Rectocele? Anxiety? Terrible bowel issue spoiling my life.

[Beancounterzz]

Baby number one 18 years ago was 9lb, labour was long and I ended up with a failed ventouse and emergency episiotomy, cutting straight down to the edge of my anus.

I all appeared to heal ok but since then I always found it easier to fully empty my bowel (I’m the early days it helped support the stitched area) to press or support my perineum whilst emptying my bowel.
Second baby 2 years later literally slid out with no help at all.

Over the years I’ve had bowel urgency issues, could never hang on for too long, especially if upright. This has got gradually worse over the past 4 years (I’m 48 now) to the point where I have now developed anxiety when I go places in case there isn’t toilet close by. Most trips out now consist of me having a smallish nervous poo before I leave, I leave the house and as soon as I step into the shop I will suddenly have the urge to go. If there is a toilet close by then I can go but after that will often continue to feel the urge (and sometimes still lose a small amount of faeces) if not then I have no control and it will slowly come out. I then have to go home. I’ve been caught out many times and since Covid restrictions are lifting and we can go places almost every time I go out! I’m largely fine at home.

I think there’s a few things going on, the anxiety around it all provokes the voiding but also control issues that are not helping, I cannot physically hold it. When going to the toilet, after I’ve emptied my bowel I still often press into the perineum and more faeces come out which tells me it’s sitting in the lower part of my rectum but I obviously can’t feel it.

GP has offered me 50mg Sertraline that I haven’t started as I would prefer not to go down the route of anti depressants - I’m not depressed, I just need this issue sorted so I can have my life back and go places and long walks without worrying.

If it’s a physical issue then getting that sorted will stop me worrying but I’m not sure where to start, is it physical or all in my mind?

Has anyone else had this please?

From what you describe it sounds like a physical issue, possibly complicated by understandable anxiety around toileting/toilet access.

I had a similar first labour and now have rectocele. Fortunately I don't have continence issues (did in the early months) but the stuff you describe about incomplete bowel movements and having to create resistance is familiar.

I would ask GP for a referral to gastroenterologist.

Meanwhile, check your diet. Try to work out the right amount of fibre for you - this might be a lot, it might be just a little.

Drink lots of water. Peppermint tea daily is good for all digestive issues.

Get enough exercise daily. Walking will do.

Good luck!

That sounds awful op. I have trouble holding a poo once I get the urge so if I'm going out somewhere I make sure I've gone before I leave by using glycerin suppositories, maybe these could be of help until you get a permanent solution?

Thanks all.

Funnily enough I tried a glycerin suppository for the first time today as I was planning on going out this evening.
I inserted the suppository around 15.30 and did have a small loose bowel movement within 20 minutes. Since then I’ve been quite crampy, windy and am passing small amounts now and again.

My bowel feels sore and very sensitive now, slightly like I need to go all the time again. I darent be too far from the loo feeling like this so have abandoned plans to go out.

I’m disappointed as I hoped I could ‘clear out’ quickly and then feel empty and be sure I wouldn’t need to go. Not sure this is going to work.

@cosmopolitanplease is this normal? I’ve never used a suppository before.

Sorry to hear you are struggling.

Can you see another doctor? Or push for a referral? It sounds like you have been massively fobbed off. Yes anxiety IBS is common but not being able to hold it and the situation you describe there is something physical going on.

Luckily my GP was great when I was having a flare up she sent me for tests (colonoscopy type thing). There was nothing wrong but just to know things were normal helped massively.

Short term. Can you use Imodium instants? I have ibs, it’s much more under control than it used to be due to cutting out dairy but if I’m going somewhere I know I’ll feel stressed then I take Imodium and know I don’t have to worry. Also colpermin is good and it is less strong.

Hope you are able to find some answers- I feel like this is a female issue where women get fobbed off but that should absolutely not be the case so please keep pushing.

Not normal in my experience OP no, if I use a suppository it takes less than five minutes to work and then I feel 'cleared out' and fine. Sorry it didn't work for you, it sounds like you may have something else going on like ibs or a food sensitivity? Starting a food diary might be useful x

Hi hun so sorry you are dealing with this
There is a fantastic support group specifically for prolapses on fb search for FPOPS UK
You will get lots of support and advice xxxx

I would say that this is a physical issue that has been compounded severely by anxiety. If you are largely ok at home then it can't all be physical can it?

I've suffered with anxiety surrounding my bowels and bladder for years. Like you, I was fixated on where toilets are. I don't even have any real health issues, it's just the fear of needing to go and not being able to find a toilet. It got worse during lockdown because all the toilets were shut.

But that panic really does trigger the bowels. It's fight or flight - the body senses danger and tries to empty itself so that it can respond quickly.

It really started to control my life. I couldn't go on long car journeys, countryside walks, anywhere out of distance of a loo. I would google any journey or new place to see where toilets were before I would go. I still do that if I'm honest.

I take citalopram now and while it hasn't 'cured' me it has given me the strength and confidence to face my fears a bit more. I still have several nervous poos before I go out. I still overthink and google routes. But I'm improving and getting out more than I did before so I wouldn't write off the medication thing entirely.

I do hope you can get a handle on this as it seems you are battling both mental and physical issues. It can be very debilitating and you have my full sympathy.

@Beancounterzz how are you getting on?

I'm in a similar situation to you, but I don't suffer with anxiety. But when I go for my daily walk I desperately need to open my bowels after 20-30 minutes and don't make it home. I'm not constipated, in fact I think my stools are a pretty normal consistency. I always try to go, before the walk, but sometimes I'm just not ready. I probably have an accident twice a week and it's so depressing.

I have had a prolapse repair twice (the last time with mesh) and I definitely have the prolapse back. It feels uncomfortable down below and now I'm using pessaries for the vaginal dryness.

I saw my GP before lockdown, who recommended I lose weight which I have done (2 stone and now a healthy BMI). She tried to fit a pessary ring but she said my cervix was too low.

I don't know if I need to see someone about my bowels, a gynae or a physio.

Hi, thanks all for your replies.

I joined a couple of Facebook groups for prolapse and they suggested taking psyllium husk to try and bulk up my stool to make it easier to pass fully formed movements.

I’ve been doing this for a week of two and it’s pushed me slightly towards constipation so better from the point of view of stopping the urgency. Not sure whether it’s doing any good if I do have some sort or prolapse though.

I’m going to see how I get on with this over the next couple of weeks. I can live like this at the moment and am feeling far more confident

I would suggest you look for a specialist women’s physio near you if there is one. They can do an internal check and tell you where the weak points are and give you pelvic floor exercises to do to build all the strength back up down there.

Only thing is you may need to pay unless you can get GP to refer.

I also have this problem, and it’s awful. It really affected my mental health for a while, as I was finding it so distressing. I have come to terms with it more now, after being open and talking to other women with similar problems. I think I now have a bowel prolapse.
I went to a women’s physio, and found it really helpful. From the physical perspective and also psychological. She was an amazing woman, who had so much empathy and understanding. Such an underfunded part of the NHS, and an example of how little thought is given to women with childbirth injuries.
I saw a gynaecologist, and then the colorectal team. I found both to be useless, and found the colorectal surgeon to be rude. I asked about a stoma bag, and was asked about how my partner would feel about it! He was told in no uncertain terms that I wasn’t there to discuss my partners views. I don’t think that all doctors are like this, so it is worth asking for a referral.
I saw the physio after the gynaecologist/colorectal team. It was such a relief to finally be listened to.
Sorry, that ended up as a rant. But I just wanted to let you know that you are not alone.