Stage 4 Rectocele

Hi Cecilly - I don't know if anyone can answer your question for sure. We know that you have struggled with your symptoms for many years here. If things got worse after all the poking and prodding that went along with those procedures that you had, then logically you should be able to get yourself back to where you were, with time, patience and a little extra effort. You say that your prolapse corrects itself when you bend over, but the bulge returns as soon as you stand up. You are experiencing the exact dynamic upon which the Whole Woman work is based. With correct posture and breathing, you are trying to maintain that same position of the organs in the belly, rather than in the vaginal space. Post-hysterectomy, there are greater challenges, but I think you know this from many forum posts and many responses that you have received from Christine and others. There is nothing else, but to just keep working. - Surviving

Hi Cecilly - you mentioned in your first post above, that you were watching your posture. Can you tell us how you watch your posture, and where did you learn posture? You have been here on this forum a very long time, asked questions and received good answers, but have you studied Christine's work? You must have her book or some of her video's, all of which describe correct posture in detail. This is where we point everyone who comes onto the forum asking about posture. - Surviving

hi cecilly - you definitely want to get your posture info directly from Christine's work - book/streaming etc if you aren't already.
but what Surviving meant was that you've demonstrated perfectly what's going on in our pelvis/pelvic organs. from the waist down we're 4 legged animals - so all our organs *should* rest in our lower belly and you see when you bend forward, they do... but because we're 2 legged creatures from the waist up, we need a strong lumbar curve to recreate the 4 leged-ness down below.
picture a cow (still breastfeeding so i feel like one lol - i'm sure the anatomy is different but the thought process will work) but a cow's pelvis will have a similar orientation to ours but she's standing on 4 feet. when you lift her up and plant her on her 2 back legs her pelvis will be tilted back and leaving a big hole for all the organs to fall through. we have strong lumbar curvature that keeps our pelvis in the correct 4 legged orientation - if we let it! and don't let societal norms, soft furniture, reclining, sucking and tucking etc... tilt it all backwards.

*edit - just googled cow pelvis and it doesn't really look like ours... but the general idea is the same! In my mind anyway... any 4 legged animal will give you the right idea.

Hi Cecilly,
I am wondering if it may be time for a consult with Christine. There are no guarantees for any of us with this work, especially after having a hysterectomy. The only other thing I can think of would be Christine's post hysterectomy program as she does have more insights and suggestions there that may be helpful.
I think you already know the dynamics have changed once your uterus was removed, but hopefully you can keep your pelvic organs moving forward as well as you can.

The post hysterectomy program is here:
https://whole-woman.thinkific.com/courses/saving-the-post-hysterectomy-w...

Sounds like we have the same or similar condition. Not sure what stage my prolapse is, possibly 2 or 3. It is at the opening of my Vagina to where my clothing rubs on it so I must wear loose fitting jeans pants etc. The posture and exercises seem to help. Went skiing this year and noticed the full feeling of prolapse. I worry if my skiing will make it worse wondering if I should get a pessary. I make sure and keep my bowels loose to avoid extra pressure. What is a V2 supporter?

Hi Lea and Cecily,

Although the rectocele is uncomfortable, it probably can’t get a lot worse than it is now. The good news is, it may be preventing the vaginal vault from literally turning the vagina inside out, which manifests as a football-size protrusion containing loops of small bowel, which must be responded to surgically.

I try to help post-hysterectomy women understand that keeping the abdominal wall relaxed and the intestinal contents weighted toward the front can help prevent so-called vault prolapse. You may have to really “baby” the rectocele in terms of a very good diet and helping the rectum fully evacuate (splinting), but this is all part of caring for the body in the aftermath of surgical alteration of the pelvic cavity.

Remember that your rectum is tightly adhered to your spine and cannot fall out. A lot of misdirected internal pressure can cause the rectal lining to peel off its foundation, resulting in a rectal bulge, but that is uncommon in women (more common in men!) as the vagina is the path of least resistance to intraabdominal pressure.

Search the internet for the V2 Supporter. My apologies for not having yet been able to materialize the Whole Woman Supporter, but some of the materials in my unique design have been very difficult to source.

I would say, do what you want to do in life - with the help of WW posture and an external support garment. You may find you are able to learn to ski in such a way that does not send internal pressures to the back of your pelvis. Only you can keep an eye on your symptoms, but I wouldn’t let a rectocele bulge worry you. Please try to understand that your intestines should be carried forward and away from the outlet at the back.

Wishing you well,

Christine

I did some downhill skiing during the 20-year period between the start of college and the birth of my first child. Another 3 decades have passed since then, but I have considered this in light of prolapse and I'll tell you what I think.

We often reassure prolapsed women that they can do pretty much anything they want to do, as long as they can learn HOW to do it safely, and to do this, they need a complete understanding and practice of WW principles. This is not a blanket statement, and certainly not one that I would ever make to a woman who has had hysterectomy and/or other "repairs".

I personally think skiing would be very aggravating to prolapse, because you are constantly using that abdominal core to pull up and take the weight off your skis long enough to turn them, at a body angle that is not acute enough to protect the organs from pressure.

I wouldn't mind hearing from anyone else who skis with prolapse. Prolapse or not, I'd never resume the sport because of my age (I don't need to put myself in the path of a broken bone) and the fact that I'm more bothered by cold and snow with each passing year. For the younger ones, and especially those who have avoided surgery, I'd love to know if this is one of those things that can still be enjoyed. - Surviving

Hi Surviving,

I hope Lea and other post-hysterectomy skiers will report back to us on this subject.

I’ve worked with enough women after hysterectomy to understand that they have lost their “core”, which is the great muscle and surrounding thick mesentery and ligaments of the uterus. The uterus is the central hub that keeps the sacrum horizontal in women. We know this because when it is gone the sacral angle widens, which is manifested by loss of wide-radius lumbar curvature.

The result is significant impact on their balance. I have seen this and many of my practitioners have seen this as well. Unfortunately, not one study exists on the subject in either the gynecologic or orthopedic literature.

When we use our “core” correctly, the muscles of the abdomen have lengthened, allowing the pelvis its anatomic position, which is orthogonal to the abdominal wall. Our great strength and ability to balance comes from being able to stiffen our torso with intraabdominal pressure. We stiffen the torso by lengthening the muscles, not shortening them. The capacity to lengthen them most is on the in-breath, and this is when the abdominal wall provides the most strength and lifting power - hence heavy weightlifters greatly expand their abdomen on the upthrust. There is never any pulling in or contracting a “core” because when the rubber meets the road in the most strength-demanding sport that exists, the abdominal wall must be held out, not in.

Why should it be different in any other sport or dance? I used to take my granddaughter to ballet class and was amazed at the data on this subject from the more advanced class that was held just before her beginning class. The teenager who was the top dancer - beautiful balance and form - was the only one who still maintained the childhood dynamics of her abdominal wall, meaning her midriff was consistently held out, not in. It made all the difference in her performance, but the teacher certainly did not realize it and I could see those dynamics being trained out of her.

Post-hysterectomy women have lost their true core, and as the sacrum rotates slightly back for lack of the connective supports that keep it tethered forward, the lower abdomen rotates backward as well. This is evidenced by a navel that faces up. In natural posture the female navel faces slightly down. The most striking feature of the post-hysterectomy woman is a large, rotated lower belly. The belly is large because loops of bowel previously held high in the abdomen have fallen into the space once occupied by the uterus.

So…the question for the post-hysterectomy woman becomes whether or not she can re-create enough natural dynamics of the abdominal wall to maintain strength and balance. It is possible the intestine-filled lower belly could work, but the risk is loss of strength in the lower back due to radically changed dynamics there as well.

I feel the need to clarify when we talk about the female “core”, as still after all these years we battle wrong views in the world of what true abdominal strength really means.

Hugs,

Christine

Thanks Christine for this post.

I of course understand the difference between the male and female "core", a distinction which is fundamental to this work. My point was that (whatever your gender) your abs get a serious workout when you're skiing, and a protective posture/body angle would be very difficult to maintain. Much more difficult after hysterectomy and other surgeries. I don't think dancing is a particularly good parallel, and I'm hoping for more insight from someone who does ski. - Surviving

I agree - I wasn’t comparing post-hyst dance to skiing, but only putting the wish out there that all of sport and dance be influenced by natural human posture, which has become obliterated in modern times.

Hi Cecily,

The uterus and all its broad attachments are what separates the abdominal from the pelvic cavities. Yes, the loops of bowel are there to stay in the lower belly. You may be able to move them up momentarily, but there is no way to keep them there.

One of my favorite exercises for strengthening the core is simply to lie down on your back and bring knees to chest. Stretch your arms all the way to the floor above your head and hold your baton (or rolling pin, etc) overhead with arms straight. If it is uncomfortable, put your hands/baton on a small pillow. On the in-breath (important that it’s on the in-breath), touch your toes to the floor. On the out-breath, bring knees back to chest. This seems extremely easy at first, but you will be surprised how well it exercises the entire abdominopelvic interface. Work up to 20 or so sets.

Thank you very much for being with us all these years, Cecily. I do hope the WW work is making your journey easier.

Christine