BUTT STUFF SERIES WITH AMELIA
PART 4: PROLAPSE & BOWEL FUNCTION
Sometimes constipation isn’t about the stool itself - it can be about what’s happening around it.
If you regularly feel blocked, strain to open your bowels or never feel completely empty, there can be several possible reasons. In some cases, a prolapse can affect how the bowel and surrounding tissues move during a bowel motion, making it harder to empty comfortably.
Two types of prolapse that can affect bowel function are rectocele and internal rectal prolapse.
What is a rectocele and how can it affect bowel function?
A rectocele occurs when the front wall of the rectum bulges into the back wall of the vagina, creating a small pocket.
Instead of moving straight out through the anal canal, some stool can collect in this pocket during a bowel motion. This can make it feel like stool is stuck or that you haven’t completely emptied your bowels.
People with a rectocele may notice excessive wiping or difficulty getting clean, needing to return to the toilet shortly afterwards, or changing position to finish emptying. Some people may also need to support the back wall of the vagina or the perineum — between the vagina and anus — with their fingers to help stool come out. This is known as splinting.
Not everyone with a rectocele has symptoms, and the size of a rectocele doesn’t always match how severe someone’s symptoms are. Rectoceles can also occur at different levels within the vagina, which can influence assessment and management.
What is an internal rectal prolapse and how can it affect bowel function?
An internal rectal prolapse, sometimes called an internal rectoanal intussusception, occurs when the walls of the rectum partially fold inwards during a bowel motion. Unlike an external rectal prolapse, nothing protrudes outside the body. Instead, the rectal wall folds into itself, which can narrow the pathway for stool to pass.
People may experience excessive straining, a feeling of blockage, incomplete emptying, multiple trips to the toilet, or the sensation that stool won’t come out despite pushing. Some people may also notice thinner stools.
Interestingly, internal rectal prolapse can sometimes be seen during defecography — a test where someone is observed while trying to empty their bowel — even when they don’t have symptoms.
Can prolapse cause constipation?
Prolapse can contribute to symptoms that feel very similar to constipation, including difficulty emptying your bowels, excessive straining and feeling like stool is stuck.
A rectocele or internal rectal prolapse may affect the pathway stool needs to travel through, making bowel emptying more difficult. However, not everyone with prolapse will experience bowel symptoms, and constipation can have many other causes too.
This is why it’s important to look at the bigger picture rather than assuming that constipation is simply about stool consistency or needing more fibre.
What are the signs that prolapse may be affecting your bowel function?
If you regularly feel blocked when opening your bowels, never feel completely empty, need to return to the toilet several times, or have to change position or use your fingers to help stool come out, it may be worth having your bowel function and pelvic floor assessed.
These symptoms can occur with prolapse, but they can also have other causes. A pelvic health physiotherapist can assess how your pelvic floor muscles, bowel habits and symptoms may be contributing to difficulty emptying and help determine whether further assessment is needed.
How can pelvic health physiotherapy help with prolapse and bowel function?
A pelvic health physiotherapist can look at how your pelvic floor muscles, bowel habits and symptoms are interacting with your prolapse and bowel function.
If you regularly strain, feel blocked or never feel completely empty after opening your bowels, identifying what is contributing to the problem is an important first step. The most appropriate management will depend on what is causing your symptoms and how your prolapse is affecting you.
It’s also important to know that more straining isn’t always the answer. If prolapse is contributing to difficulty emptying, repeatedly pushing harder can potentially make things worse.
At The Healthy Peach Physio, we can help you understand what may be contributing to your constipation, difficulty emptying your bowels and other bowel symptoms.
Other Blogs in the Butt Stuff Series
Deep dive into education written by our pelvic physiotherapist, Amelia, all about the butt stuff – including the anatomy of your bowels, and factors involved with treating constipation, incomplete emptying, and faecal incontinence, leaking & urgency.
Prolapse & Bowel Function: Can Prolapse Make It Hard to Empty Your Bowels?
Why Is It So Hard to Empty My Bowels Completely?
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