I am 58 with constipation and rectocele. How to manage both?

Question

Hi doctor,

I am a 58-year-old woman dealing with chronic constipation for over 18 months. I typically have only two bowel movements per week, and I spend about 15 to 20 minutes straining during each attempt. Despite using over-the-counter laxatives three to four times a week, I still feel bloated and have a constant sense of incomplete evacuation.

My stool is often hard, type 1 or 2 on the Bristol stool chart, and I have noticed my abdominal circumference increases by about 1.18 to 1.57 inches by the end of the day due to bloating.

Recently, I developed a visible bulge at the vaginal opening, especially after standing or lifting anything over 11 pounds, and there is a sensation of pelvic heaviness. My gynecologist diagnosed me with stage II pelvic organ prolapse, mainly involving a rectocele. I am concerned that the excessive straining is worsening the prolapse.

Could the rectocele be the main reason behind my constipation, and what treatment options, surgical or non-surgical, are available to address both issues effectively?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

According to your medical history and concern regarding constipation from what you have described, you have been dealing with constipation for around 18 months. You are also taking a laxative for constipation, yet you still feel an incomplete evacuation after a bowel movement.

It is important to know that most laxative agents, when taken in the long term, can cause side effects like frequent abdominal bloating, abdominal pain, weight gain, anemia, and other gut issues. So, what you are feeling now, abdominal discomfort and bloating, may be due to the continued use of laxatives.

Also, due to frequent straining during bowel movements, it is possible that you have developed a rectocele (a part of the rectum that bulges into the vagina). It is important to note that rectocele does not cause constipation, but instead results from ongoing constipation and frequent straining. That is why it is crucial to stop straining immediately during bowel movements.

Before considering surgery, there are some simple changes you can make in your lifestyle and eating habits to improve constipation and rectocele.

Increase fluid intake.
Do regular exercises daily, like walking.
Avoid fast food, spicy food, oily food, and food that contains high fat.
Add high fibre-containing foods to your diet.
Avoid heavy, spicy meals before sleeping.
Please avoid heavy weight lifting or straining to get relief from rectocele.

These methods will reduce your dependence on laxatives, and eventually, you will see relief from rectocele also. However, if despite all changes, your symptoms continue or worsen, surgery for rectocele may be considered, but that is usually the last resort.

I hope this answers your query.

Thank you.