A rectocele occurs when the supportive tissue separating the rectum and the vagina weakens, allowing the front wall of the rectum to bulge into the back wall of the vagina. This bulging creates a pocket where stool can become trapped, leading to a sensation of incomplete emptying. Passing a bowel movement often requires significant straining, which is a major contributing factor to the worsening of the condition. The following strategies focus on creating optimal conditions for easy stool passage and providing physical support to counteract the bulge.
Modifying Stool Consistency
Achieving the correct stool consistency is the foundational step for managing a rectocele, as hard, dry stool is much more likely to catch in the rectal bulge. The ideal stool, often described as type 3 or 4 on the Bristol Stool Scale, should be soft, formed, and passed without effort. This requires a balanced approach centered on dietary fiber and adequate hydration.
Dietary fiber is divided into soluble and insoluble types, both necessary for healthy bowel function. Soluble fiber, found in oats, apples, and beans, dissolves in water to form a gel that softens the stool. Insoluble fiber, present in whole grains and vegetables, acts as a bulking agent, adding mass and stimulating movement through the colon.
The recommended daily fiber intake for most adults is between 25 and 35 grams. Increasing fiber intake must be accompanied by a significant increase in fluid consumption. Without sufficient water, added fiber can create a hard mass that exacerbates straining and discomfort.
When diet and hydration are insufficient, short-term use of supplements should be discussed with a healthcare provider. Bulk-forming agents, such as psyllium, absorb water to increase stool size and softness. Stool softeners like docusate sodium increase the water and fat the stool absorbs, smoothing its passage.
Active, stimulant laxatives are discouraged for regular use because they force the colon to contract and can lead to dependency. A mild, osmotic agent like polyethylene glycol may be a better option, as it draws water into the intestines to soften the stool. The goal is to achieve consistently soft stool that reduces the need to push forcefully.
Optimizing Bathroom Mechanics
Body positioning during a bowel movement dramatically affects the ease of evacuation by adjusting the recto-anal angle. Sitting on a standard toilet keeps the knees lower than the hips, causing the puborectalis muscle to remain partially contracted. This creates a natural kink in the rectum, forcing the need to strain, which worsens a rectocele.
Elevating the feet onto a small stool or specialized bathroom device raises the knees above the hips, mimicking a squatting posture. This simple mechanical change relaxes the puborectalis muscle, effectively straightening the recto-anal angle and unkinking the rectum. By aligning the rectum more directly with the anal canal, this position allows the stool to pass with minimal effort.
Breathing and relaxation techniques are important for preventing the damaging effects of straining. Instead of pushing down forcefully (the Valsalva maneuver), focus on deep, abdominal breathing to relax the pelvic floor. Gently exhale while making a soft sound like “moo” or “oh,” which helps open the anal sphincter and encourages natural stool movement.
Responding immediately to the urge to defecate is crucial for optimizing bathroom mechanics. Delaying a bowel movement allows the colon to absorb more water, causing the stool to become harder and more difficult to pass. Sitting on the toilet for no more than five minutes should be the goal; if the bowels do not empty completely, return later rather than engaging in prolonged straining.
Utilizing Support Techniques
When softer stool and ideal positioning are insufficient, specialized support techniques can physically assist the stool’s exit. These maneuvers, known as splinting, counteract the rectocele pocket that prevents efficient rectal emptying. Splinting provides temporary external or internal support to the weakened tissue.
External digital splinting involves applying gentle pressure to the perineum, the tissue between the anus and the vaginal opening. Using a clean hand or wrapped toilet paper, press gently against this area, pushing slightly upward and backward toward the tailbone. This external pressure supports the posterior vaginal wall, helping to flatten the rectocele pocket and guide the stool toward the anus.
Internal digital splinting is a more direct method requiring the insertion of a clean finger into the vagina. The finger is positioned against the back wall of the vagina, directly over the rectocele bulge. Applying backward and slightly upward pressure physically straightens the weakened rectal wall, allowing trapped stool to bypass the pocket and continue its descent.
Thorough hygiene is non-negotiable for internal splinting; hands must be washed before and after the procedure to prevent bacteria introduction. The pressure applied should always be gentle yet firm, ensuring the maneuver is not painful or forceful, which could cause injury. If a finger is uncomfortable, some individuals use a thumb or a specialized vaginal support tool for leverage.