Sharing the Wisdom

Dear Mermaid,

I am so happy for you! You know how worried I was (and I’m sure many of the women here were) that such a young woman was in so much distress. You will make a wonderful therapist!!

As for your Grandmom, I believe she is in the exact same boat as the rest of us. Unbeknownst to many of the women here, we have colons falling into our rectums and levator muscles so saggy that our anus has become the most dependent portion of our intergluteal area. Indeed a horizontal pelvic floor! This condition remains relatively asymptomatic for years, but decreased stool diameter (caused by funneling, or sagging, of the levator muscles), constipation, and excessive wiping are early symptoms. Chronic straining can lead to a decrease in sensations (nerve damage) of rectal fullness and stool passage leading to incontinence.

You can check for early signs with a hand mirror, just like vaginal prolapse. These are a red anterior rectal wall, which is visible through a partially dilated anal sphincter. Bear down to see if more red wall protrudes. Such signs would be unusual in a younger woman, but certainly not uncommon in those past forty.

I saw a fully prolapsed rectum in a very petite woman when I was a hospital nurse and it was shocking indeed, not unlike other severe prolapses. At the time I thought it was a terrible anomaly probably brought about by abuse or something, but now understand how common the early stages are.

It is important to know just what is possible with rectal prolapse, which is 15 cm (about 8 inches) of rectal wall ballooning out – it truly does look like a bright red balloon. That is the worst it can get, which is pretty terrible. The balloon is reducible, but comes out again with bowel movements.

Like your Grandmom was told, surgery is offered as the only cure, as with all other prolapse. However, rectopexy is major surgery that carries the same risks as other operations that suspend organs to the sacrum, with obstipation as a not uncommon result.

Now, the lovely ladies who are raving about their reconstructive surgeries do not take into consideration that many of these operations set female anatomy up for progressive rectal prolapse. In order for the anus and rectum to be protected, they must be able to take their normal axis, which is often obliterated by these procedures. They chuckle about “endless wiping syndrome”, which can actually be a sign of serious trouble to come. Chronic dependence on laxatives only exacerbates the problem.

The only difference between you and your Grandmom is that she will respond more slowly to this work. However, if she has all her organs she will be able to see some degree of result just like the rest of us. You are one of those who understands that every level of medical intervention takes us further away from our ability to turn back the clock on our symptoms. I believe stabilization is just as possible with rectal as with vaginal prolapse.

I would order the dvd for her so she can gain a good understanding of the posture. Please tell her the necessity of no-straining and the easiest way to do that (rock up onto her feet.)

Here’s another idea. I DO NOT KNOW IF IT WILL WORK, but I think it’s worth a try. I’ve completely forgotten what they are called, but there is a very strong bandage with a hole in the middle for sealing around colostomies. There are different sizes for different-sized stomas and they are as hypoallergenic as possible. If she is having significant protrusion, I wonder if placing one of these over her anus would allow for a bm, but hold her rectal wall back?

Vaginal and rectal prolapse should be very rare occurrences amongst civilized peoples. It is imperative that we gain an understanding of the role our outer frame plays in keeping our insides well positioned for proper support and functioning.

Hugs and wishing your Grandmom well!

Christine

Hi All, I thought it was just me. It doesn't always happen, just every now and again if I am under a great deal of stress which causes me to become a bit constipated for a few days. Now I know to be extra careful about straining at these times, and ignore it at my own peril.

I have discovered that another thing happens when I am under a great deal of stress. I hurry about the place and get all hunched up and tuck my butt under. I suspect it may be when I morph into male warrior mode to just get through a hurried and stressful patch, which happened to me the last couple of weeks at work.

As well as getting a bit bound up, I found that my prolapses were descending again (bugger!), then I caught myself out of posture more than once and realised what was happening. The strange thing is that you can't hurry when using Wholewoman posture. You have to walk slowly. When I walk fast I lean forward and automatically seem to change my centre of gravity or something. I also lose my lumbar curve.

So I am now just trying to slow down my walking which also has a calming effect. If I am in a real hurry, I just jog which gets me there a bit faster than a fast walk, but has a relaxing effect and the extra exertion seems to use up a spot of adrenaline as well.

I would not care to repeat the last two weeks at work and hope I am not in such a stressful situation again for a long time. It was necessary at the time, but has passed now. It has taught me something new.

Cheers

Louise

Christine,
I recently saw my nurse-practitioner re concerns I had about possible rectal prolapse. I only noticed this after examining myself when I read your post to Mermaid. There is a protrusion (perhaps 1cm thick) of tissue around the anus during (and only during) bowel movements that spontaneously retracts. It is not at all bothersome, and I would not have noticed if I had not read your post. Anyway, my practitioner said that it is possible that I've always had this and just never noticed it before and that it might simply be normal for me. As long as it doesn't get any worse and I don't have any other symptoms, she seemed to think I should simply monitor it for now. I had been concerned that perhaps the pessary was causing this, but she disagreed - in fact, she seemed to think that the pessary was helpful in keeping things in place. BTW: she did check to see that the cystocele is still about where it has been, and I have no signs of any additional prolapses. So, I'm back to daily use of the pessary (removing every night) since it provides tremendous relief especially when I am very active.
J.

Hi Jean,

Just keep your eye on it over time. I think it’s likely many of us have similar symptoms – hard to imagine not after three or four or five decades of unnatural straining against the toilet seat. I retract my statement that prolapse is solely a disease of civilization, though. After looking into it a bit more I see that even wild animals (seems mostly carnivores) have been spotted with rectal prolapse. We’re much more protected than they, however, with several additional anatomical and physiological mechanisms that create an anti-prolapse and incontinence system when on our feet. Intraabdominal pressure becomes a non-issue – we just have to be in the right shape.

Not to be a curmudgeon about the pessary (I’d wear one if I could), but doctors have commented on the results of wearing them over time. This is from Nichols and Randall (1989):

“(The patient) should be advised that the pessary is only palliative, not curative, and acts by continuing a stretch in the opposite direction of tissues that have already been pathologically elongated. Silent progression of the prolapse and widening of the levator hiatus usually will continue until a pessary can no longer be retained.”

Now granted, these guys were surgeons and not in the business of handing out pessaries, but one hopes they were making honest observations anyway.

I think the situation is more complex than N&R realized. It seems if a thin pessary, like the ring with support, is allowed to take the natural axis of the vagina then that area can close almost completely as it needs to in order to flatten against the forces of intraabdominal pressure. I don’t know for sure, but it seems that women with prolapse of the anterior wall as their primary symptom do best with this sort of pessary. Some women wear them for years with no exacerbation of their symptoms. I don’t know if this will be the case with the donut – just monitor the situation and you should be fine.

Christine

Christine,
I fully concur with your sentiments about pessary use. I find it tremendously helpful now, but I'm leary about long-term use. As you have pointed out, it is an artificial device, a foreign object in the body. I don't want to rely on it always as a crutch, and I'm hoping all the attention to posture, diet, WWFB, etc. will eventually give me enough relief from symptoms and the confidence to pitch the donut. Not there yet, but willing to work for it (-:
J.