10 Rectocele Repair Rules for Avoiding Repeat Prolapse Surgery

If you’re unsure how to prevent repeat rectocele repair, you’re not alone! Rectocele Repair Rules

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

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. rectocele repair rules

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 it can be to empty 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 rectum. 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

Bristol Stool Chart

Click to enlarge

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. Choose Pelvic Floor Safe Exercises

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.

Prolapse Exercises eBook Download Now

6. Avoid Gas (Wind) Producing Foods

Gas or wind in the bowel is caused by:

  1.   Swallowed air
  2.   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:

  • Onions
  • Garlic
  • Corn
  • 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.

7. 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.

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:

  1. Providing internal support for your repair so that it doesn’t return
  2. 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)

Take appropriate action to manage these lifestyle factors with pelvic floor safe weight loss exercise and safe lifting techniques to protect by your prolapse repair long-term.

10. Take Immediate Action for Constipation

What do you do if you suspect you are becoming constipated after rectocoele repair? Laxative Suppository

  • 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
  • Antidepressants
  • Narcotics
  • Diuretics

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 key points long-term key points will help you to ensure your best possible outcomes after your rectocele repair.

Further Reading

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

» How to Empty Your Bowels to Overcome Bowel Movement Problems

We Welcome Your Comments



  1. Hi I’m 26 years old and I have developed a anal fissure but I have never been concipated, my stomach works fine however 4 months ago I had a hard stool which caused this anal fissure, but I it’s has not healed and it’s 4 months now, it heals abit then tears again, the only thing that helps prevent it from opening up again is me taking soflax tabs to make stool Soft, now it’s been 4 months I do not want to take these laxatives anymore I need this thing to heal and I not take laxatives because laxatives might cause worst problems whenever I stop the laxative the fissure comes again please help

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi there
      The absolute priority is to keep the stool soft and this can take 6 months to heal in combination with medication – if the stool gets hard the fissure will just keep splitting, the newly formed tissue needs to be protected. Stool softener such as Coloxyl is usually indicated and glyceryl trinitrate is also used to relax the anal sphincter too (check with the pharmacist first, it’s over the counter in Australia I’m not sure about elsewhere) however it can cause headache and check first as there are some contraindications. Anal fissure is one situation where I endorse medication for healing. Another option is Movicol or polyethylene glycol (available in the US as Gavalax or Miralax I believe). These are osmotic laxatives that work by drawing fluid into the bowel. Movicol can be taken for extended time frame without dependency and this may be an alternative for you to discuss with your pharmacist too, I hope this info helps!

  2. I have a vaginal rectocele- it doesn’t’ bother me or protrude out of my vagina- my husband and I want to know if i
    Is it ok to experiment with anal play and butt plugs or could this be dangerous for me?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Marcia I can’t say whether the anal play will affect the rectoele however it can contribute to rectal prolapse issues

  3. PS physio also said my rectocele was in two bits…can you enlighten me as I haven’t a clue!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Sorry Alex I have no idea either – best to clarify next treatment

  4. Hi Michelle, I was diagnosed with a rectocele a year ago and was put on a waiting list to see a physio. dr told me not to exercise. Eventually I had 3 physio appointments and was told to do kegel exercises, fast ones and hold ones, I started off doing 5 x 4 second holds and worked up to 10 x 15 second holds. On my third appointment I told the physio that I had now started leaking whereas I hadn’t before I started the exercises. That was ignored and I was told my prolapse had got worse and was nearly out. I really struggled with the mental health side of the diagnosis because I had just lost 3 stones and was feeling and eating healthy. I asked to be referred to a Urogynae and was told the GP had to do that. A letter was then sent to my GP saying I had a grade 2 and stating the kegels I could now do and my pelvic floor tone was 4/5 but no mention of anything getting worse. My GP refused to refer me due to the operation not working and pessaries being for old women. A year on the weight has gone back on and my prolapse is worse. I also stopped doing the kegels as if I do not do them then I do not link. My question is this…can Kegels make things worse or move the prolapse so that other issues crop up? I am now struggling with pain in my pelvic floor area whereas I had none before probably because I am now overweight. I couldn’t even paint the garden fence. What would you suggest I can do to help myself as I would prefer to avoid an operation if at all possible. I am trying to get the weight down using a cross trainer. Thank you for your time Alex

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Alex
      Did anyone check to see that you’re doing the Kegels correctly. If you bear down doing Kegels rather than lift inwards this could potentially worsen prolapse. Weight gain won’t help the situation unfortunately so try to manage that with your diet rather than relying only on exercise. Are you able to see another GP to access a referral to Physiotherapy for the pelvic pain? This needs to be assessed and treated accordingly. Pessaries are definitely not only for mature women, this is outdated thinking I’m sorry ton read you’ve been told this. All the best Alex

  5. Hi
    I had rectal prolapse surgery two weeks ago.
    I can’t empty my bowl ! I’m full of wind and very bloated.
    Gone off my food, I was eating prunes pears and oranges. Also A stool softener.
    I feel like prolapse is coming back
    Can I use a suppository ?
    Feeling very low now in myself

  6. Hi 5weeks ago I had posterior prolapse surgery when can I resume exercise using weights for upper body workout also I am unsure when I can resume riding my horse again , lifting hay nets brushing my horse etc. Ridi ng my bike too. Will I hear from the hospital any physio sessions etc. Thanks

  7. After reading the comments here, the resources from Mayo Clinic and treatment for prolaspe it seems that surgery is not a good option. Is there any new research and best practices for prolaspe other than what has been in place for decades?

  8. Hi -6 months ago I had vaginal prolapse surgery , pelvic floor repair. Now I feel again that pressure and something like a ball in my vagina. What shall do?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Doina
      Best to return to see your specialist along with doing pelvic floor exercises and really managing bowel emptying and stool consistency well too

  9. hi,i am 75, I had about 25 years ago a complete hysterectomy with cystocele and rectocele . for about 6 months now I have been having problems with bowel coming out on its own. I also have I think a hemmoroid that occasionally come out about size of nickel and will bleed sometimes and I am using hemorrhoids cream suppository’s do you think the rectocele has failed and allowing the bowel come out on its own. I do have an appointment with ob/gyn in a week. I have not had a internal for several years . what do you think my options are for correcting this problem. thank you for your help

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Gerry
      My apologies this requires an assessment for correct diagnosis and then treatment. All the best with your management.

  10. Good morning. I’ve recently had a recotcele posterior vaginal wall repair (4 wks) and I think my internal stitches may have come loose early – I have what can only be described as four pointy flaps of skin moving around loosely in my vaginal canal and one point is protruding out. It’s causing a constant dragging sensation. This has occurred in the last few days. I’m trying to obtain an apt with my surgeon as really can’t wait until 12 weeks post op. Is this a possibility? It seems like where they made the incision hasn’t healed together. Really just seeking some reassurance or reasons of what it could be, so I can consider my options. Thank you.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Laura
      Thanks for your message – this is really something that your surgeon needs to look at urgently especially if there’s a chance you have an open wound. Have you contacting his/her rooms regarding your concerns? If for some reason you can’t be seen, then visit your doctor for an internal exam as soon as possible

  11. I left a comment an hour or so ago but would also like to ask whether there are any exercises I should begin before seeing my dr at my 6 wk post-op visit?
    Thank you!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Ruth
      It’s best to ask your doctor about the exercises they recommend at this stage before proceeding with their recommendation.

  12. Hi after healing from rectocele surgery are you able to return to reasonably high impact workouts if you strengthen your pelvic floor? How about with a pessary? I love lifting weights and doing hiit workouts and running but have been advised to hold off since developing a rectocele after a traumatic birth (grade 2). I’m considering either surgery or a pessary along with pelvic floor strengthening. I really miss working out hard and am keen to return to it.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Kate
      Yes I understand, this is one of the big challenges with a prolapse and being able to work out at a high intensity. I think it’s important to know that having the surgery doesn’t mean that you can return to previous exercise – in fact the limitations are greater after the repair. If you can cope with a pessary and pelvic floor strengthening this will be the best way forward as long as you can manage comfortably. Unfortunately some women are led to believe that surgery is the ultimate fix and they can return to previous high intensity and impact exercise. The real risk in this case is the return of the prolapse and further surgery especially when the surgery is doesn’t at a young age. Wait as long as you can and make your first surgery your best surgery if it comes to this. All the best

  13. Is it normal to still have a clump of tissue just inside the vagina after posterior repair? I’m 5 weeks post op and have had a horrible cough for about 10 days. I feel the bulge more so now than before surgery. Does that clump of tissue get smaller? Would pelvic floor therapy help to massage the scarring? I’m only 36 and a pretty active person. I’m terrified now to get up off the couch from lying flat. I called my doctor and he said it was definitely unfortunate timing but doesn’t want to see me any sooner than my appointment in 4 weeks. He said it could have failed but nothing can be done yet. I just can’t find any answers.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Courtney
      That sounds awful to be left not knowing after what you’ve been through, I completely understand your concerns. This will be easily diagnosed either by your local GP or a pelvic floor physiotherapist (if you’re in Australia you don’t require a referral). Yes there are techniques to help with scarring and yes pelvic floor exercises can make a difference too. It’s important to get off the couch and start walking, the less you do the more your body becomes debilitated. You can follow my guidelines for walking after prolapse surgery here https://www.pelvicexercises.com.au/walking-after-prolapse-surgery/ Yes a cough may have caused a recurrence of the prolapse or it could be scar tissue. See if you can make an appointment with a women’s health physio and if not see a doctor who will take the time to assess so that at least you know what you’re dealing with. I hope this gives you some direction Courtney, all the best

  14. Hi,
    Would it be safe to walk up exactly 40 steps after a hysterectomy, rectocyle, cystocele surgery? I live on top floor of apartment.
    Thank you!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Dee
      I’m not sure whether you mean immediately after surgery or after recovery so I’ll make this general. It’s the stepping down the stairs that creates increased impact on the pelvic floor rather than the climbing up the stairs. Tips: step down lightly and avoid carrying heavy loads while walking downstairs. All the best

  15. Hi I’m having severe rectal pressure it hurts real bad it’s starting to annoy me now as no one believes me my bowels never feel empty even I do go same time every day on start seen physio it’s being going on 3 years some day can’t even walk as it hurts to bad NY coccyx bone also hurts anyone else with same issue as I’m losing my mind

  16. Hello there,
    I have both your book and video.
    I do have a question, I am remodeling my bathroom and will purchasing a toilet. I notice there are toilet lids that vary greatly from narrow lids to very supportive lids that are wide. Would you be able to advise if one style would be better over another. I do have a rectocele and am doing my Kegels regularly bit since bowel emptying is another factor I would be interested to know if you have a thought s on this.
    Thank you!

    • Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Debbie
      Thanks for your enquiry. This is a good question. I’ve never really considered the lids as much as the height of the toilet. Assuming your hip and knee joints are OK i would opt for a lower toilet rather than a higher seat. I think that the lower frame allows more of a squat position than a higher seat however you need to be able to maintain the inward curve in your lower back when sitting. The seat should allow for the legs to be spread wide apart when sitting to allow for lean forward position. If the seat is too wide this may prove difficult so I don’t think a wide seat is necessarily better. Some women of small stature find that using a phone book to raise the knees can assist emptying too so this is probably worth considering in regards to the size of the toilet base if this works for you. Anyway some things here for you to think about, I hope this gives you some ideas Debbie, Cheers Michelle

  17. I had surgery 4 weeks ago.. today the bulge return after trying to have a bowel moment. Does this mean my repair needs to be redo

    • Michelle Kenway Physiotherapist says

      Hi Kristi
      You’ll need to keep your stool soft and avoid straining with your bowel movement. Healing takes 3 months in total so there’s still healing remaining. Your doctor will check your repair at your post op appointment and will be able to tell you whether your prolapse has returned. All the best to you

  18. Hi Michelle, I had rectocele, cystocele bladder repair from a prolapse in 2016. Then again in 2018. Five and a half months after surgery, I am constipated with pain in rectum and It feels as if my rectum is poofing out. I can raise it with kegles but won’t stay until I can relieve constipation. If I take something to relieve constipation, I have loose stool for days afterward. Kegles have always been painful for me.

    • Michelle Kenway Physiotherapist says

      Hi Jane thanks for your message. This is something you need to see your doctor about. It is likely a rectal condition as opposed to your previous vaginal prolapse issues (different to rectocoele). You will likely need a colorectal specialist referral and it will be a good idea to see a Pelvic Floor Physio to determine the cause of your discomfort with Kegels especially as they will likely be a long-term management exercise for you so important that you’re doing things well. Meanwhile try to address your constipation as a matter of priority – this constipation reading may help you get started, whatever you do don’t strain to empty.

  19. Caroline bautista says

    Thank you so much for this site found it really useful

  20. I had rectocele surgery 2 weeks,ago. I’ve been taking stool softener as prescribed.and moved my first bm 5 days after surgery. I have been going somewhat regularly however today I cannot pass my bowels as they are so hard. I’m not straining but have tge urgency and feel a hard ball wanting to pass. I took miralax 2x today and I have tried a fleet suppository as that has worked in the past. No luck and I’m so scared that I’m going to cause another prolapse. Help!!

    • Michelle Kenway Physiotherapist says

      Hi Lorna
      Constipation can often occur after prolapse surgery as you know. It’s really important to contact your doctor regarding this issue to help you with your recovery over the coming months.
      All the best

  21. Caroline says

    Hi I had both front and back vaginal repair as well as my womb lifted 5 days ago and although I have drunk lots of water, eaten all bran and taken fybogel I can’t seem to do a poo!! I am packing wind and urinating but very worried about the other

  22. pauline says

    Hello. I had a posterior repair 3 weeks ago I had blood from my urethra that as now turned brownish in colour. I had antibiotics for water infection but not sure if still go it. I don’t feel poorly I still feel some pressure in my Virginia does this sound normal. Regards pauline

    • Michelle Kenway Physiotherapist says

      Hi Pauline
      Thank you for your email. This question is one you need to discuss with your surgeon. All the best for your recovery

  23. Hi Michelle,

    Thank you so much for your amazing site. It provides a wealth of information in a way that’s easy for laypersons like myself to understand.

    My fiancee was diagnosed with a larger rectocoele when she was having a colonoscopy and rectal check in March this year to investigate rectal bleeding (no other symptoms). She is only 30, is a healthy weight and has not had children. The surgeon said to do physiotherapy and if this doesn’t work she will need surgery.

    Since the colonoscopy she has had bowel symptoms which the GP said must be from the rectocoele. She is having mild seepage, bowel urgency, hard stools and bloating. She gets a sensation like something is stuck; she has to do the finger trick on occasion to be able to go. For some reason it seems to have suddenly been aggravated.

    We have two pelvic floor physiotherapists in our area with the same qualifications (diploma of pelvic floor physio); however, the much more experienced one with the better reputation has a three month wait to get into, whilst we can see the other one in a weeks time. We aren’t sure whether to wait for the better one or see the other one sooner. There is a practice policy where you aren’t allowed to see both – if you’ve seen one you have to stick with them. What would you recommend a person does in this situation? We don’t want it to get worse but we also want to ensure we give physio the best chance possible to work.

    • Michelle Kenway Physiotherapist says

      Hi Kahlan

      Thank you for your question. You can feel reassured that both physiotherapist’s will have an understanding of how to help with these types of bowel problems with both having qualifications in this field. It could be worth phoning the practice and explaining your wife’s problems and asking which physiotherapist has a special interest in dealing with bowel problems. You might also discuss this issue with your wife’s general practitioner who should be familiar with a good referral source to help you. All the best for your wife’s treatment, Michelle

  24. Hello!
    I had rectocel surgery three days ago and feel blessed to have happened upon this site. So helpful. My question is, is it normal that on the fourth day, I should feel like my vagina is full of something? I assume it’s just because of the swelling, but this is similar to how it felt prior to surgery, so just curious. I don’t think I’ve damaged anything since surgery. Probably sat up too long today (8-9 hours) after reading your blog. Yesterday was sitting up for about 3 hours. Thank you for your time and assistance!!

    • Michelle Kenway Physiotherapist says

      Hi Misti

      It’s really early days for you and it’s likely you’re noticing swelling or perhaps stool ready to pass. Try to avoid prolonged sitting at this stage and really try to vary your activity that you get a really good balance between gentle walking, some sitting and sufficient time resting in bed with a pillow underneath your legs to reduce pressure and relieve swelling. When you are upright swelling will tend to accumulate in and around your wound compared with lying down.

      All the best for your recovery,

  25. Michelle,
    I had rectocele repair in February and am grateful that I no longer suffer with the tissue pushing out of my vagina, not to mention improved bowel function. But I recently tried to have intercourse for the first time post-surgery. It was very difficult, painful, and afterward I realized there was a bit of tearing inside and minor bleeding. Will this lessen over time? My husband has ED issues as well so the whole experience is challenging now for us both. Any suggestions? Maybe others have this problem as well??

    • Michelle Kenway Physiotherapist says

      Hi Suzanne

      Thank you for submitting this comment, it’s a really important issue and women along with their partners are often completely unprepared for how to deal with intercourse after prolapse surgery. I think this article on prolapse and sex will help you more than I can in a short comment. I’m not sure whether you’ve had mesh repair I’m assuming that you haven’t. If you have had mesh it’s important to discuss any bleeding with your surgeon. Otherwise can be a matter of combining relaxation, appropriate positioning (side lying with your back to your partner to allow you to control penetration depth, really good lubrication and a graduated approach to returning to intercourse. Sometimes this can involve just digital penetration for some time progressing to partial/full penetration.

      I hope this information helps you and your husband Suzanne.

      All the best

  26. I work on a farm and ride horses and lift hay bales etc. what kind of a recovery time am I looking at b4 I can resume these activities? My concern is that I will not be able to do heavy work ever again. . .50-60 lbs lifting .

    • Michelle Kenway Physiotherapist says

      Hi Francine

      You will need to discuss returning to these types of activities with your surgeon – I am sorry to say that they are high risk activities for repeat prolapse and not usually recommended post prolapse surgery, your surgeon didn’t discuss this with you before your surgery?


  27. Hi Michelle

    Eventually seen my consultant again and he says its my front wall that has collapsed not the rear as previously but if that was the case why do i feel a huge bulge when my bowel fills. Is it my body playing tricks ? He has said to go back for a bladder test and then we can see. If he does an op to sort front wall he will put few extra stitches in to tighten bowel but wont do that on its own. We are to try tablets first to help stress incontinence. In the meantime I will keep on with the pelvic floor exercises. Wish I had found your site before I had my op as I feel I would have been better prepared. Still think i am back to square one

  28. Thank you Michelle, I will see him in one week. Can I ask a different ? how quickly can one prolapse after rectocele surgery if they were pushing? Would it be quickly done or does it take a while? Reason I ask is because I quickly stopped after reading this but it was 3 days of pushing gases and liquid stood and is light pushing ok. Thank you

    • Michelle Kenway Physiotherapist says

      Hi Stefanie

      A prolapse can happen at any time it really depends on the tissue supports. Most women in Australia are discharged with stool softener medication to help them in the first 6 weeks post op (at least). Not sure where you’re writing from but might be worth discussing appropriate medication to help keep your bowel regular, soft & well formed over the coming months.

      Hope all goes well for you

  29. I have anterior and posterior repair with hysterectomy 3 days ago and today I’ve been straining alot to try to let out gas. I’m worried after reading this, have I reprolasped and how would I know because I’m currently in alot of pain? Thank you

    • Michelle Kenway Physiotherapist says

      Hi Stefanie

      With any post op concerns like this you need to speak with your surgeon. It’s not possible to diagnose without an assessment.

      All the best

  30. I had a rectocele at the end of October and although I thought I was doing everything I should I am devastated that I am now in a worse position than I was before the procedure. I dont know whether to ask for it again or put up with it. Would improved pelvic floor through exercise mske the symptoms better ? I am almost scared to go back to the consultant as I feel it’s my fault.

    • Michelle Kenway Physiotherapist says

      Hi Sue

      Sometimes prolapse surgery fails and yes i suggest you should return to your consultant. First of all get an accurate assessment of the situation and you will need an examination to establish this. Prolapse surgery can fail for a number of reasons and why would it be your fault? You say you did everything you knew to do, what more could you have done? Try not to be hard on yourself Sue – I don’t believe that any woman who chooses to undergo prolapse surgery sets out intentionally or otherwise to cause a failed repair. Let’s say you strained because you got constipated after surgery – you may not have been sufficiently equipped with the knowledge on how to go about preventing or safely emptying after surgery in which case you can’t be blamed. Regardless the priority is getting you back to good health and wellness and you will need to return to your surgeon or seek another opinion to assist you. Yes sometimes pelvic floor exercises can assist with postoperative recovery too. Speak with someone you can speak to openly – maybe your understanding doctor and go from there.

      All the best

  31. I had a rectocele in December 2014 I’m still having the pressure of feeling I’m not empting my bowles I hurt so much every day and its getting worse to day I felt down there as I pushed I’m worried I feel a big lump or buldge on my right next to me rectum. What is it

  32. Michelle,
    I am 12 days post bladder and rectal prolapse surgery, when should I see decreased swelling and is it too soon to start my kegel excersises.
    Thanks Jackie

    • Michelle Kenway Physiotherapist says

      Hi Jackie

      It can take weeks for the swelling to decrease – this is variable depending on the type of procedure, how much time you’re spending upright, body weight etc. Most surgeons advise women to wait 4-6 weeks post op before recommencing Kegels. When starting them it’s important to start gently usually lying down as shown in this video for post operative pelvic floor exercises

      Remember the importance of alternating lying down with walking, when you spend time lying down the swelling decreases with healing. The important thing is to balance upright and lying down resting during recover.

      All the best

  33. Dear Michelle:

    I had a vaginal vault repair, bladder sling and rectal prolapse repair 10 days ago. I feel good, except that I cannot get the consistency of stool any thicker than pudding , and it just slides out. If I cough or walk or sit, it doesn’t matter. I know it is early yet, but is this normal? I do have a lot of gas and it comes out with that too. I am feeling pretty discouraged right now. Also,the only restrictions the doctors said was no lifting over 5# for six weeks. I am afraid to walk too far or anything like that because I want to give everything they did inside time to heal and don’t want anything to stretch. Just how little activity is advantageous for a good repair right now?

    Last question. In a few months, should I be able to pick up my two year old grandchildren and hold them again?

    Thank you

    • Michelle Kenway Physiotherapist says

      Hi Wendy

      I understand you must feel discouraged however this will most likely improve with time and healing. It’s really important to give your repair the best opportunity possible to heal especially over the first 12 weeks so it’s vital to follow your doctors instructions, avoid heavy lifting, rest to allow healing and avoid straining.

      Gas and bloating will increase pressure on the pelvic floor. This information about bloating and diet may assist you – good diet to avoid prolapse and constipation and gas is very important postoperatively as is keeping the stool soft and well formed.

      I would think you can cuddle your grandchildren now – I am not sure how old they are, small children can be nursed sitting down without any problems at all. Probably avoid lifting them off the ground at least until well healed.

      All the best

  34. After being indoors for two weeks I am keen on going for walks again. I want to walk about a mile at the most on my first outing is this likely to upset the operation. I have had several repairs and have just bought a walker with seat to assist me to enable me to walk without carrying any extra weight.

  35. Michelle, I need your advice. I am only 24 years old and my passion has always been running. I have full blown rectal prolapse for almost 3 years before realising anything was wrong – even though I had to use implements to help me go to the toilet. I had surgery for this about 8 weeks ago and I feel fantastic it has drastically improved my life. I have your book , and am trying to do pelvic floor strengthening exercises and am avoiding constipation, straining etc etc. BUT I am at a loss about what to do about running, can I return to it? It was my passion and I was running maybe 60-70 miles a week. I dont want to not be able to do it, but I dont want my prolapse to come back. What can I do to limit my risk? Does my weight matter (if it is useful I am probably underweight and underfat for my height – 5ft 3 female, 96lbs, with body fat of 14.4% with very little in my abdominal area). I need your advice…. am feeling lost especially as I just moved across the world away from my family, friends and doctor.

    • Michelle Kenway says

      Hi Gabby

      Being so young and having a prolapse repair increases your risk of repeat prolapse since this repair needs to last a long time. The fact that you’ve had surgery increases your risk of repeat prolapse. Added to this is the issue of pregnancy and childbirth should this arise that loads the pelvic floor too. So it really makes sense to avoid unnecessary risks to your pelvic floor. Running is a high impact exercise and high impact exercises load the pelvic floor especially when repeated. You can read more on prolapse and running here https://www.pelvicexercises.com.au/prolapse-and-running/. Alternatives to running are cycling and this can provide women with the capcity to exercise at high intensity while minimising the load on the pelvic floor.

      So unfortunately you have decisions to make based upon what you know about running and your personal risks as well as your pelvic floor capacity for support. Equip yourself with as much information as you can about pelvic floor recovery, risks and rehab as well as pelvic floor safe exercises as this is something you will manage lifelong.

      I hope this gives you somewhere to start and some direction, I really understand your dilemma Gabby.

      Best wishes

  36. What exactly are the inappropriate general exercises and lifestyle factors after rectocele? I’ve had to go back for a secondary repair and dont want to go a 3rd time.

    • Michelle Kenway says


      Thanks for your question and yes I completely understand your concern about unsafe fitness exercises after repeat prolapse surgery.

      High impact exercises are the ones to avoid i.e. those fitness exercises that involve landing heavily usually from both feet off the ground position. This article will get you started with exercises to chose and those to avoid https://www.pelvicexercises.com.au/prolapse-fitness-exercises/

      You will find a lot more detail on unsafe exercises to avoid after prolapse surgery in Prolapse Exercises Inside Out book see https://www.pelvicexercises.com.au/pelvic-exercise-products/pelvic-exercise-books/prolapse-exercises/

      Hope this helps you know a little more about unsafe exercises to avoid post prolapse surgery


      • Hello Michelle
        I enjoy your site. Your comments in the past have helped me. I had a bladder lift, rectal lift and a hysterectomy a year ago. The Dr asked me to quit lifting for a year. I did not lift for a year now. I am from Canada there is allot of snow. I was a pro with the snow scoop. The s snow scoop is a thing you push big scoops of snow up a snow made ramp to make big banks. I am thinking of ways to shovel again. Is there a safe way to shovel? A small shovel perhaps? Are my snow scoop days over? Also I read that lifting heavy should be something I never do again. Well, I’m from farm country so just this morning my dad wanted me to carry a bull strap and rope. I declined and got my husband to take them. I was wondering would using a wagon harm me? Pulling in a wagon? Is that bad. There is allot of wood to burn here too. I’m just thinking about life strategies. I’m 46 and have three kids but the doctor says to be careful because I’m young to have had the surgery. I don’t want any complications. But i do miss using my strength.
        Any advice you have I will listen too. Oh, also. I don’t know if my muscles are too strained but kegals cause excruciating pain in my rectum. Like cramps so my family doctor said simply to avoid them. Is there alternative you can suggest. I found yoga useful in the past to relax that area but haven’t done yoga since the surgery.

        Thank you

        • Michelle Kenway says

          Hi Shannon
          This is so challenging for you – heavy lifting, shoveling snow and pulling wagons are not appropriate for any woman after prolapse surgery. These types of activities really do increase loading on the pelvic floor which needs to be avoided after prolapse surgery long-term. This needs to be work that others can do and they need to understand why these activities aren’t appropriate – remember prolapse and repair can’t be seen from the outside so it can be difficult for others to understand restrictions. I understand you miss using your strength, I wish I could suggest otherwise however unfortunately in this case I can’t.

          AS far as Kegels go it would be useful for you to see a Pelvic Floor Physiotherapist to check your technique is correct. It is possible that some women contract too strongly, do too many exercises and don’t sufficiently relax their pelvic floor muscles completely after the contraction. Your doctor is correct is saying to avoid them if they are painful and cause spasm in the rectum. It may well be that if you can learn to relax the pelvic floor muscles that encircle the rectum so that you can improve and maintain your pelvic floor support long-term.

          I hope this helps you a little Shannon
          Best wishes

  37. Hi I am 7 weeks into recovery after rectocele repair sphincter repair pelvic floor rebuild and vaginal repair after 16 years worth of damage after having a baby. All the damage occured because of surgical error not naturally. I am worried that after so many years of living with these problems that they will reoccur In the future and the repair won’t hold are all the above tips still applicable when I have had a whole new pelvic floor rebuilt? My surgeon says at the moment the muscles aren’t really doing anything and says physio should help but I am keen to do whatever I can from home to make sure this never happens again thanks

    • Michelle Kenway says

      Hi M
      Yes along with strengthening the pelvic floor as an absolute priority these rules apply to those factors that increase the risk of repeat rectocoele in women so very important to know about them, especially while your body is still recovering. These are the things to adhere to now nd long-term, especially good bowel management.

      All the best for your recovery

  38. Jennifer says

    Hi Michelle,

    I’m 44 years old (mom to three boys 8 and under) and about two years ago I had robotic repair on a prolapsed uterus and then six months later a rectocele repair. Following the surgeries I was told that I could return to my normal activities, which included “boot camp” style exercising, running, etc. I did not feel comfortable returning to such high level activity so I stopped exercising for the most part out of fear. Two years later and 20 pounds, I started exercising again (all traditional exercises). And I’m seeing weight loss and I’m getting strong again, but within the last month I have felt a rectocele develop again (my uterine prolapse surgery appears to be holding in place quite well – for now) and I’m thinking the exercises that I am engaged in are the culprit (as I generally avoid constipation).

    Quite honestly, I’m writing because I’m so upset about this. Can I get really strong and fit again without causing myself more damage?

    I hope you can help give me just a bit of peace of mind about this.


    • Michelle Kenway says

      Hi Jen
      You must really be feeling quite devastated after all you have been through with this.

      First and foremost there is no reason why you can’t exercise again, this time you need to do it in an educated manner and adopt pelvic floor safe exercises for weight management and general health. There is no good to be gained in looking back other than to learn that something needs to change to help you stay active and manage your body weight long-term.

      There are some things that you may like to consider:
      – Your pelvic floor muscle strength may be lacking, if you can improve this you will be better able to exercise as well as promote internal support long-term
      – Consider seeing your gynaecologist and discussing a support pessary as a stop gap to help you delay or avoid further surgery if this is a direction you would like to take
      – Get yourself educated in pelvic floor safe exercise for weight management.

      You will find many resources freely available on this site to help with prolapse and weight loss exercises The Inside Out Strength Training DVD is designed for women with prolapse and the Prolapse Exercises book has a dedicated section to pelvic floor safe weight management exercises to refer to if you need further information.

      I hope this gives you somewhere to start Jen
      All the best

  39. Hi Michelle,
    Again it is good to revisit these rules re good bowel habits and techniques to avoid further surgery.