonderful!