Bowel movement posture for rectocele

Violin - WW toileting posture is designed to hold the organs forward, away from the vaginal space, with the goal of not having to splint, and not having to strain either. So keep working on it from that perspective, and as long as you need to splint, I guess you'll have to do whatever's necessary. - Surviving

Hi Violin,

It sounds like you are trying to maintain lumbar curvature in the WW toileting position, which is not what we do.

Remember from the video that when standing and sitting with lumbar curvature the anus makes a right angle with the rectum, helping to prevent fecal incontinence. This angle, made by the anorectal muscles of the pelvic wall, must be straightened for easy elimination to occur.

Slight counternutation of the pelvis (straigtening lumbar curvature) slackens the puborectalis so that the pelvic wall can distend. It is distention, not contraction or elongation, that opens the anorectal angle (self-observation, not found anywhere in medical literature - but it is self-evident!)

When leaning forward with bottom elevated, the pelvic organs have dropped into the hollow of the lower belly where they are protected from the forces of intraabdominal pressure. Go ahead and push (all animals do) in this position, while protecting your back vaginal wall with splinting, and rest assured your organs will be okay.

Christine

“So I just have to get my pelvic floor muscles to where they can push without breath-holding” sounds like a PT-ism (lol). How would you do this and why?

Hi violin1,
It may be a good idea to look into Christine"s fundamentals video:

https://www.wholewomanstore.com/Whole-Woman-Fundamentals--Posture-and-To...

It has the basics of posture and toileting in it.

Hi violin1,
Yes, you can have the legs touching the toilet seat; we just don't want the full pressure on the seat. It is a leaning forward position as Christine's explains so well above.

Hi Violin,

Bless your heart! Clearly you are dealing with a lot, but I believe by bringing your pelvic organs and connective tissues back into proper alignment your condition can be helped immensely - but please be patient as it will take time.

Yes, as Aging said, lean forward and get your weight off the seat every time you need to push.
I understand your fear (and have no way of knowing how your particular anatomy was changed by the surgery), but it is entirely natural to inhale and hold the breath to have a bowel movement. This increases the intraabdominal pressure necessary to overcome anorectal pressure so stool can pass through the canal. Like water in a barrel, pressure is applied to the body walls, which naturally distend.

You seem to have the very common concept of a soft-tissue pelvic floor that is pushed down and stretched out with every BM. Therefore, we must make every effort to make the floor stronger, smaller, and tighter. It is not a useful concept. Depending on how we sit, the pelvic muscles can be more like a floor or more like a wall - we like to keep them more like a wall. When you sit down on a toilet and push against the seat, you are sending pressures straight down to a floor. When you lean forward and lift your bottom slightly off the seat, the vertical anal triangle of your pelvic wall allows pressures to move through naturally, while your bladder and uterus are protected in your lower belly. This is truly the natural position of elimination for women.

When you try to breathe through a bowel movement, rather than closing your glottis (throat) and gently holding the in-breath (Valsalva - these guys always had to name anatomic structures and functions after themselves), half the time you are trying to expel stool while your abdominal and pelvic walls are contracting. No wonder your poor muscles are hyper and confused.

My guess is the feeling of incomplete emptying is coming from both the rectocele pocket and your puborectalis muscles. In normal defecation, the muscles contract immediately after a BM, pinching off the last of the stool. Short, cranky muscles may be contracting prematurely and pinching off stool before it is completely expelled. What is left in the rectal vault may be causing the symptoms you describe.

What is there to do but support your rectocele with a good diet and splinting (which eventually women are able to stop having to do), and naturalize your pelvic anatomy and dynamics with the WW work? Hopefully by now you understand there is no surgical cure for these conditions. Supplemental hormones have no place in a healthy female body either.

Wishing you well,

Christine

I don't know how much this will actually be helpful but I will share anyways. One of the small things that actually helped during my PT sessions before finding WW was learning how to reduce the tension in my pelvic floor. I was never able to do kegels much because my muscles would get so hypertonic that I could not even relax them enough to pee.
I had to seriously retrain my muscles down there. So I would have set times during the day when I would focus on relaxing those muscles with every breath, using the image of a sail filling up with air (or a sand on a trampoline).
I don't have to do it much now, because they work much better on their own, but this may help some in releasing tension that is keeping your muscles from stretching and functioning properly.