mucosal lining prolapse and pregnancy


Hi all,
I'm new here and have bought the book, I'm slowly working my way through it. I have a 3 yr old by csection and a 1 year old by homebirth, who presented with an elbow over the nose and a hand over the opposite ear. That birth gave me a severe second degree tear that healed with a keloid scar, and two subsequent surgeries to repair the tear. Since those two surgeries (about six months ago), I've had two instances of straining to poop, and what I think is a mucosal lining prolapse. To make it more exciting, I just found out I'm pregnant.

I went today to a colorectal surgeon, who was very doom and gloom. He said he can't tell what kind of prolapse I have without more tests, that I can't do anything except PT until after I've delivered, he wants me to have anal manometry and a bunch of other stuff. I have no symptoms other than the two instances where my colon has popped out and I popped it back in, and the occasional difficulty pooping. Since those two times (about a month or so ago), i've changed my diet alot and have added much fiber and prunes. It hasn't happened again. (Although I'm sure as I get further along that may change.)

i'm having a hard time finding anything on this. Everythign seems geared toward rectoceles. Maybe I'm thinking of this the wrong way, but I think of a rectocele as the bowel sort of falling over into the vaginal wall, whereas my colon actually comes out of my body. Are they treated the same way? What else should I be doing? I think I'm going to have a c-section for this pregnancy, but I can't find much on if that will be beneficial or not, or if just being pregnant is going to cause horrible problems, according to Dr. Doom. (He told me if my colon falls out again I can go the ER and he'll come and put it back in. Um..thanks?)

I realize I haven't exactly put forth a cogent or coherent request...but help, please. Any advice, reading materials, etc is welcome.

On your pregnancy. I did a little reading on rectal prolapse and the doom and gloom seems to be everywhere.
I think wholewoman ideals will help here- I have no idea how much.
The first advice I would give is to never strain again. EVER. not to lift even.

I assume that sometime during the birth or subsequent surgeries your anal sphincter was damaged and probably cut. I would be curious and would have to check that out (by inserting a finger and trying to squeeze.

Since rectal prolapse is caused by the weakening of the ligaments and muscles that hold the rectum in place it seems like a good place to start is working on getting your organs in the most optimal position possible. And starting a program to strengthen the entire body would be good too- especially the glutes. The ballet work out from the book is great for this.

I think your pregnancy will put stress on your condition- the relaxin hormone will only help those ligaments to stretch more- but you do not have to entertain the thought that you will be constipated just because you are pregnant. Take a good magnesium supplement and you won't have any issues.

I am not sure what will be your best birth choice. Obviously another VBAC has the least risks for you and your baby. Lower mortality rate, lower infection rate, and many other amazing benefits. I would think a C- section would stress the ligaments just as much as vaginal birth but I can also see how the potential for more damage to your perineum and possibly anal sphincter would be worrisome. With your recent surgery you will not have had enough time to thoroughly heal and we all know scar tissue does not stretch well. I can tell you that you can have a no push birth- which will help your situation. You can have your baby born in a beautiful position and not tear at all and have no damage done at all. This is a possibility as much as damage is a possibility. You will have to do your research and have a support team that knows ahead of time that interventions are not allowed.

Hopefully other people will chime in here- you have a lot to consider.

the lack of information on this topic is really disheartening. I've read most of Saving The Whole Woman, and rectal prolapse (not rectoceles) is mentioned on ONE PAGE. In one paragraph. I've ordered and read every pelvic floor book I can find, and they all say essentially the same thing: rectal prolapse is where the rectum comes out of the body, but its pretty rare and almost always involves fecal incontinence. This is the SUM TOTAL of the information I can find on this. Not, how it can be managed, what to do if you have it, but three damn lines telling me its rare and causes fecal incontinence.

I googled rectal prolapse pictures. Now I'm seriously depressed.


Hi and welcome L,

I believe one of the greatest tragedies of our time is the fact that our caregivers – those upon whom we depend to inform us in the direction of greatest health – are often bearers of terribly inaccurate and self-serving information.

Yes, rectal prolapse is a relatively rare condition compared to vaginal prolapse, but certainly common enough (thanks to modern diets, laxative abuse, lifestyle factors and surgeries) to have a more prominent place here at wholewoman. The subject would require at least a chapter, but I think to answer your specific question, this quote from Benson’s, Female Pelvic Floor Disorders, is useful:

“Mucosal prolapse does Not progress to complete rectal prolapse and is considered part of the spectrum of hemorroidal disease.”

The form of disorder that does result in complete rectal prolapse is ‘internal intussusception’ of the rectum – where the bowel turns inside out. As you are probably aware from your readings, the prolapse begins at the rectosigmoid junction and as the intussusception progresses, it pulls the rectosigmoid area away from its fascial attachments so that the lower bowel loses its support.

This is the scientific explanation for Blowing Our Guts Out – something we’ve been avoiding like the plague by Never straining against the toilet seat, but rather lifting ourselves slightly off by leaning forward so that our feet bear all our weight.

Dr. Doom was filled with gloom because he knows how seriously horrible the operative response to rectal prolapse really is. The surgeries have not changed in 30-40 years and they are all wrought with failure and high morbidity. Here’s Benson again:

“Numerous approaches have been described, and are classified accordingly as transabdominal, perineal, or transsacral procedures…Transabdominal procedures utilizing pelvic floor repairs have been largely abandoned because of technical difficulties and high recurrence rates…Perineal and transsacral procedures result in higher rates of recurrence than transabdominal procedures.”

I don’t know if you’ve had time to understand the natural anatomy of the pelvic support system – which most definitely includes anus and rectum. To put it bluntly, the “hole” is Not at the bottom, but rather at the Back. Therefore, we hold our pelvic organs toward the Front of the body where they remain perpendicular to the pelvic outlet. The organs – including the sigmoid colon (starting point of intussusception) is held in the hollow of the lower belly and kept there by the process of natural breathing and the natural shape of our spine.

Alemama gave you sound advice. If it were me, I would try to avoid repairing the scar any further, continue with a very healthy diet, and begin the postural work, which includes firebreathing and nauli. I think once women really give firebreathing and nauli a chance, they’ll see that THEY hold a key to bowel re-positioning and support that no surgeon will ever be able to match.

Wishing you well,


Sorry...need to edit...firebreathing and nauli should not be done during pregnancy

is gentle ballet workout -- see 2nd ed. of Saving the Whole Woman. Maybe try some other things - someone recently mentioned results from vitamin C; I've had results with very gentle rebounding; consult your inner wisdom about what can help you to heal. And, of course, check with your doctor or midwife.


I've decided to get a second opinion at a colorectal center at a bigger hospital. Since I'm pregnant, i'm not having surgery any time soon, and honestly, with everything I've read about the dismal success rates, it will have to get a LOT worse for me to even consider it.

However, Dr. Doom wants me to come in and have anal manometry, emg and nerve conduction tests done. Since nothing can be done until after I've delivered anyways, I'm not sure I see the point of these tests, and being in the first trimester, not sure I feel like doing anything anyways.

Is it worth getting these tests done? What kind of information will this provide? Dr. Doom said he couldn't diagnose what kind of prolapse I had without more tests. Is there any point in me doing this stuff at this point in time?

The tests you mention simply measure anal pressure, nerve and muscle strength. I cannot advise one way or the other on the tests except to say they are part of the medical management of prolapse. There may be some useful information for you there. On the other hand, we sometimes irreverently comment that we would flunk all their tests anyway. Christine

Thanks SH for bumping this. The subject does come up from time to time, and this thread serves to reinforce the point that diligent WW work is the best and only real course of action to follow. - Surviving

i feel for you..i suggest getting a second opinion, this type of condition is not something to take lightly..i had my son 4 years ago and from a difficult vaginal birth, i have a rectocele, mucosal lining prolapse and effects my life everyday, even as we speak some tissue is outside and my wall has dropped...
i would suggest to do kegals while sitting up as that makes the pelvic floor stronger, always do the whole woman posture, make sure to take something to help bowel movements..
ive been through hell in regards to this, before during and after bowels, the wall collapses making everything so difficult..if its soft then it will be less pressure on ur rectal wall and wont be so traumatizing....
i would see 2 other rectal surgeons, one of them may suggest something beneficial for you that can help you, ofcourse tests are out of the question but it doesnt hurt to seek professional advice.
prayers out to you..

SH, reading that thread had my heart racing as twice in the years before I knew I had garden variety prolapse, I have felt something hard and uncomfortable out the back of me when straining. I assume this is intussusception or part of my rectum. I just looked at some drawings on google.

When I moved it popped back in. Obviously I stopped straining after that. The first time it was only slight and the second time was more scary. I never knew what it was but it did not feel right and still makes me feel uncomfortable thinking about it. I hope with WW and managing my constipation (diet related) that I won't have this again.

Thankyou for bumping this. It is better I know what it must have been. You are great at bumping things and I always find something useful in them. I have been working on the tailbone stuff from the last bump you did.

I hope you get some relief soon!!!

Why are you suggesting Kegels, I wonder? Have you read any of Christine's writings on the subject? Squeezing those muscles does nothing to move our organs forward and can actually aggravate prolapse. Just don't want to confuse people. This is an open forum but that doesn't mean we will ignore questionable suggestions from members. - Surviving

SH, I'm over my freak out about what happened in the past with things protruding in my anus but I did need to face it. Thanks for bumping the post.

I am very kind to my body now but I do have to watch constipation so carefully. I have food intolerances and not enough bacteria in my digestive track I am sure.

I know I get gas from the plum plant family and I also have a problem with coconut (I feel sick and bloated) which has date and palm in that family. I don't mention this to suggest these cause any issues for you but rather that there is so many facets to food intolerance such as the family of the plants and cross reaction with other foods and pollen not to mention the chemicals in the food (amines, oxilates etc) and the the well known gluten, dairy, nuts etc groups. You mentioned you have looked at individual foods for your gas issues so I wondered if you looked at other groupings. I know it's hard and a real pain to deal with. I still cannot figure out my son's eczema and am still working on my sensitivities but I know it's food and I will find the answer if I keep working through all the possibilities. I know it's not just one or two foods for him so know it must be a group that probably has some similarities but what group I don't know. I have done all the usual culprits and the chemical compounds and next I will work through the family of plants for my 4 year old.

I don't know if this helps but I know you are a researcher so thought it might be of some interest.