Rectal prolapse as result of rectocele...

and all I could find were studies showing the reverse; that there is an association between rectocele and anal spasms, where the sphincter will close. However, personally, I think my anal sphincter is more relaxed than it was prior to my having such a severe rectocele. But that isn't proof the rectocele caused it. Other things may have, including merely decreased muscle tone in the whole area. Most likely they share the same root cause (episiotomy?) rather than causing each other.

Now, I am making the assumption, probably wrong, that rectal inversion through the anus is associated with a weaker sphincter. I've no idea if that is the case. Now that I think of it, that probably IS wrong, as prolapse through the anus happens when you strain, thereby pushing anything that will come out, out. So it's probably related more to how your internal tissues are anchored, or not, than to the condition of the sphincter.

On the one hand, the rectocele itself is pulling the tissues toward the vagina, so perhaps that lessens the chance of them exiting the anus. But also, the interior of the rectum is more lax, so then maybe the chance is increased.

Ugh... that's a lot of words to say "I don't know." :(

Hi Kiki,

Well...neither the medical literature nor women's experience draw any parallels between the two. I would agree with one of the last points Anne made - that rectocele actually relieves pressure on the lowest portion of the bowel by blowing out toward the vagina and therefore creating a right angle to the anus. In other words, rectocele is protective of rectal/anal prolapse just like cystocele is protective of SUI.

Christine

Hi Kiki

Christine is out of town for a few days so she won't be visiting the Forum until she gets home. Be patient. I am sure she will respond.

From my point of view, I am sure I have had cystocele for a very long time, and have certainly had Stress Urinary Incontinence since childhood to some degree or another. I figured out a long time ago that there was another mechanism for maintaining continence besides the sphincter at the bladder end but, until I realised that a kink in the pipe as a result of some sort of malpositioning was that mechanism, it never made sense. I have never been able to stop the urine stream either (that is not as a child either).

If you go back to the Jello model, and consider the bladder as a bag of Jello tethered to the vulva by the urethra, think about it positioned forward over the pubis and held there by the fascia surrounding it, with no kink in the urethra.

Then picture it prolapsing, sliding backwards a bit (because of damaged fascia) over the pelvic floor with a kink in the urethra.

Then picture it in Wholewoman posture, tipped forward again but perhaps not as far forward because it is now only held there by posture, as the fascia are damaged. I would think it unlikely that any sustainable posture alone would be able to keep it back exactly where it started, (probably back far enough to keep pressure off the vulva is fine in a practical sense) so there would probably still be some protection from SUI with the urethra still slightly kinked. I hope my understanding is correct. Have a look at Fig 13.2 on page 120 of STWW second edition (Fig 68, p165 1st ed.). I think the kink is where the urethra joins the bladder. As the bladder tips backwards the join moves upwards relative to the body of the bladder so the urethra no longer leaves the bladder at a 90 degree angle and flattens itself, stopping free flow of urine. I hope Christine will correct me if I am wrong.

We'll see what Christine says when she gets back, and what other Members think.

Cheers

Louise

Hi Kristina,

You’re asking about a very complex physiologic process that still has urogynecology scratching its head. Some of the finest research describes the urethra as rotating slightly as it “sits” back against the vesicovaginal fascia (strong tissue layers between bladder and front vaginal wall) with rises in intraabdominal pressure.

Urinary incontinence is considered to be a symptom complex that includes diverse relationships of causes, which combine in different ways to account for varying degrees of the condition. These can be inflammatory, neurologic, congenital, anatomic, and– of course – “iatrogenic”, which means “medically caused”.

I think it’s simplest to imagine that in cases of SUI the urethra has lost its underlying support so that it does not “sit” as well against the front wall. It is theorized that a suburethral sling once again provides firmer support as the urethra rotates and sits back.

Although there are all combinations and degrees of severity of prolapse and SUI, it is a general truth that women with significant cystocele experience little SUI. This is because, as Louise said, the bladder base falls away from the front of the body and unnaturally kinks the urethra. I’ve always considered this a blessing because even having to manually lift the bladder out of the way to pee is better, imo, that uncontrollable SUI.

As to whether women, like Alemama who are able to substantially reduce the bulge of their cystocele, will suddenly begin to have trouble with SUI – I rather doubt it only because they are at the same time restoring firmer support to the fascial layers. I suppose we will see every combination of success and setback along the way but we can’t know until we get there.

:-) Christine

p.s. Two lovely ladies having lunch nearby stopped by the Center today to see what it was all about. They were of Hispanic heritage and we had a wonderful chat about prolapse, incontinence, surgery, and loss of our traditional healing modalities.

One elderly woman said she had suffered with mixed urinary incontinence (urge and uncontrollable loss without pressure increases) since she was a young child as have several other members of her family. She remembers her grandmother drawing a bath for her into which were infused certain herbs, soaking in the tub, being tightly wrapped in a towel afterward, and the incontinence cured for some period of time!