Rectocele can be a really challenging problem to live with. It can be embarrassing to talk about
especially when it comes to emptying your bowels and knowing how to stop your prolapse getting
worse. Hi I'm Michelle and today I'm going to be guiding you through how to avoid your
rectocele worsening and also through the things you can do at home to repair this condition.
Sowe're going to be going through a number of things I'm going to be talking to you about,
how to empty your bowel and I'm going to be giving you some really important dietary information
to help you manage your rectocele better. We're also going to be going through some rectocele
repair exercises and finally I'll be giving you some information on emergency management
for constipation if you do get constipated. Now just before we start I really need to explain this
condition so that you understand it well because the better you understand it, the better you'll
be able to manage it yourself. So if you just take a look at this little image here you can
see this is a side on image and you can see just how close the rectum and the vagina are together
so they're actually nearly adjacent. So this is part of the cause of the condition. When you have
a baby the walls of the vagina become stretched or if you are straining to empty your bowel and
when the tissues stretch they become floppy and weak. So if you imagine and I've got something
to help demonstrate this for you today. So you imagine this is the vagina, a very long vagina,
this is the front wall and this is the back wall. It's the back wall here that becomes loose and
floppy and what happens if the rectum is right next to it, when the bowel movement comes down
it presses in and if you can imagine this is the back wall of the vagina the stool actually pushes
in like this into the back wall of the vagina and that bulge that you're feeling is the back wall
actually pushing in with the stool pushing through behind it. So every time you use
your bowel this is part of the reason that you have problems using your bowel and you feel that
dragging sensation down through and out of the vagina is because of that tissue stretch. So
what can you do to manage it? I think the first thing we need to go through is really good bowel
management and I'm going to share some really good tips with you on how to empty your bowel.
So the first thing to do is to obey the urge when you feel the need to go to the toilet then go
don't hold off and the other golden rule is to never strain. Never bear down, never push down
to strain and I'm going to show you now how to empty your bowel safely and effectively without
straining. So let's go through this technique step by step and you can practice this at home.
So first of all, I'll come to the side so that you can see what I'm doing
when you're sitting on the toilet. You've got the urge to go, remembering that sometimes with
a rectocoele you might not feel the urge you might just feel a heaviness, so be aware of that
as well but when you do get the urge to empty you lean forward with the inward curve in your back.
So the temptation can be to do that when you do that you push down and you make that rectocele
bulge and become worse the way I just showed you. So if you lean forward in this position
and when you start to empty, you take a couple of deep breaths, actually four to five deep breaths
and when you relax the breathing the pelvic floor muscles will relax and they will open up. So what
we're going to do is just take a couple of deep breaths, breathing in and breathing right into
your belly and let it go and again breathing right into the belly and letting it go. Now what you can
do then is you can get some toilet paper, wrap it round and round your hands and you can support
that area right up to the front of the anus and hold that area up as you empty. The other thing
that some women find really helpful is to use a couple of fingers inserted into the vagina and
support that. So you're basically stopping that from coming through you're holding that wall
upwards if that makes sense and that makes it easier for then the bowel movement to actually
empty. I that makes you feel squeamish which is fine, there are products available such as Femmeze
and I’ll leave a link below and that's a device that actually inserts into the vagina to hold
the back wall and I'll leave a link for that below as well if you're interested.
So let's go back to the position and technique. So you're in that position, what you then do is you
make the sound and when you say “MMM” your waist goes wide and when you relax your tummy forward
you actually open up the anal sphincter and that then allows the bowel movement to come
through. Now I have this in much more detail in the video above if you'd like to go through that
in further detail but it's a mood to poo. So it's making your waist wide into a barrel shape and
“OOO” in that position all in that one movement and that is how you empty without straining.
At the end of the movement then you draw up and lift and squeeze in and around that area
to bring the tissues back up So that's the mood to poo technique and I'll put the link down below as
well. Now the second thing I'd like to go through today is some dietary information to help you.
So your diet is really important and a really important part of you managing your rectocele
really well. You've also probably heard about the importance of fibre and yes fibre is really
important in your diet, we all know that, however the temptation is to try to have a lot of fiber
and what fiber does when you’re constipated, what fibre does is actually bulks the stool
and makes it larger. So that when you have a rectocoele and having a lot of fibre, you can end
up with a really bulky stool which is not what you want. Again you can refer to the video above but
what happens is if that stool comes down and that pocket is sitting there like that and dries out,
it becomes very hard to shift. So we'll talk about the emergency management for that in a little
while coming up in this video but basically your diet or the type of diet that you have is going to
affect your stool. So you're aiming for a type three to four on this bristol stool chart which
means that you're aiming for a smooth soft well-formed stool and that's the best type
of stool to empty, not too hard and not too runny because both of those things can have an effect
or both of those types of stool can have an effect on the rectocele and your ability to empty.
Now the second thing that I'd like to mention in terms of diet is the importance of not having
foods that make you gassy. If your rectum is full and you actually can't pass gas then you're going
to be inclined to want to push down and strain, and also the gas can get trapped in your stomach
and feel really uncomfortable as well and you might have experienced that problem as well.
So the types of foods that can cause gas are the cruciferous vegetables
and you can look those up on the internet.Things like broccoli, brussels sprouts, those greens,
obviously beans. Some women have problems with lactose and they can benefit from actually taking
lactose tablets that will actually stop the lactose bloating and forming gas in the stomach.
Also too the other things that we often reach for when we're constipated, things like your
dried fruit because the dried fruit also sit's there, creates gas and it also too does bulk the
stool. So two things to think about there with your diet first of all we were talking about the
importance of not bulking your stool too much and secondly avoiding your gaseous foods. So
what can you do to repair this condition? There's a number of things you can do.
The first thing is your kegel exercises, now I want to show you the pelvic floor here and
let's have a look and see what kegel exercises actually do. I'll get you to come in a little
bit closer and have a look. So remembering that the pelvic floor muscles are underneath where you
sit. So these are the sitting bones and these are the pelvic floor muscles here and you can see how
they encircle around the rectum there. When these muscles are strong they help to support
and lift that area. Now once the tissue has stretched inside the vagina that's stretched and
that is not going to fix so unfortunately that's within the vagina and that is not going to repair,
however what you can do is to do exercises to strengthen this area underneath and that actually
lifts the pelvic floor to sit higher. So this can reduce the prolapse symptoms and it can also
hopefully then prevent or reduce your risk of the prolapse getting worse.
If you'd like to know more I've got a video above on kegel exercises for beginners and also too
kegel exercises for women with prolapse and you might like to refer to those videos for details,
but knowing that when you do these exercises it's important to be lifting and squeezing the muscles
in and around the anus so that circular area. So you're doing that action in and around the vagina
and you're also tightening in and around the urethra or the opening to the urine passage. So
that action is like that and I've got all the sets and reps and the number of exercises to do
linked in that video and I'll also put the link in that below. The second thing I'd like to mention
is the importance of general exercise. Now general exercise is very important if you're living with a
prolapse. When your body is fit and strong, you'll put less pressure on your pelvic floor and aside
from that we all know the benefits of general exercise.Now the things that you need to avoid
are things like high impact exercises like running and jumping because they are going to put pressure
down on your pelvic floor and they're the types of exercises that can make the rectocele get worse.
The things to choose are things like low impact exercises, like riding a bike or
walking exercises where you've got at least one foot in contact with the ground too all the time.
It's also important to do strength exercises and you don't need to give up the gym.
If you want more information on strength exercises you can refer to my book here on
prolapse exercises and I've got full programs there that teach you how to manage your weight,
how to do your prolapse exercises and also how to exercise safely with a prolapse.
The other thing to think about is to avoid intense abdominal exercises.
So you remember a moment ago I was talking about the importance of not pushing down. When you do
lots of abdominal curl exercises you're actually training the muscles that actually push everything
down. So there's some really nice alternative abdominal exercises you can do too and they're
also in the book as well. You'll also find those in other videos I’ve got available on YouTube.
Now let's talk now about emergency management for constipation because this is a really big issue.
I think the first thing you need to do is to anticipate when you're going to be constipated
and avoid it happening in the first place. So for example when we go away on holidays that's a time
that many women get constipated. Try to anticipate this might be going to happen. The best products
that you can actually take are macrogol products or osmotic laxatives. Now you can see above here
I’ve got osmolax shown here and also I've got a packet and a box of Movicol here I wanted
to show you as well. Now this is the flavor free version and I like that best because it has a less
irritating effect on the bowel but this product actually comes in sachets and basically what you
do is you mix the sachet in water and you drink it and what this does is actually softens the stool
it it draws extra fluid extra fluid into the bowel and it softens the stool and it actually helps it
to pass through the bowel so that it helps to keep that nice soft well-formed stool. It's a lovely
product in that it's not irritating to the lining of the bowel like some of your natural products
like Senna which actually irritate the bowel and cause dependency. These type of macrogel products
don't do that so they're often or they're mostly safe for most women to take and also for children
there’s a pediatric version as well. So speak to your doctor or your pharmacist about that,
obviously you do that before you take any medication. But if you get really constipated
what you can do is you can increase the number of sachets you take and you can take up to eight
sachets a day if you're really constipated and obviously you'd be spreading those out during
the course of the day but again speak with your pharmacist about that. Now let's say that's not
working and there is a really hard stool blocked in through the bowel and through the rectum,
what you can do then is speak with your pharmacist about a suppository which is like a little tablet
that inserts in through the back passage. something like a glycerol suppository and it will
immediately help you to empty the bowel. It'll soften the stool in that area and it'll empty it,
it's not something that you do regularly. It's much more of an emergency management situation
but bear that in mind it's much better to do that and to use that rather than be straining and
sitting on the toilet for a long time. You want to be sitting there for two to three minutes maximum
and that's it, you don't sit on the toilet straining and bearing down for a long time.
So we've gone through a lot there haven't we, we've talked about first of all what a rectocele
is, we've talked about the types of foods to avoid, we talked about how to empty your bowel
and then we also talked about the importance of general exercise and kegel exercises to
repair the area and then finally we talked about your emergency management if you do get really
constipated. So I really welcome your comments and questions about this issue because it can be
a very private issue and it's very often hard or difficult to discuss this with other people. So
please feel welcome to comment, put your questions below and if you found this video helpful
I would really appreciate it if you could give it a like below, because then YouTube
will recognise this and recommend this to other women that are experiencing the same problem.
So I really thank you for watching today, I really hope this video helps you manage your
rectocele better and I'll look forward to seeing you next time, bye for now.