Rectocele Repair: Improve Bowel Emptying and Recovery After Prolapse Surgery

Rectocele repair recovery often raises a practical question: how can you empty your bowels comfortably while the repair heals?

These ten tips cover bowel habits, constipation, pelvic floor exercises and return to activity. Follow your surgeon’s individual instructions, especially in the first weeks after surgery.

Some women are unsure how to manage their bowel movements after rectocele repair or reduce avoidable pressure on the healing tissues. A rectocele is a bulge of the rectum into the back wall of the vagina; the operation is also called posterior vaginal wall repair or posterior repair.

Pelvic health physiotherapy can help you:

• Empty your bowels with less straining
• Identify bowel habits and recovery factors you can improve
• Plan pelvic floor exercises and a gradual return to activity before and after surgery

1. Avoid Straining

Try to avoid excessive straining when opening your bowels after rectocele repair. Constipation and repeated straining can place pressure on the pelvic floor and the healing repair. If you strained before surgery to empty your bowels, you may need to change this familiar habit.

How to avoid straining

• Use a comfortable bowel emptying position and technique.
• Aim for stool that is soft and easy to pass.
• Ask your surgical team in advance what to do if you become constipated after rectocele repair.

2. Correct Bowel Movement Position

After rectocele repair, sit fully on the toilet seat rather than hovering. A position that helps one woman empty comfortably may not suit another, especially if bowel symptoms persist after surgery.

A comfortable position to try

• Sit with your feet supported and your knees comfortably apart.
• Lean slightly forwards if it helps, resting your forearms or hands on your thighs.
• Let your abdomen and pelvic floor relax; avoid forcing a rigid posture.
• If a footstool helps you pass stool without straining, use one. Stop or adjust the position if it worsens pressure, discomfort or emptying.

3. Correct Your Bowel Movement Technique

Before surgery, some women with a rectocele press on the vaginal wall  or support the perineum to help pass stool. Bowel emptying difficulties often persist after surgery.

Discuss ongoing bowel emptying difficulties with your surgeon or pelvic health physiotherapist. Ask your surgeon before using vaginal or perineal support during early healing.

The following relaxed breathing approach may help you avoid breath-holding and excessive straining.

Watch this bowel movement video for a demonstration.

‘Brace and Bulge’ Technique

• Go to the toilet when you have a clear urge to open your bowels.
• Sit comfortably as described above and take a few relaxed breaths.
• Breathe out gently as you allow your lower abdomen to expand. A soft “moo” sound can help some women avoid holding their breath.
• Allow the pelvic floor to release rather than pushing hard. If stool does not pass, take a break and try again later instead of repeatedly straining.
• Afterward, let the pelvic floor return to its resting state. Follow your clinician’s guidance on when to resume pelvic floor strengthening.

4. Correct Your Stool Consistency

Hard stools can be painful and difficult to pass after rectocele repair. Very loose stools may also make bowel control and emptying harder. Opioid pain medicines, including codeine, commonly cause constipation.

Aim for a soft, formed stool that passes without excessive straining. Types 3–4 on the Bristol Stool Chart can be a useful guide, although your comfortable stool consistency may vary.

How to manage your stool consistency

• Eat regular meals and drink enough fluid, according to your medical advice.
• Adjust fibre gradually to your tolerance; sudden large increases can worsen bloating for some women.
• Discuss your usual bowel pattern and any constipation with your doctor before surgery.
• Ask your surgeon whether a stool softener or osmotic laxative is appropriate after surgery, and follow the prescribed plan.

5. Choose Pelvic Floor Safe Exercises

Gentle walking is commonly encouraged during post-operative recovery. Build activity gradually and follow the restrictions and timing given by your surgeon and pelvic health physiotherapist for lifting and vigorous exercise in the early healing period.

When you return to abdominal exercise and strength training, start at a manageable level, breathe through the effort and adjust activities that cause pain, heaviness or a noticeable increase in prolapse symptoms. Ask your pelvic health physiotherapist for an individual exercise program if you are unsure.

6. Try to Limit Gas-Producing Foods

Gas can come from swallowed air or fermentation of foods in the bowel. If bloating makes you uncomfortable after rectocele repair, identify your own triggers. Avoid bearing down repeatedly to pass wind.

Foods and drinks that may produce gas

• Onions and garlic
• Beans and lentils
• Some fruits, including prunes and stone fruit
• Cabbage, broccoli and cauliflower
• Wheat bran and some high-fibre supplements
• Carbonated drinks

Individual responses to these foods and drinks vary. You do not need to remove all these foods.

See our article on relieving gas after pelvic surgery. If symptoms are persistent or you suspect irritable bowel syndrome, ask a dietitian whether a supervised low FODMAP approach is suitable.

7. Empty When You Sense the Urge

When you feel the urge to open your bowels, this is the best time to go to the bathroom. If nothing happens after a short attempt, get up and try again later.

Avoid long periods sitting on the toilet seat and repeated straining.

8. Strengthen Your Pelvic Floor Muscles

Pelvic floor muscles help support the pelvic organs and contribute to bowel control. Pelvic floor exercises may be part of your recovery plan, but the right starting time and programme depend on your operation, symptoms and surgeon’s advice.

How can pelvic floor strengthening help?

1. It can improve pelvic floor muscle function and support.
2. Together with bowel habit changes, it may help you manage symptoms and bowel control.

Exercises cannot guarantee that a rectocele will not return. If emptying remains difficult, assessment can identify other contributing factors.

9. Manage Lifestyle Risks

Long-term habits that can affect prolapse symptoms include constipation, smoking-related chronic coughing, and activities that repeatedly provoke symptoms. If weight or lifting is a concern, seek individual advice rather than avoiding all strength training.

Use lifting techniques and a gradual exercise plan that allows you to breathe comfortably, avoid straining and manage symptoms. Discuss persistent cough, constipation or other health issues with your doctor.

10. Act Early When Constipation Starts

If you are becoming constipated after rectocele repair, act early. Avoid repeated hard pushing and ask your surgeon, doctor or pharmacist which treatment is suitable for your stage of recovery and other medicines.

• Follow the bowel plan provided by your surgical team.
• Avoid suddenly adding large amounts of fibre to your diet if you are already constipated.
• Seek medical advice if you cannot pass stool or wind, have increasing abdominal pain, vomiting, fever or other concerning symptoms.

Medicines that can contribute to constipation

• Opioid pain medicines, including codeine
• Iron supplements
• Some calcium supplements and calcium- or aluminium-containing antacids
• Some antidepressants and other medicines

Ask your doctor or pharmacist to review your medicines if constipation persists.

Some women need a prescribed laxative for longer; do not stop it simply to minimise your medicine intake.

Key Points for Rectocele Repair and Recovery

• Keep stools soft and avoid excessive straining after rectocele repair.
• Use a comfortable bowel position and technique that work for you.
• Return to pelvic floor and general exercise according to your individual recovery plan.

More Information

How to Ensure Successful Rectocele Surgery – Pros & Cons of Rectocele Repair Surgery

How to Empty Your Bowels to Overcome Bowel Movement Problems