I struggle with the same question. My rectocele opened two or three years ago, in my early '50s. For me, the problem was not leakage but managing excretion itself. The prolapse is large enough that stools get stuck in it and back up. I have spent the last several years fine-tuning my diet to keep stools soft enough to keep moving but firm enough to make it out of the malformed plumbing without the help of the surrounding structure.

When the bulge you described first happened, I did not understand what it was. I went straight to the doctor but did not get help there. I became so obstipated that I damaged myself when I finally passed too large a load. I ended up in the emergency room but the damage was already done. Then I saw a specialist who discussed surgery and prescribed pelvic floor therapy. Therapy helped, teaching strategies for how to splint, use a toilet stool, and relax the resulting pelvic floor spasming, with which I still struggle.

I had leakage with miralax, which does ease constipation, but I eventually retired it to firm up the stools enough to make it through my malformed plumbing. Now I eat pumpkin seeds, homemade red cabbage sauerkraut, tons of leafy greens, psyllium husk, and guar gum every morning.

But there's no way to undo the actual damage without surgery to seal up the herniation. It's bizarre to be able to feel individual stools from the outside with my hand and have to guide them out myself manually. With the right diet, I have been able to do more without splinting, but to finish, I have to provide a manual assist. And I have nerve pain at my pelvic floor now that I can manage but can't seem to completely resolve.

I have hypermobility and a connective tissue disorder that makes my tissues stretch too easily, which is why I have held off on the surgery so far. I understand that the surgery is often ineffective even in people without this challenge, and even more ineffective in people who have it. I've heard a fair amount of complaints from those say that their other pelvic prolapse surgeries work well but not the rectocele repair. But every once in awhile, I hear from someone who says that it was a godsend. To me, it sounds like a gamble. It could be life-changing, and I could make things even worse, with new sources of nerve pain. No way to know on the front end which way it will go.

I desperately want to be "fixed," but I am worried that the surgery will not hold and I will wind up worse. I've worked really hard to get to the point where I can manage a normal life, which I didn't think was possible at the beginning of this awful story. My onset coincided with the start of the pandemic, when getting away from my small town didn't even seem possible, so I had to learn to live with it. But even now, I worry that I won't always have the strength in my arms needed to splint manually and torque my body to be able to pass stools.

Since it started, I've now had a bunch of medical consults with mixed recommendations. One surgeon recommended I go forward with repair surgery, but others have been less encouraging. I don't know who to listen to. That's why I haven't done it so far, but I share your concern about waiting until I'm older and having the recovery prove even more difficult.

I would be very interested in others experiences with this problem. I share all these details to let you know that a rectal prolapse is in fact survivable, though incredibly frightening at first. With time and practice, things normalize that you couldn't possibly imagine could ever seem normal. At first I thought I would never leave the house again, and it took a long time, but I fully live in the world again. But I still fantasize about a magical surgery that will just cure me from this isolating and painful disability.

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