Good to hear from you and that you were tested and checked out.
Here are my thoughts:
1. What did this defecography say about your anorectal angle?
As I remember your pre-op defecogram, your angle was around 90 degrees for continence, then the angle widened for evacuation likely to around 130-145, then angled again for continence at 90. This is how it SHOULD go. This means that prior to surgery your puborectalis muscle relaxed and allowed the rectum to straighten for defecation, then the puborectalis muscle tightend again to angle the rectum for continence.
So this is why I am asking you what the anorectal angle did on this post-op defecogram. Let me know.
2. If on this post op defecogram your anorectal angle stayed at 90 degrees the whole time, even when you were pushing, then you have either developed "non-relaxation of the puborectalis muscle" that is what physical therapy is for
OR the surgery somehow injured the nerve which controls the puborectalis muscle, thus no longer allowing the puborectalis muscle to relax and tighten.
OR the surgery scarred the levator ani muscle to which the puborectalis is attached in which case physical therapy and even a botox shot into the puborectalis muscle end plates would do no good. THis is what happened to me.
3. Are you bloated now because you are not able to pass sufficient amounts of stool now like you could immediately post-surgery? This is what it sounds like. Correct me if I'm wrong.
4. Hate to tell you this, but even with my ileostomy, even though (so far thank god it is working) I still am bloated! My surgeon told me the other day that it could be due to my pre-existing IBS. IBS (Irritable Bowel Syndrome) only affects the colon! As I have an ileostomy I am not using my colon. I could not quite wrap my head around his explanation, but he is a surgeon and GI docs have more knowledge of the function of the GI system, so am not criticizing him, but I was a bit surprised at his answer. Then he said he thought maybe I had sensitive nerve endings in my small intestine. To my knowledge the small intestine does not have nerve endings that is why we can touch our stoma (or people can even injure their stomas) and we don't know it as there are no nerve endings. So I'm still trying to figure out my bloat issue. Don't forget I have TON of scar tissue in me from the disaster surgery that lead to me needing the life saving lysis of small bowel adhesions and the ileostomy, so I may have some left over adhesion not obstructing me, but maybe causing me bloat? In my case, who knows?
BUT a GOOD sign for you Boat is that immediately post-op when you felt well and stool was passing well and you were hungry, eating, and not bloating, sounds to me like if you can get that stool passing again, however you need to do it, you may likely not have bloating forever.
Hope this answer makes sense. Ask me for questions or clarifications and I will be glad to get back to you. Remember there is no MD in back of my name, I just have a WHOLE lot of experience and knowledge I gained from having to see 11 top surgeons nationwide prior to getting my gut damage fixed the best that could be done with the ileostomy. So I have absorbed some info along the way.
If you could not really feel the contrast in your rectum for this post-op defecogram, did they think that you had some mega rectum issue from all those years of constipation or did some nerves in your rectum get damaged? I think they had ruled out mega rectum prior to your surgery?
How far up is you anastomosis? If it is very far up and you have like 6-8 inches of rectum then you likely have no nerve damage. If they put the anastomosis far down, then nerve damage could be cause of your issues. Yet that would not explain the success you had immediately post-op. Takes 2 weeks for scarring to manifest, .........wow wish I could figure this out for you.
Glad the doc was not totally closed to the idea of ileostomy if you need it as you do need something that works. AND you would do fine with an ileo. They are manageable after you get the hang of it. But do try the PT then if that does not work ask to be put deep under general and try a botox shot into the end plates of the puborectalis muscle and the levator ani. The body has to be totally unconscious so this muscle can be stretched and injected. I learned this from one of the top docs in America, the one who saved my life. He is great! Retired now, but very knowledgable. He was I think HOPING I was not scarred and that this shot would work. It did not for me. But, if it was just "non-relaxation of the puborectalis" supposedly it would have worked.