I have had a problem having a bowel movements since the birth of my third child five years ago. The stool pushes against the vaginal wall instead of exiting the anus. I sometimes have to push against the skin to get the stool to exit. I had an episiotomy with all three children, but I've noticed problems only since the third. I have not had the courage to explain this to my OB/GYN. Is this common, or is something really wrong that I should discuss with my doctor?

-- Jackie

What you describe is called a rectocele. This is a weakness of the back wall of the vagina, between the rectum and the vagina, often due to childbirth. Tissues and muscles are stretched and torn, resulting in a pouch in which stool may collect. Some women, like you, may need to "splint," or use their fingers to put pressure on either the back wall of the vagina or the area between the vaginal opening and the rectum in order to have a bowel movement. This is not normal and should be evaluated by a gynecologist. Don't be embarrassed -- we are trained to deal with this problem, but we can't help you if we don't know there is a problem.

The usual course of treatment for a rectocele is surgery. The stretched and torn tissues are identified and brought back to their proper positions through a vaginal incision much like an episiotomy. If the rectocele is large, excess vaginal tissue may be removed to restore a more normal diameter. All gynecologists are trained in this surgery, but there are also subspecialists available (urogynecologists or pelvic reconstructive gynecologists) who can handle the very difficult cases. You do not need to suffer -- make an appointment to discuss this with your OB/GYN.