# If My Symptoms Are Caused By Rectocele, is diet irrelevant?



## Stilicho (Jul 6, 2009)

Hi there guys, I mentioned in an earlier post that my doctor says I have a slight rectocele. This could truly explain what's been going on with me; why my only symptoms is sensation of incomplete evacuation, but no significant constipation, diarrhea, cramps, or abdominal pain. It might also explain why no dietary modifications have had any significant effect on my symptoms, for better or for worse.My doctor says that there is no magic cure for rectoceles. All that is recommended is a high fiber diet and lots of water to keep the stool soft so it will pass easily, and also to take a laxative if it seems to help. Surgery can be performed, but it is risky and you might end up worse off than before. And I am not considering surgery because the truth is that I believe I WOULD end up worse.So, the rectocele is there, and without surgery, it's there to stay. So it seems to me that what I eat is largely irrelevant. Am I off base here? What do you guys think?


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## AIRPLANE (Mar 15, 2004)

Stilicho,I have what is considered a 'small' rectocele. I briefly considered surgery for it, but have read of so many women who ended up worse than before. Some of them would have repeat surgery- and each one just weakens the muscles and ligaments even more. I also know that I don't heal well when having surgery in that area- ever since my vaginal hysterectomy many years ago, I have had additional burning and irritation issues- also think it gave me more vaginal adhesions (which I probably already had some of before) which makes the rectocele more stubborn and difficult to correct by alternative means.Since you don't have pain, I assume that your rectocele is strictly a case of things being too relaxed and so you need strengthening exercises (not 'just' Kegels). Most of the time, rectoceles that are strictly due to lax muscles are caused by childbirth and/or frequent straining during evacuation, possibly intense exercise and heavy lifting. In my case, it is actually a subset of pelvic floor muscles that are too tight- so there is pain, spasms, and a lack of circulation, and the rectocele is what I call my 'weak spot in an otherwise tight area'. Also, I was working at a repetitive job at the time which set the whole pelvic floor problem in motion- it could have been a torn ligament or maybe even a burst ovarian cyst. I tried in vain to do Kegels, which is the only advice I was ever given. I have since learned that that was the wrong advice in my particular case because I'm already too tight.I have another thread going about a book written by a physical therapist who was recently on ABC's 20/20 (but for too briefly and nothing in-depth) named Amy Stein- it's called 'Heal Pelvic Pain'. While you don't have pelvic pain, the book does have strengthening exercises for people who either do not have pain/tightness or who have resolved that part of it. The exercises do involve Kegels- but they are only part of them.There are also physical therapists who specialize in pelvic floor disorders (which things like cystoceles and rectoceles are a part of). However, finding one who is up-to-date and fully knowledgeable can be difficult. I went to 2 such PTs in the last couple of years and I didn't feel that they offered the in-depth and variety of treatments that I know are available. It 'might' be easier if your issue is strictly due to lax muscles as opposed to tight ones, which are a less widely acknowleged problem. Even still, if you do try this approach, you may have to go to more than one PT to find the best one for you as there seems to be many different types of training- no two seem to be exactly alike.As for diet, I haven't found anything that really helps the incomplete evacuation. The reason for the fiber is probably to hopefully bulk things up enough so that stuff doesn't get stuck in the rectocele. I have alternating symptoms, and it doesn't seem to matter which one I have- things still get stuck in the rectocele and also the muscles don't move very well- they don't go through the full range of motions due to the tightness and adhesions- which doesn't help either. This lack of 'range of motion' probably applies to muscles that are too weak also, I would imagine. So it isn't necessarily the rectocele alone that is causing the incomplete evacuation- it's the condition of the muscles that usually accompanies it- either too tight or too loose.


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## Kathleen M. (Nov 16, 1999)

Even if the only thing you had wrong was IBS diet could be irrelevant.It is not true that all IBS symptoms are only caused by food and if you just find the right 4 foods to eat you will be normal.There are some foods that tend to be bothersome for a good percentage of IBSers but a lot of people who "just" have IBS find they have the same symptoms regardless of diet.That being said I think the only diet concern with a rectocele is to try to avoid constipation and generally there is some amount of fiber and water that will keep the stool soft enough you don't have to strain to go. I would think straining to pass hard, hard to pass stools wouldn't be good for it.I think depending on location (and if you do have any rectal hypersensitivity as IBS patients are prone to have it would be worse than if you didn't) it could cause some sensations down that way that could feel like incomplete evacuation.


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## Stilicho (Jul 6, 2009)

Airplane,Thank you for the response. I should have mentioned this in my post - I'm not sure if you were able to tell from what I wrote - but I am a man. Apparently it is very rare, but men do get rectoceles. Since the anatomy is so different, I am not sure if the exercises you spoke of apply to me. It has been very difficult for me to find information on rectoceles in men on the internet. Kathleen here was kind enough to point me to a couple of studies posted on the internet, and in these studies the authors confessed that rectoceles in men are so rare that the medical community really does not understand their significance in men, nor what should be done about them. I'm assuming, however, that they cause the same basic problems. I am seeing a new GI doc in September to get a second opinion, because I feel like I'm really in the dark about all of this.Also, I just had a test done called a defecography, which is supposed to confirm the presence and size of my rectocele. Still waiting on the results. Have you had this test?Anyway, best of luck and I hope you being to feel better soon.


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## AIRPLANE (Mar 15, 2004)

Stilicho,I did not realize you were male- I have heard that while rare, rectoceles can occur in men. I would be interested to hear what they have to say about your defecography test.As Kathleen said, and as one of my physical therapists mentioned, there can sometimes be a sense of incomplete emptying even if that is not really the case. I can usually tell though because I often will use aloe/vitamin E suppositories along with a cream to reduce irritation after a movement- needless to say, I can tell, when doing this, if I indeed I have anything left by how well the suppository goes in. Even though you are male, the issue of pelvic floor dysfunction still applies. The doctor who wrote the foreward to Amy Stein's book mentioned that he was taught very little about it in med school, and that he was never taught anything at all about pelvic floor disorders in men.Amy also has a section in her book called 'For Men Only'- however, most of the book and the exercises apply to both men and women. Men can also have either too tight or not tight enough pelvic floor muscles. There are also tests that can check for this, like biofeedback or some kind of EMG (same things maybe?) where they put a sensor in the rectum. In my case, I have known ever since this started after the repetitive job thing that triggered it that I have tightness issues pretty much through my whole abdomen and pelvis- both muscular and adhesions that can form with the tightness condition. The causes are numerous- many of them I had never heard of before I read this book. There can even be a genetic predisposition to it.The main gist of the book, however, is about people who have tightness issues- which, based on what you've said, you probably don't have. The only part of the book that would apply to you then would be the strengthening exercises- which you might get advice about from your doctor if that is what they think you may need.Yes- I have had a defecography which showed the rectocele. Also an anal manometry. It had been previously diagnosed by a gynecologist not too long before, although I believe I have had it for over 2 decades yet nobody ever diagnosed it until much later. As I mentioned in the Amy Stein 20/20 thread, I recently went to a new gastro for evaluation. He recommends the exercises in the book, along with possible additional pelvic floor evaluation at a pelvic floor clinic that is connected to a local colon & rectal practice. I'm amenable to this, although after the previous testing at a different location, they had recommended a two-week physical therapy course that was coded as biofeedback which my insurance wouldn't cover- I couldn't afford the out-of-pocket cost of $6,000.00- $7,000.00. So hopefully this clinic would have alternatives that I could afford or maybe they would try to convince my insurance company to cover it if they recommend something similar.


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## Stilicho (Jul 6, 2009)

Airplane,What you are saying makes a lot of sense. About seven years ago, I was struggling with prostatitis - difficulty urinating, incomplete urination, etc. I now remember that one of theories being discussed as to the cause was a dysfunction in the muscles of the pelvic floor. But when my symptoms abated, I never followed up on it. With the problems I'm having now, I bet there is a connection. It would make sense of a whole lot of things.I'm going to follow up on seeing a pelvic floor therapist.Thanks again.


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