Rectocele? When to seek advice/treatment?

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I'm 30 (just!), had a baby 3 months ago, vaginal delivery with forceps. All happened very quickly (combination of epidural and monitor not picking up contractions), baby in distress and no time for episiotomy. Instead I had a second degree tear basically from anus to God knows where (stitches went up to about an 1-1.5 inches internally). Also had damage to my urethra.

Everything has healed well. No incontinence (very good at doing pelvic floor exercises!), slightly traumatised by the whole thing but have had a smear and intercourse with no issues.

That said, I'm pretty sure I have a rectocele. It started at about the time the stitches dissolved. I had a pretty persistent cough which is when I was first aware of it; when coughing it felt like something was protruding. Since then it's got worse/larger. I'd say when sitting (have had a poke around when sitting on the toilet) it's gradually increased from "I think there may be something there?" to a bulge about the size of a golf ball which blocks my vaginal opening (although is soft and reducible). I can feel it bulge when I cough, sneeze, lift anything or stand up from sitting. It doesn't seem to be causing any problems other than I never feel like I've completely emptied my bowel any more.

I did mention it to the nurse who did my smear and she said to monitor it but it seems to have got bigger since then even (just last week). There wasn't much to see when she did the smear as when I'm lying down gravity is on my side.

At what point does it require further attention?

I have one, had it since I gave birth to my second child 14 years ago. GP/nurse both had a look, GP said I could be referred to the hospital but that they won’t do anything until you’ve completed your family.

#4 is due in May and it will be one of the first things I ask for after I’ve healed

I would go and see your GP and ask for referral to a women's health physio. They can examine you and tailor your exercises to your condition, also give you lifestyle advice to prevent things getting worse, for example swimming puts a lot less pressure on the pebic floor than running.

GP said I could be referred to the hospital but that they won’t do anything until you’ve completed your family

I figured that'd probably be the case. We're undecided yet as to whether we want a second child, decided to discuss it in a few years.

I would go and see your GP and ask for referral to a women's health physio. They can examine you and tailor your exercises to your condition, also give you lifestyle advice to prevent things getting worse, for example swimming puts a lot less pressure on the pebic floor than running

Thank you. I don't run any more (never enjoyed it but have run up to marathon distance so that'll do me!). I am overweight and I know that won't help things. My main form of exercise is cycling although I've not got back in the saddle since having baby as was waiting for everything to heal sufficiently, but I do think the size and where this is, is likely to cause problems with that.

I had one (and a bladder prolapse too - lucky me!) and finally went to get it sorted out last year, my youngest was 6. The surgery is major (not painful though) and the recovery period is extensive. My surgeon was very forceful at reminding her patients that the more and longer you rest for, the less chance of your prolapse returning! It takes 3-6 months for the tissues to all knit back together properly so you start off on extremely limited activities (no lifting ANYTHING for first few weeks) and gradually increase. I'd have found that stage impossible with younger children (no lifting children!) so I'm quite glad I waited a while. Unfortunately, it hasn't sorted out the stress incontinence so will probably need another op for that at some point.

(no lifting children!)

I know this is making it worse already but it can't be avoided when he's only 3 months old. He's 18lbs already

Cycling is supposed to be ok so long as you don't stand on the pedals, but there is the comfort factor to consider. Small changes to lifting technique can help too, for example putting your shopping in 4 bags when it would fit into 2 means each is much lighter to lift. Harder to adjust babies, but good manual handling technique such as getting very close to them before lifting them helps. Also getting out of bed, roll onto your side and push up with your arm, don't sit straight up from lying on your back. It all helps.

I wish I could sit straight up in bed! Pregnancy, a beast of a child and no sports massage for over 12 months is taking its toll!

I hadn't thought about things like standing and cycling. I tend to do a lot of spin classes for quick cardio in a short time period so standing there is pretty low impact as it's high resistance. I don't tend to stand when I cycle much as my balance is awful and I seem to get more power when sitting than standing.

Sent too soon...

I must get back to the gym so I guess I should be having a conversation with someone who knows what they're on about to make sure I'm not doing anything to exacerbate anything.

Is this something I need to be examined for (nurse did have a look but couldn't see anything as I way laying down) or can I get away with a phone consultation and descriptions? I have a medical background particularly in anatomy, so can describe things and answer questions accurately

I was told to avoid spin classes , I think the high resistance aspect is not great either. I'm not medically qualified BTW, just been there with the prolapses.

I think you would actually need to see the physio, they can feel you doing your pelvic floor exercises and tell you which parts need most exercise (or most relaxation, many women suffer with too-tight muscles down there too). You might get away with a phone consult with your GP possibly. Have a look on your surgery website and see if any specialise in women's health.

One of the GPs has a DRCOG so I'll try and start with a phone consultation with them and see what happens.

I meant that no lifting children is a restriction after the corrective surgery not that you shouldn't lift him now. That's part of the reason I waited so long to tackle it.

I meant that no lifting children is a restriction after the corrective surgery not that you shouldn't lift him now. That's part of the reason I waited so long to tackle it

Oh I got that, but I'm aware that lifting him now isn't making things any better, not helped by the fact that he is so big (and is only going to get bigger) He's sticking perfectly to the 98th centile for both height and weight so I do avoid carrying him wherever possible on that basis alone!

My DS was a great lump too! He's 12 now

Mine was a tiny scrap, but a forceps delivery, I think that's what set off my problems. I had surgery when my youngest was about 7, mine suddenly got a lot worse then but I wish I had known about avoiding high impact exercise etc as it might never have got to the stage of needing surgery if I had been more careful.

Forceps delivery was on my birth plan from day 1, it was kind of non negotiable. They definitely used them as my husband was horrified that they were assembled when inside, but when he was born you'd never have known he was a forceps delivery, he didn't have even the tiniest mark on him so I'm not sure why they actually bothered, they can't have done much with them.