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I got a RVF after giving birth to my son in September of 2010.  I waited until he was 10 months old to have it fixed because the first CRS I saw who was going to fix it I simply wasn't comfortable with, so I looked for a new surgeon; I also wanted to wait until my son was older and more independent before having the repair because of the lifting restrictions.  It has been 7 weeks since my advancement flap procedure, and I am healed -- so far so good.  I am writing specifically for those women out there who have not yet had a repair done to let you know that it CAN work on the first try.  I am going to give my advice/what worked for me, and then I will no longer be checking this website because I just want to move past this horrific experience.  It feels so wonderful to feel normal again and not have to worry about the horrible symptoms from an RVF. 

(1) You need to find an surgeon who is specifically experienced with repairing RVF's, not just a good CRS.  A surgeon who is experienced with this type of problem will do all necessary pre-op tests (MRI, ultrasound, sigmoidoscopy) BEFORE doing any repair to check the damage and make sure you are getting the right repair for your problem.  If your surgeon does not order these tests and says that s/he can tell if muscle is damaged too just by doing a physical test of the rectum, turn around and leave.  I was fortunate that I had no other damage besides the RVF (if you have muscle damage and just have a flap repair, it can fail because your muscle damage needs to be repaired in addition to the RVF or it will break down the repair).  Also, your surgeon should give you explicit instructions for before, during and after the surgery.  What happens after the surgery is JUST AS important as the skill of the surgeon for healing.
(2) The advancement flap procedure SHOULD NOT be done as an outpatient procedure.  An experienced surgeon should keep you in the hospital at least 2-3 days.  Also, my surgeon does not recommend having a repair done until at least 6 months after giving birth.
(3) You should have a course of antibiotics on the day before surgery and should be prescribed antibiotics after surgery for at least 10 days.  I personally recommend taking a probiotic because antibiotics can wreak havoc on your digestive system.
(4) You need to follow a soft food, low-residue diet for at least 6 weeks after surgery but ensure that you take stool softeners, fiber supplements and if necessary mineral oil laxative to make sure you are having soft, daily BMs.  The low-residue diet is extremely important to follow.  The first week after the surgery, you should be on a liquid only diet. 
(5) Absolutely NO LIFTING ANYTHING (including a baby) for 6 weeks.  You need to rest A LOT and take it very easy even if you're in no pain or discomfort.  Lifting will destroy a repair. 
(6) No sex for 3 MONTHS after surgery.  Also, no tampons, douches, etc. for 3 months.
(7) Keep the area very clean.
(8) I was able to continue to breastfeed my son during my recovery.  I just had my husband and mother lift him up on me.  My surgeon said that breastfeeding would not complicate healing.  However, I personally am glad that I waited until he was older (10 months) before so that my hormones got a little more back to normal.
(9) I had some gas/stool passage after my repair (week 2 of recovery).  I totally freaked out and thought it failed.  My surgeon said that it's not uncommon for that to happen as the healing is taking place and to just wait and continue doing what I was supposed to do.  I did, and soon the symptoms stopped, and I haven't had any symptoms for almost 5 weeks now.  So, don't assume that your repair failed and start lifting up things, go off off your prescribed diet, etc. if this happens because IT DOESN'T mean it necessarily failed.
(10) Pray and don't be afraid to ask for help and support from others. 
(11) Finally,stop reading these message boards or you can make yourself way too anxious and think that surgery isn't going to work.  What it seems like is that most of the women who post are those in the minority whose first surgery wasn't successful -- thus they have horror stories about multiple surgeries, colostomies, etc.  My heart really, really goes out to them, but MOST women DO heal after the first repair attempt (even if it doesn't seem like it from the stories on the internet).  I had to force myself to come on and write this because I just wanted to forget all about it...but I thought other women might need to hear a success story from a first repair.  My surgeon said that for a simple RVF from obstetric injury in a woman who doesn't have other health complications such as Crohn's Disease or immune problems, 85% of advancement flaps work on the first attempt if the women follow all of the right post-surgical instructions.

I hope this helps other women out there because I know how difficult it is to deal with this problem.  You have to believe that you will get better and that this will be just a temporary (although horrible) problem to deal with.  Best of luck to all of you! 

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im so happy for u
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I am extremely extatic for you . This is wonderful news. I have fistulising Crohn's disease with a RVF , and as you know , just mortifying they are. I have had 2 minor repair attempts that failed. I truly believe that this can be fixed but you need the right doctor doing the procedure who knows his stuff. Where is your surgeon and what is his name? Can you recommend him to me? Thank you. I have had Crohns /colitis since the age of 11. I am now 50. This fistula is just ruining my life. I am a very strong woman, hard worker and never complain. I just want this fistula fixed ASAP by a very professional healthcare team who know 100% what they're dealing with. Thank you for your wonderful,positive post and may you live the rest of your life 100% in perfect health. xx
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