Rectrocele and my wonderful new treatment

Hi Pamela

Welcome to the Forums. I have had a similar experience with rectocele for many years, then worsening at one point about five years ago when I had a lot of stress induced constipation that eventually sent me to a gynaecologist for a formal diagnosis of my suspicions.

I can see that rectal irrigation would work, cos it removes the lump of stool that is keeping the rectocele fat and impinging on the vaginal space, and therefore preventing the rectum from receding back to where it would normally be. However, I don't know that I would want to be using it every day in the longer term as the rectum would not be able to do its own work of telling you it needs to empty, and may get lazy. On the other hand in the short term, if it has dilated considerably, rectal irrigation may help it get back to being a more normal sized cross-section, so it may allow the rectum to recover itself without getting stretched out again all the time. The human body is amazing how it can recover itself.

The problem however, is not the rectum per se, but the breakdown of the rectovaginal septum, the fibrous framework of fascia that separates the vagina and rectum and prevents the rectum impinging on the vagina, in the first place. You will know from feeling it yourself in your vagina that a rectocele varies all the time, depending on our bowel habits and our diet, so you will get different descriptions of degree from different doctors at different times (of the day, and during the menstrual cycle).

It is gratifying to hear that your first doctor didn't suggest surgery, even though he came across as dismissive, as many do. I think it is TMI for them, but surgery has its own perils anyway. It is predictable that the colorectal *surgeon* and the gynaecologist suggested surgery, as that's what they do and make a living from. Pity the poor woman who does not have the resources to do her own research! It is also gratifying to hear that more women are refusing surgery, and rightly so.

One of the basic principles of Wholewoman work is to keep the stool soft enough so that we experience the need to empty the bowel and respond asap, so that the stool doesn't build up and blow out the rectovaginal fascia. Fibre seems to wake up the bowel, keep it active and seems to strengthen the 'please empty me' signals. To do this you need enough fibre, both soluble and insoluble in your diet. Also reducing the amount of animal protein in the diet and replacing it with vegetable protein will add more fibre. This in itself is often enough to keep the rectocele from manifesting too often. I found that chronic stress was my constipator. The fact that I was under a lot of stress also meant that I ate differently, and not so healthy a diet. I was also full of adrenalin, which dried my whole system out. These factors caused further constipation. Then the constipation stressed me out even more.

Clothing is another factor. All humans experience intraabdominal forces from breathing, moving, intestinal movement, coughing, vomiting, laughing etc. If you compress the abdomen and waist you prevent the abdominal wall from acting as a cushion to absorb these forces, so they have to go elsewhere (ie out the bottom end). Allowing your abdomen to expand freely with loose waisted clothing, lowline trousers and skirts, and stretchy fabrics allows the abdominal wall to do its cushioning and expanding work.

Posture is the other factor. Check out the FAQ's on the main website to learn about this. WW posture rotates the pelvis forward so intraabdominal forces act sideways on the rectum and vagina instead of directly downwards, Downward directing of intraabdominal pressure is what happens in modern 'fitness industry' posture with a tucked in tummy and butt. I suggest you buy Chrsitine Kent's book, Saving the Whole Woman, 2nd edition to understand this better.

BTW, my rectocele rarely bothers me these days, and is always managable. I now trust my body to recover itself after the odd setback, as long as I look after it, so I don't get distressed and stressed about it any more. My marriage, which was the source of so much stress five years ago, is now on a much better footing, so that stress is gone too.

Cheers

Louise

Hi Pamela

Yes, I agree that the amount of fibre is a bit of a balancing trick. I know that my bowel motions are sometimes very soft and sometimes more solid, but that doesn't worry me. I think the main effect of fibre is to keep everything moving, rather than grinding to a halt. I have never used stool softeners or laxatives, so I can't help you on that. I believe in making my intestines work for a living rather than helping them, if possible, and that is all through lots of veges, some fruit, legumes (cooked), seeds and nuts (raw), salads, small portions of meat, whole grains, plenty of water, some natural yoghurt, etc. I try not to eat too much cake, bikkies, sugar etc.

When you say that if you have too much fibre for lunch you get uncomfortable quite quickly, is that necessarily a bad thing? Do you mean that you need to visit the toilet quite quickly, or you get tummy aches, fullness and rectocele pressure? It takes about 20 minutes for a meal to cause the rectum to fill, so maybe what you experience is absolutely normal? I had a child with constipation many years ago, and we had to make sure she visited the toilet 20 minutes after a meal so she was already there when her rectum filled, and could evacuate straight away, while the urge was there. It sometimes worked, but her situation was complicated by other things so it didn't always work, but that's another story.

I still, after four years, have to work on my posture, but it is easy to do. It is just that our lifestyle seems to conspire to keep us out of posture, so it is always a conscious effort. You can make it easier by not sitting on chairs with backs so sitting in posture is easier. I have a stool at my computer desk, and my car seat quite upright with a wedge on the seat to keep me horizontal, and a small lumbar cushion to give my butt somewhere to go. You can perch yourself on the edge of easy chairs and sofas. Try not to sit on those dreadful plastic stacking chairs that you find in halls and meeting rooms all over the world. They are a nightmare for POP for any length of time. Don't ever sit on a chair with your legs crossed, as it means that half the pelvis is tipped back and half forward. This may be OK if you don't have POP's , but I note that most physiotherapists and chiropractors advise this too. This has been a hard habit to break, but I think it is worthwhile. Another thing is that dance has helped me to strengthen the muscles in my legs and hips, and stabilise my lower spine, pelvis and thighs, so it is easier to lift with my thigh muscles. This means less temptation to bend from the waist to pick things up, so my pelvic organs are always well forward.

You can see that I also like to make my body above hip level work for a living too. I figure that was what it was designed to do, so giving it a back to rest against is not doing it any favours. In fact it means that whenever I am sitting I am working all those muscles that maintain pelvic stability, so it is a positive move. I figure chair backs are probably good for stopping kids and drunks from falling off backwards! For that the are quite useful.

Hope this is some help. There are so many things you can change for the better, and you never know how well you can manage your POP's unless you throw everything you can at them. So, I am always monitoring myself, and I have made significant changes to my lifestyle and environments where I spend most of my time. Avoiding surgery and further damage is a high priority for me, and my new ways are no harder than my old sloppy ways. Establishing new habits and routines is a life skill I am not good at, so if I can do it, anyone can. Call me obsessive if you like, but even obsession is worth it for some things in life (like looking after POPs, looking both ways before crossing the street, and washing your hands after using the toilet!) I may also be lucky, but my POPs seem to be just about as bad as everybody else's if I don't look after them, so I can't really see how I am very different. It just amazes me how good it can get. Mine may worsen in future. I'll just have to deal with that if it happens. In the meantime I am very thankful to Christine and the support and ideas from all our Members for the improvement in my POP symptoms over the last four years.

Cheers

Louise

The good old fashioned rubber-hose-bag enema? Only two hospitals in all of England use the regular, ordinary, ubiquitous enema? It isn't ubiquitous anymore? Am I old?? WOW..... you mean this is now a lost art? Nobody's ever heard of it anymore? What am I missing here??

Hi Pamela

Yes, please do put the websites up so everyone can do their own research properly. It certainly sounds like you are convinced, and as you said, you have had success using it. A few members have posted about using enemas for relieving constipation, but not on a daily basis. I can't really see the difference myself between enema and rectal irrigation, but maybe I will when I have a look at the sites.

I will be looking for evidence of double blind trials with large samples in reputable peer-reviewed scientific journals, on the effect on the bowel (and rectum) with regular use before I believe any sales spiels on commercial sites. I hope there is good research backup for your (or their) claims. When you say "some women in the past have had to resort to splinting" if does sound to me like sales spiel because 'resorting to' seems to be one of those buzz words related to 'undesirable' or 'distasteful', that are planted in sales material to preempt attitudes of consumers. No doubt there are a lot of good little consumers out there just dying to part with their money for one of these little machines. ;-)

I am not discrediting the idea, Pamela. I will be honest enough to say that I am a cynical old bag at the best of times, and I will be the first to admit that I find blatant consumerism to be one of the worst aspects of modern life. I also object to the medical and related industries inventing problems so they can sell solutions and make dollars based on spurious claims, maybe causing other medical problems on the way.

I do splint occasionally, and find my clean thumb ready at the end of my hand to help, for nothing! It is a multi-functional tool at that, and it doesn't take up space in the bathroom cupboard. It mostly helps, though sometimes it doesn't, then I just drink more water, eat more fibre, wait until the stress passes, and away we go like normal again. Maybe I am fortunate. For those who have an aversion to splinting I am sure there is a market for rectal irrigation, as long as the scientific evidence is there to ensure that it doesn't cause more problems later down the track.

I wouldn't want Wholewoman to be promoting commercial interests that have hidden problems. I am glad you are finding it beneficial and that you have been able to draw our attention to it. Hope you keep posting occasionally to keep us informed about what happens in the longer term.

Cheers

Louise

I would love to be able to look more into this...

Sometimes youre holding someone else's heart in your hands. You can drop that heart & bruise it. You can squash that heart & hurt it. Or you can stomp on it & totally annihalate it. You stomp on that heart or bruise it. It can forever be changed ♥

I am still completely confused. What exactly is the difference? I will research and see if I can figure it out. Don't get me wrong.... I am fully on board with using a rectal "washout" - whether you call it irrigation or enema - to ease the symptoms of rectocele. This is just common sense. My tone of outrage is due to the shock of discovering that apparently it is NOT standard treatment - unconscionable, that doctors recommend surgery without ever suggesting that patients try this first. Whenever my rectocele makes it difficult to evacuate, I use little Fleets... duh!

Pam, thank you for the additional information about your irrigation system. This is indeed little more than the traditional enema. Your medical system has quite a nerve supplying you a bag and tube by "prescription only" - and charging you an arm and a leg for some special pump! - when this same thing has been a staple since time immemorable. Here is what we in the U.S. have in nearly every grandmother's bathroom closet:

http://www.amazon.com/DuroMed-Mabis-Douche-Enema-Kit/dp/B000SM6LNK/ref=p...

And you certainly don't need a prescription to buy it. This familiar red rubber bottle serves for "rectal irrigation", for douche, or for just a bottle of hot water to cuddle with for pain or cramp relief. I thought everybody in the civilized world had these things. The only difference in this "patented system" they gave you is the balloon thing you pump up to keep the catheter in place, and of course, the pump. I can see where their fancy patented prescription-only system would be useful in the case of paralysis patients, but for regular people, you just hold the thing in place with your hand. As for the pump, you can get a pump effect simply by raising the bag to a higher height. More water pressure. That's all a pump does, increase the water pressure. We'd hang these things up on the shower curtain rod and had all the pressure we needed. You could turn it on and off by simply pinching the tube shut. Pinch, open, pinch, open and you get a spurting pump effect.

Now doctors are trying to tell you that you can't do this to yourself without a prescription? And they charged you 250 pounds for a pump thingie? Good lord. I am sorry, they are ripping you off and complicating up something that has always been very simple. Well I am very glad it works for you and I agree the "wash" is THE way to go to solve rectocele impaction problems. It's the gold standard. It's just that I am pretty disgusted that your medical system is pretending this is some complicated new procedure, and they assume lay people are too stupid to do it without medical permission and supervision, and to add insult to injury, charge you an obscene amount for a pump when all you had to do is get a longer tube and hang it way high if you want more pump effect.

Wow... well at least they gave you this instead of insisting on surgery, I guess I have to give them that. But your whole story serves to reinforce my belief that when it comes to "privates" problems, grandma still knows how to handle it more safely, and much more cheaply, than the modern "advanced" medical field.

The Fleet is a small mini-enema, single use. It's just a little plastic bottle with a tapered tip. You get on hands and knees, insert it, squeeze the contents (saline) into your rectum, wait 5 minutes or until you feel the urge, and go!

Here it is:

http://www.drugstore.com/qxp15093_333181_sespider/fleet/enema_ready_to_u...

Hi Pamela

Thanks for the website information and the detailed description. Sorry if I seemed a bit over the top with pulling you up. I'll check out the websites over the next couple of days. Now I can see what position you are coming from, and it sounds like it works well. Even if it does take longer I think I would prefer the bag at shoulder level version over the pump.

I did a little research myself and discovered that the way all these washout methods work is to dilate the rectum and/or colon a bit more than it is already. This sets off the emptying signal to the brain. It would also break up the contents and make them more mobile . I imagine the pump works quicker because it uses more pressure, dilating the rectum faster and more. For a person with intact fascia around the rectum this might not present a problem but if the fascia is already damaged I would think that further dilation repeatedly could stretch it further, and damage it more, especially if used on a regular basis. For this reason I think the bag at shoulder level would be gentler and less problem in the longer term (apart from being far less expensive, more compact, and not power-dependent).

We always seem to want to do everything faster these days, when slower is often more in tune with the needs of our bodies. For a person who needs to do everything fast no doubt there is a market, but the topic I created last night does show that there is enormous variation in normal for women when it comes to bowel emptying, both frequency and how long it takes. I doubt that your guests would think that taking half an hour in the toilet was over the top, and really it is none of their business anyway. Think of the amount of time teenagers take for a shower!!!! ;-)

Hopefully you will slowly become more comfortable doing rectal irrigation when you need to. We are brought up with an aversion to anything to do with the bowel and emptying it. eg Poo is germy and dirty; vomiting is unpleasant, but diahorrea is not even talked about. We talk about vomiting, but diahorrea is referred to as "the other end too" or "the runs" or "going". We can't even use the appropriate words. As for haemmoroids? TMI. It is a big ask for you to be comfortable about talking about rectal irrigation, and explaining to customs officers about the pump, but I am sure they have thick skin when you read about some of the dodgey things that people have in their luggage. A letter from your doctor to carry with you might save unnecessary explanations. I am sure that there are many people who carry these pumps on aircraft if constipation is as common as it seems to be.

I think that the silence that AnneH mentions about who has or doesn't have an enema kit in their cabinet is another aspect of that aversion. BTW Anne, we never had one in the cabinet when I was a kid, and we don't have one now. Every family is different.

Cheers

Louise

These are very informative websites, Pamela. I can see that these people provide very thorough guidance, cautions and contraindications. At http://www.burdettinstitute.org.uk/648.aspx you can also find a really good article on how the bowel works and empties. I have never seen such a clear article explaining this.

Unfortunately I couldn't find the article on rectal irrigation and rectocele either.

It appears that this form of irrigation is safe because it is only water. Other enema products use either saline or sodium phosphate of some sort, which effect the bowel in different ways. The latter have counterindications for those who have sodium sensitive conditions such as high blood pressure etc. There was also mention of hypocalcaemia, presumably because the sodium replaces calcium in some molecules in the body. I guess this means that Fleet enemas, which seem to be a household word to some people, are not as non-invasive as they seem, even though they are widely used, and have their own set of caution information as they contain sodium.

However, they do make it clear that colonic irrigation should only be used after non-invasive methods, eg laxatives, diet changes, pelvic floor training etc. I dunno, I think some laxatives are pretty undesirable, eg paraffin, a mineral oil derivative. No wonder it makes you empty ya bowels!!

I also noticed that the pump thingy actually blows up a balloon in the rectum. I think this is to keep the catheter inside the rectum while the water is pumped in. I guess you would just have to make sure you don't inflate it too much.

Thanks for doing the research and finding such an informative site.

Cheers

Louise

I have been using the Peristeen system for a couple of years now and it has been very helpful to me. It is like a glorified enema - the inflatable cuff on the rectal catheter helps to keep the water up there! It is a very good way to achieve a good clear out, which has been great for me because not only do I have a rectocele but I also have a tendency to get bowel obstructions owing to slow gut motility. I've not needed to go to hospital since having this equipment. It eliminates any strain involved in defaecation and for me keeps the rest of my bowel going, which is critical! My debate is how frequently to use it - daily is too much, weekly is not enough. But of course now that I have heard about WW principles this adds an extra tool-kit to my tool box, as I would prefer to be able to DIY more often rather than have to rely on this. I will also add that I use Fleet bottles as warm water containers. The solution in a Fleet would I think be far too aggravating for me, so I tip it away and use the empty bottle. This can then be sterilised in Milton or hydrogen peroxide and is good for many applications. It is a lot more portable too and can keep me out of trouble when I am away from home, but is not nearly as effective as Peristeen. Peristeen is available on prescription (but many docs will not have heard of it - mine was prescribed for me by a specialist continence physiotherapist - some of them are very good!) and Fleet bottles at any chemist. Coloplast make the Peristeen system and they have a good demo animation that explains what it is, but their version is very sanitised! The reality is a somewhat messier affair - but I remain a fan in spite of that! It is great to feel empty - I now realise that most of my life I have been "full"

I love Louise's responses in this thread, especially her suggestions on getting your bowels in order with good diet and whole woman practices. These irrigations may be in need on occasion, but there is the worry of getting addicted to them, and then the body loses its natural movement.
My husband's grandmother always did full on enemas and got to the point where natural peristalsis just stopped working for her. A shame really.

In the last week or so following working on the WW posture I find that I am having BM only once a day and my stools are more formed. I have never suffered from constipation but always needed to have a BM post lunch or late evenings. I have lactose allergy so avoid dairy particularly yoghurt and ghee(clarified butter). I have substituted milk with Soya milk along with cereals.From completely giving up dairy, in recent years I have milk with tea ,cottage cheese and occasionally cheese. I am a vegetarian and consciously incorporate many coloured vegetables and fruits in my diet. I have just received Christine's book and First Aid to prolapse CD. Learning the moves is not easy but I am trying to read, view and imitate.
I do get a little gassy post lunch but don't seem to need to evacuate , a new phenomenon.Is the WW posture at work? Of course, my back feels a little strained(no pain) through being forced to sit without a backrest and I feel a strange sensation as if of fullness in the lower belly.
Where in Christine's book does she mention how you can go about lifting and carrying without it impacting POP? I did find some suggestions on how to sleep on one's side etc. Or is the ability to lift and carry a fall out of better strength in thigh and back muscle?

I still catch my belly feeling strange too and I was just thinking about that tonight. Fullness is a good way to describe it. Full of air and life maybe as it is not all being sucked from it by pulling it in. I'm a year into this too!! How much I had trained my belly to go against it's nature.

Hi Kittu,
Sounds like you are off to a great start! Christine does demonstrate lifting in the First Aid Fir Prolapse dvd, along with tons of other helpful information about getting around in our daily lives. Keep the object close to your body as you lift it up, and be sure to hinge at the hips on the way down and back up, keeping the lumbar curvature in place.

I love the encouragement which comes from belonging here. Thank you . I did find the references Christine makes in her DVD to bending and lifting. I was so afraid to stoop to lift anything even something really small which had fallen on the floor for fear of POP getting worse.Now I can watch myself and attempt to maintain the 90 degree angle as much as possible.

KC, I have been doing this work for 5 years, and although the posture itself became second nature for me years ago, I still have to be mindful when bending and lifting. I guess I always will. When I correct my body position I can feel those organs moving to a better place. - Surviving