If you’re unsure how to prevent repeat rectocele repair, you’re not alone!
Many women are discharged from care after rectocele repair without clear guidelines for how to prevent repeat prolapse.
Read on now to learn:
- 10 Essential rules for avoiding repeat rectocele
- How to ensure your successful rectocele repair
Written for women with rectocele problems, this article is by Pelvic Floor Physiotherapist Michelle Kenway, author of Prolapse Exercises Inside Out.
1. The Golden Rule – Never Strain!
Never strain to empty your bowels!
A major cause of rectocoele is straining with constipation. Straining often becomes a habit as rectal prolapse problems worsen.
It is vital to avoid returning to your pattern of preoperative straining to empty your bowels after your rectocele repair.
Keys to Avoid Straining:
- Using the correcting bowel emptying position and technique
- Correcting your stool consistency so that it is easy to empty
Emergency bowel management strategy is outlined below to avoid straining if you become constipated after rectocele repair surgery.
2. Correct Bowel Movement Position
It‘s easy to fall into the trap of using the wrong position to empty when you have a rectocoele. Some women hover over the seat (which tightens the anal sphincter making things worse). Many women with rectocoele slump their spine forward to empty their bowels.
After rectocoele repair women often need to retrain and correct their sitting posture on the toilet to empty well and avoid straining.
Correct position to empty your bowels:
- Sit on the seat (never hover)
- Lean forwards (not backwards)
- Position your hips and legs apart
- Rest your forearms of hands on your thighs to support your trunk
- Maintain the inwards curve in your lower back throughout
Note: Some women find that positioning their knees higher than their hips by placing each foot on a wrapped toilet roll can assist them to empty however this doesn’t hold true for all women with rectal prolapse problems.
3. Correct Bowel Movement Technique
If you’ve lived with a rectocoele, you know how hard this can make emptying your bowels.
Chances are that you are in the habit of using all manner of techniques to empty you bowel. Some women need to use their fingers inside the vagina or lift and support the perineum with their fingers to empty their bowels. This is because the rectocele causes waste matter to move into the prolapse rather than out of the rectum.
After your rectocele surgery you may continue to support your perineum with your hand if you need to.
This ‘Brace and Bulge’ bowel emptying technique is taught in clinical practice to help women empty their bowels and avoid straining. Learn this technique by watching our bowel movement video
‘Brace and Bulge’ Technique
- Go to the toilet or bathroom when you feel the appropriate urge to empty
- Position yourself sitting correctly on the toilet (described above)
- Perform 5-6 relaxed deep diaphragmatic breathing exercises – these help to relax your pelvic floor muscles
- Brace to make your waist – if you say and hold the sounds “SSSS” or “Moooo” this can help bracing
- Bulge your lower abdomen forwards as you brace your waist – this is an essential step as it relaxes your anal sphincter allowing you to empty
- When you’ve emptied your bowels lift and squeeze your pelvic floor muscles
4. Correct Stool Consistency
If your stool is too hard or too soft emptying your bowels will be difficult after rectocele repair. Unfortunately one of the side effects of pain relieving medications like codeine and narcotics is constipation which can make stools hard and difficult to pass.
The ideal stool consistency after rectocoele repair is a soft well formed stool that passes easily.
The ideal stool consistency to aim for long-term is Type 3-4 on the Bristol Stool Chart (shown right)
How to correct your stool consistency?
- Eat stool softener foods if your stool is too hard
- Avoid eating too much insoluble fibre
- Avoid suddenly increasing your fibre intake
- Discuss your constipation concerns with your doctor before your surgery
- Speak with your surgeon about stool softening medications or osmotic laxatives to use after surgery
5. Avoid Gas (Wind) Producing Foods
Gas or wind in the bowel is caused by:
- Swallowed air
- Bacterial fermentation of unabsorbed food in the large bowel
If you are prone to bloating and gas with particular foods watch out for this pitfall after your rectocele repair. Repeatedly bearing down trying to pass wind and alleviate gas discomfort can cause you to bear down strain your pelvic floor. Pass gas when you feel the urge and try not to ignore or defer passing wind to avoid bloating and abdominal pain.
Gas producing foods & drinks include:
- Legumes (e.g. baked beans, chickpeas, lentils, mung beans, broad beans)
- Psyllium (Metamucil)
- Some fruits (e.g. apricots, nashi pears, prunes, plums)
- Cruciferous vegetables (cabbage, broccoli, brussel sprouts and cauliflower)
- Wheat – based products (e.g. bran)
- Nuts (e.g. cashews, pistachios)
- Carbonated drinks
For more information refer to our article on how to relieve gas after pelvic floor surgery.
There is no one rule fits all when it comes to gas producing foods. Some women have specific sensitivities such as fructose, gluten and/or lactose. If you know your gut reacts to specific foods or fluids then to limit or avoid these foods. The low – FODMAP diet is an excellent resource from the Monash University for women with IBS, fructose, gluten and/or lactose intolerance.
6. Obey The Urge
The correct urge to empty means recognising and acting immediately on the real need to empty your bowels rather than going to the bathroom ‘just in case’.
When you feel the appropriate urge to empty your bowels act on this urge and visit the bathroom. If you defer the right urge too long you can stretch the rectal tissues and reduce your rectal sensation.
Avoid prolonged sitting on the toilet seat which results in straining, contributing to repeat prolapse.
7. Choose Pelvic Floor Safe Exercise
Some general exercises can overload and strain your pelvic floor after rectocoele repair.
General exercises to avoid include intense core abdominal exercises, high impact fitness exercises along with specific strength training exercises and techniques.
8. Strengthen Your Pelvic Floor
Your pelvic floor muscles extend from your tail bone at the back to your pubic bone at the front. These muscles actually form part of the anal sphincter and they support your rectum when you empty your bowel. Regular pelvic floor exercises (Kegels) are an important for long-term successful recovery after rectocele repair surgery.
How Does Pelvic Floor Strengthening Help?
Strengthening your pelvic floor after your rectocoele repair has two main benefits:
- Providing internal support for your repair so that it doesn’t return
- Ensuring your best possibility to empty your bowels without straining
9. Manage Lifestyle Factors
Some lifestyle factors can increase the likelihood of repeat prolapse after rectocoele repair.
Lifestyle factors that increase the load on the pelvic floor include:
- Obesity (abdominal fat)
- Heavy lifting
- Smoking (chronic coughing)
10. Take Immediate Action For Constipation
What do you do if you suspect you are becoming constipated after rectocoele repair?
- Avoid straining – this can cause repeat prolapse
- Avoid suddenly increasing your fibre intake – this can make your constipation worse.
Take immediate action and speak with your doctor or pharmacist about the most appropriate medication to soften your stool and help you empty your bowels without straining – this will depend on your stage of post operative recovery, your general health and other medications you may be taking.
If you suffer from chronic constipation ask your doctor about the potential side effects of other medications you are taking on your bowel movements.
Medications known to cause constipation include:
- Iron supplements
- Calcium supplements
- Antacids (containing aluminium or calcium)
- Anti inflammatory medications
When you have emptied your bowel take appropriate measures using the information above to help you avoid repeat constipation. This can be a matter of trial and error to get the right stool consistency with diet and laxatives. Your goal should be to minimise the use of laxative medications over time.
Key Points for Rectocele Repair & Recovery
Managing your rectocoele repair well with these 10 rules can help you ensure the success of your surgery and avoid repeat rectocele.
- Managing your bowels well is vital for successful recovery and rectocele repair.
- Strengthening your pelvic floor will help you ensure your best possible rectal support and bowel emptying.
- Avoiding inappropriate general exercises and lifestyle factors known to contribute to prolapse problems
Following these kep points long-term key points will help you to ensure your best possible outcomes after your rectocele repair.
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out.
Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.