Let’s Talk About Rectocele
Women’s pelvic floor health is not exactly the most popular conversation around the dinner table. Throw a little rectum talk in there and you’re suddenly the least popular dinner guest ever.
The reality, though, is that the female pelvic anatomy does its job really well some of the time, but there are some notable exceptions. The muscles of the pelvic floor act as a sort of sling to keep the pelvic organs where they belong. These muscles can weaken, and then things can start sagging down into foreign territory. That means the bladder, the uterus, or the rectum can prolapse, causing problems like urinary or fecal incontinence.
When we don’t talk about these things out of embarrassment, it means that people are less likely to seek help for pelvic floor issues. According the the Department of Women’s Health, 1 in 5 American women have some form of pelvic floor disorder. Despite this being a common problem, I suspect many people are unaware of that because it’s so seldom talked about. I’ve never heard from anyone who has a pelvic floor prolapse, and I’ve never disclosed my own rectocele to anyone until now. Go big or go home, right?
The most common type type of pelvic floor prolapse involves the bladder. However, this article is going to focus on rectocele, since it’s the condition that I have. Rectocele involves a weakening of the muscle in the rear wall of the vagina, allowing the rectum to push forwards and downwards. The mucosal layers are still intact and separating the vagina and rectum, so there’s no movement of feces into the vagina, but the muscle layer in between the two has weakened. The diagram above shows a milder rectocele, but in more severe cases the rectum can push further downward and toward the vagina.
The Department of Women’s Health lists a number of risk factors for pelvic floor disorders:
- vaginal birth(s), especially if the infant is over 8 1/2 pounds
- long-term pressure on the abdominal area, such as ongoing cough or regular straining when having a bowel movement
- peri- and post-menopause
- family history
I know exactly when mine developed. I was in my 20s and on a multi-day kayaking adventure. I was straining my core all day long to feel more stable in the kayak. At the end of the second day, I got out of the kayak and immediately knew something was wrong. I felt like I was having a baby. Or perhaps like my insides were falling out. The only way I could tolerate walking was if I had a hand between my legs applying pressure to keep my vagina inside where it belonged. At least there was no one else on the beach to witness that song and dance.
Things healed up relatively quickly post-kayaking with no intervention, but as time went on, I noticed I was having difficulty with bowel movements, and I felt a pressure against the back of my vagina. It’s gotten worse as I’ve gotten older, and much of the time now I have to apply pressure with my fingers against the skin between my vagina and anus so I can push the rectum back where it belongs so things can exit out the anus as they’re supposed to. Perhaps this sounds a bit disgusting, but this is my everyday reality, and it’s the reality for a lot of other women too.
There are several types of interventions that may be used to address pelvic floor disorders.
- Pelvic floor exercises ( Kegels), which a physiotherapist can help with
- Change the diet to produce softer stools that are easier to pass, by incorporating more fibre and water
- Avoid straining during bowel movements
- Losing weight if one is obese
- Avoid lifting heavy objects
- Pessaries are removable devices inserted into the vagina to support the pelvic organs.
- Surgical repair
Pessaries are prosthetic devices inserted into the vagina. They are fitted by a health professional, who will chose the shape of pessary that’s appropriate for the woman’s condition.
Pessaries can potentially cause irritation and even open sores in the vaginal wall, especially if they do not fit well. There is also a risk of vaginal infections, which can be decreased with regular cleaning. For postmenopausal women, the topical application of estrogen may be required to strengthen the vaginal wall tissue enough to support a pessary.
Surgical treatment is used as a last resort. The aim is to remove the extra rectal tissue associated with the rectocele, and strengthen the septum between the rectum and vagina with stitching and possibly a reinforcing mesh.
I’ve chosen the do nothing route for now, although I’m fairly certain that by the time I hit menopause a pessary will be in my near future. I don’t particularly fancy the idea of wearing a pessary, but then again, I’d also like my rectum to stay where it belongs.
If you’ve made it through this far, congratulations. A willingness to feel uncomfortable and a little bit embarrassed is something we need more of in this world. There are a lot of people who have “icky” health problems, and burying our collective head in the sand doesn’t make those problems go away. Talking about them, though, can increase treatment-seeking and make those problems a whole lot easier to manage.