Rectocele Repair, my experience post-surgery

Sharing my rectocele repair journey in case it helps.

I gave birth to my son 24+ years ago, a rectocele developed afterwards and was manageable until menopause, and then it got worse and I scheduled a posterior rectocele repair. The week before surgery it was starting to descend out of my vagina (ugh).

My background: 64 years old, active lifestyle, hike 4-6 miles daily with our pups + lift weights. No other medical issues except for urinary incontinence (Bulkamid was injected into the urethra during surgery to help with this). I take post-menopause HRT, vaginal estrogen, and testosterone; no other meds. I eat lots of veggies and drink lots of water. Previously thought I had IBS due to issues pooping (now think it was only due to the rectocele).

Normally I work full-time but was not working at the time of surgery, and was grateful not to have to sit 8+ hours a day. To have to go to a job and sit on a computer chair after this surgery would have been unbearable.

As always, this is simply my experience – your journey may vary greatly. Email your doc if you have concerns.

What I would advise if a friend was having this procedure:

1)     Start the Miralax (prunes or whatever your doc prescribes to help you poop) 1 week BEFORE surgery. Take twice a day. This will save you a lot of pain. Apparently anesthesia shuts-down normal activity of the colon for weeks post-surgery.

2)     Buy a doughnut pillow to sit on. Anything that takes pressure off the vulva and perineum. I was sitting sideways on my hip for five weeks.

3)     Ask your doc when you can start to use Dermoplast (20% benzocaine) to deaden the perineal pain.

4)     Stop the ibuprofen when you can, since it can cause constipation. It helps with the inflammation and acetaminophen can help with the pain.

5)     Be prepared to sleep more, nap when you can, and lower your expectations of what you can get done the first two weeks.

6)     Vaginal estrogen helps heal the tissue: see if you can get a prescription. My doc said apply it 3x/week (normally it is only used 2x/week).

7)     Make sure you have some water-based lubricant to help with the friction in the vulva (walking around, sitting) for the first couple of weeks.

8)     Follow the instructions to ‘only lift 10lbs or less’ for the first 6 weeks. At some point you will realize you picked up 20lbs and did not feel any strain in the pelvic floor (~4 weeks for me). Then you can start to increase the weight. I have two energetic Huskies and had someone else walk them for the first 13 days. Initially it did not feel great walking them (they pull) but after 3-4 weeks it was fine.

9)     Have throat lozenges or numbing spray. The intubation can cause a very sore throat (felt like strep) and painful ears for 3+ weeks. I kept wondering if I caught a virus from the hospital but it was only the damage caused by the breathing tube.

10)  Be prepared for brain fog. I never have any issues with it before and found that I was slightly confused for the first 7+ days post-surgery.

11)  Have a small towel or washable pillow to place in-between your knees while sleeping on your side. This helps to take the pressure off the vulva and perineum.

Pain: for the first two weeks: I would rate the pain 6-7 on a scale of 1-10. The ibuprofen and acetaminophen mainly controlled the pain (I did not take the oxy-condone). By the third week I was only taking acetaminophen once to twice a day and I lowered the dose to 325 or 500 mg. I did not want to block all of the pain since I thought it was likely I would overdo it if there was no discomfort (and then possible tear the sutures). By week 5 I was only taking 325mg a couple times a week. By the end of week six I realized I was no longer taking meds.

Pooping: Took prescribed Miralax once a day starting the day after surgery but it was not enough. Two days post-surgery I woke up to find the perineal suture had fallen out. Pooping was pure torture (even though I was trying very hard not to strain), it felt like there were sharp lava rocks in my colon. The rectal bleeding scared me, I was very worried the incision had been torn (I emailed the doc’s office with photos of the external incision and they were not concerned). On the doc’s advice, increased Miralax to twice a day. Over time found it was best to take Miralax after I walked the dogs and then a second dose after dinner. By the 6th week, I found I only needed to take it once a day if I also had a high fiber meal that day. My colon is different after the surgery, pooping is more difficult, and I am still taking Miralax (sometimes half a dose) once a day, even though I am 11 weeks post surgery (hoping to get off it soon).

State of the vagina: for the first 2 weeks the tissue was so swollen and painful that I could not bear to put vagina estrogen inside and only put some on the opening to the vagina. By week 4-5 the incision felt lumpy and bumpy (doc said this would be gone by 3 months). Definitely would NOT have wanted to have intercourse before 6 weeks – no way! Around week 5 the brown discharge from the old blood started – it ended around week 7. After surgery, the vulva (outside tissue) was very swollen and then felt like a deflated balloon – they stretch this tissue to do the surgery - and it did not feel normal for six weeks. Using the lubricant helped with the friction in the swollen tissues.

State of the perineum: this was actually the most problematic part of the surgery. Sitting on a perineum that is swollen and stitched up was pretty terrible. I would either sit sideways on one hip or sit on an exercise ball (also found the camp chair helped) – but a hard wood chair would have been torture. Peeing caused burning pain from the acidity. Even 6 weeks post-surgery, the perineum was sensitive and sometimes painful. I had light bleeding from week 4-onward while pooping but the doc checked the incision week 5 and said it was okay. Using dermaplast 3x/day really helped with the pain, especially before exercising. Long-term changes to the perineum: it is no longer an erogenous zone. All of the previous sensitivity of the tissue is gone (probably buried under the sutures) which is not fun.

Energy levels: I was surprised how exhausted I was the first 3 weeks. I was not working, not doing heavy chores, did not start walking the pups until the end of week 2 (and only short 2-3 mile walks), and yet I felt like a heavy anchor that been attached to my body. Energy started to feel normal in week 4.

Exercise: first week was very, very slow, less than one-mile walks took me ~39 mins (very slow). Second week I was a bit faster and able to walk up to 3 miles. By week 5, hiking 3-5 miles a day without any issues (still had discomfort but able to walk normal speed). By week 6-7, I was no longer noticing pain and could hike 4-6 miles.

Weird item: unless you groom your pubic area to a state of prepubescent nudity, be prepared for prickly and uncomfortable regrowth. Before surgery they shave/cut the hair (they don’t want you to do this at home since micro cuts in the skin are vulnerable to infection). I found the regrowth very, very uncomfortable, especially when walking. This took about 6 weeks to feel normal again.