Bowel movement posture for rectocele


Hey Ladies!

I studied Christine's video on bowel movement posture, and I can see that it would work perfectly if I didn't have a rectocele. However, because I have to splint, I cannot get my lumbar curve in the position she is suggesting. I've tried every which way. I still end up have to slump a bit because my arm isn't long enough to splint properly with the lumbar curve in place. Yesterday, I had the thing happen where poo gets stuck in there because the movement isn't complete, and that's really rough. My pelvic floor muscles have a lot of trouble using any slight pushing movement (they are spasming and tense, and it's hard to let them relax). So, if it doesn't come right on out, I'm in trouble and have to attempt a bit of pushing. I feel stuck between a rock and a hard place. I did have slightly more success when I didn't know about the posture and was squatting, because I could lean forward and get a lumbar curve plus splint. ANY ideas would be SO great!


Violin - WW toileting posture is designed to hold the organs forward, away from the vaginal space, with the goal of not having to splint, and not having to strain either. So keep working on it from that perspective, and as long as you need to splint, I guess you'll have to do whatever's necessary. - Surviving

Hi Violin,

It sounds like you are trying to maintain lumbar curvature in the WW toileting position, which is not what we do.

Remember from the video that when standing and sitting with lumbar curvature the anus makes a right angle with the rectum, helping to prevent fecal incontinence. This angle, made by the anorectal muscles of the pelvic wall, must be straightened for easy elimination to occur.

Slight counternutation of the pelvis (straigtening lumbar curvature) slackens the puborectalis so that the pelvic wall can distend. It is distention, not contraction or elongation, that opens the anorectal angle (self-observation, not found anywhere in medical literature - but it is self-evident!)

When leaning forward with bottom elevated, the pelvic organs have dropped into the hollow of the lower belly where they are protected from the forces of intraabdominal pressure. Go ahead and push (all animals do) in this position, while protecting your back vaginal wall with splinting, and rest assured your organs will be okay.


Ah, ok! That makes sense. So I just have to get my pelvic floor muscles to where they can push without breath-holding. They are super weak. (I had a rectal surgery - not prolapse related - four years ago to correct postpartum anal tearing.) I think this has greatly upset my muscles!

“So I just have to get my pelvic floor muscles to where they can push without breath-holding” sounds like a PT-ism (lol). How would you do this and why?

Hi violin1,
It may be a good idea to look into Christine"s fundamentals video:

It has the basics of posture and toileting in it.

Oh, yes - I am afraid of doing the valsalva breath-hold thing for fear of hurting my pelvic floor. I am basically afraid to use my pelvic floor muscles! I'm just realizing that as I type! So it's ok to push the poop out as long as I'm in the proper toileting position?

I have struggled with a narrowed rectum from some scar tissue in it, and any kind of formed stool was causing anal fissures. So, in general, I've had to keep things soft and not push for fear of those. So I'm seeing how this is all connected. But, I'm doing some PT for the scar tissue that's been helping quite a bit. Still, that fear is there. I think, ironically, not pushing for all these years and not having formed stool has made things out of practice! Time to get back in shape the Whole Woman way. I've been doing whole woman kegels, and I already have the yoga video series.

Yes, I do have the fundamentals package! I just misunderstood the toileting posture.

So Christine - I want to have myself lifted off the seat so that the thigh muscles are worked, but I can still have a bit of my legs touching the toilet? So none of my weight should rest on the toilet at all? Just clarifying.

Hi violin1,
Yes, you can have the legs touching the toilet seat; we just don't want the full pressure on the seat. It is a leaning forward position as Christine's explains so well above.

One more question, Christine, if you get a chance. Do you know if tenesmus comes from the rectocele or the spasming of the pelvic floor muscles? I'm really dealing with two things; the rectocele issue and the spasming anal sphincter and levator muscles, which makes bowel movements really tricky. Then I have tenesmus throughout the day. Sometimes it seems like there's just gas that wants to move through but can't due to the tight muscles. Other times it might be stool, but I cannot tell. Then it gets stuck in the rectocele area. Super not fun.

Thanks for your help and responses! I most appreciate it. I've had a hell of a year, as I was prescribed a "natural" hormone medication and dosed incorrectly. This caused severe nausea, weight loss, and other terrible symptoms. Now this. I'm really exhausted and worn down, while I try to care for my child and work, as I'm the breadwinner. Your information is enormously helpful! Though I am grieving the use of my recliner quite severely at the moment, and feeling terrible that I spent so much time reclining while being ill this year, which obviously contributed to this issue a great deal. UGH.

Hi Violin,

Bless your heart! Clearly you are dealing with a lot, but I believe by bringing your pelvic organs and connective tissues back into proper alignment your condition can be helped immensely - but please be patient as it will take time.

Yes, as Aging said, lean forward and get your weight off the seat every time you need to push.
I understand your fear (and have no way of knowing how your particular anatomy was changed by the surgery), but it is entirely natural to inhale and hold the breath to have a bowel movement. This increases the intraabdominal pressure necessary to overcome anorectal pressure so stool can pass through the canal. Like water in a barrel, pressure is applied to the body walls, which naturally distend.

You seem to have the very common concept of a soft-tissue pelvic floor that is pushed down and stretched out with every BM. Therefore, we must make every effort to make the floor stronger, smaller, and tighter. It is not a useful concept. Depending on how we sit, the pelvic muscles can be more like a floor or more like a wall - we like to keep them more like a wall. When you sit down on a toilet and push against the seat, you are sending pressures straight down to a floor. When you lean forward and lift your bottom slightly off the seat, the vertical anal triangle of your pelvic wall allows pressures to move through naturally, while your bladder and uterus are protected in your lower belly. This is truly the natural position of elimination for women.

When you try to breathe through a bowel movement, rather than closing your glottis (throat) and gently holding the in-breath (Valsalva - these guys always had to name anatomic structures and functions after themselves), half the time you are trying to expel stool while your abdominal and pelvic walls are contracting. No wonder your poor muscles are hyper and confused.

My guess is the feeling of incomplete emptying is coming from both the rectocele pocket and your puborectalis muscles. In normal defecation, the muscles contract immediately after a BM, pinching off the last of the stool. Short, cranky muscles may be contracting prematurely and pinching off stool before it is completely expelled. What is left in the rectal vault may be causing the symptoms you describe.

What is there to do but support your rectocele with a good diet and splinting (which eventually women are able to stop having to do), and naturalize your pelvic anatomy and dynamics with the WW work? Hopefully by now you understand there is no surgical cure for these conditions. Supplemental hormones have no place in a healthy female body either.

Wishing you well,



Thank you SO MUCH for that thorough explanation! I cannot even describe how relieved I am to fully understand this. It's called so many scary things. (Dyssenergia, etc.) I was feeling really confused and desperate, as medical literature is basically like, er, we don't know how to help this. AGH!

Now I can see what's going on more clearly, and perhaps even stop being afraid of pooping! Ha! What a thought! Seriously, this explanation turns it from a scary mystery/nightmare into something so simple and scientific. My mind has been trying and trying to understand so that I can do whatever I need for my body. In the last three days since using your toileting posture, albiet slightly incorrectly, I have had MUCH less pelvic muscle tension. And yes, I can see that the puborectalis muscle contracts too early in the process.

I'm a violinist, and I've had to relearn violin posture at least 100 times as I learned new techniques, etc. I am quite sure I can re-learn how to poop and move through the day in posture. This gives me so much hope! Thank you from the bottom of my heart!

I completely agree regarding hormones. If only I had known. Sheesh. They nearly killed me. (That's not even an exaggeration, sadly.)

Enormous gratitude to you for taking the time to explain this. I will no longer be afraid to push, and I really think we need to find something awesome and name it after a woman.

I don't know how much this will actually be helpful but I will share anyways. One of the small things that actually helped during my PT sessions before finding WW was learning how to reduce the tension in my pelvic floor. I was never able to do kegels much because my muscles would get so hypertonic that I could not even relax them enough to pee.
I had to seriously retrain my muscles down there. So I would have set times during the day when I would focus on relaxing those muscles with every breath, using the image of a sail filling up with air (or a sand on a trampoline).
I don't have to do it much now, because they work much better on their own, but this may help some in releasing tension that is keeping your muscles from stretching and functioning properly.

I have been working with this extensively! They were in a complete lockdown from having an anal fissure. (The muscles spasm to protect the wound.) AGH!