DEAR DR. GOTT: I am a 73-year-old female. I have always been active, have three children (all born naturally), and had a total hysterectomy at age 45 because of a fibroid tumor. I thought that as long as my osteoarthritis didn't bother me too much, I could do just about anything. Boy was I wrong!

I developed a condition known as a rectocele after doing some heavy pruning. I could live with the condition, except that the burning is bothersome. What are my options? Can I continue to be active? How effective is surgical repair?

DEAR READER: Rectoceles occur when the wall of tissue (fascia) that separates the vagina and the rectum weakens, allowing a part of the rectal wall to bulge into the vagina. The condition typically develops after menopause when estrogen levels decrease, further weakening pelvic tissues.

Small rectoceles do not usually cause symptoms and may go unnoticed until diagnosed during routine gynecological examinations. Larger ones may cause difficulty when having or controlling a bowel movement; could cause a soft bulge of tissue that may protrude from the vaginal opening; a sensation of rectal pressure, fullness or of not having completely emptied the rectum following a bowel movement; and the need to press on the bulge of tissue to help push stool out during evacuation.

In many cases, this may be accompanied by other conditions such as cystocele (bladder pushed into the vagina), enterocele (small intestine pushed into the vagina) or uterine prolapse (uterus pushed into the vagina).

Rectoceles are usually the result of childbirth or other activities that put pressure on the fascia. These can include repeated heavy lifting, chronic constipation or straining, being overweight, or having chronic bronchitis or cough. There are also several risk factors that may predispose a person to developing this condition, such as having a hysterectomy, vaginally delivering more than one child, age, and being born with weaker-than-normal pelvic connective tissue.

Treatment is not necessary unless the rectocele causes discomfort or pain or is bothersome. If the bulge of rectal tissue extends through the vaginal opening or causes pain, bleeding, chronic constipation or difficulty emptying the bowel, a physician should be consulted.

Treatment typically begins with simple self-care methods such as Kegel exercises, avoiding heavy lifting, losing weight, increasing fiber and fluid intakes to prevent constipation, and treating chronic coughs. If these measures fail to provide adequate results, a physician may recommend having a pessary inserted, a device that supports the bulging tissues. There are several varieties of pessaries that can be broken down into two major categories — those the user removes to clean or those that must be periodically removed and cleaned by a physician. Because of the hassle they present, pessaries are not a popular choice.

The other option is surgery, recommended only for those women with a protruding rectocele, severe symptoms or accompanying conditions. The primary goal of surgery is to repair the deformity by reinforcing the connective tissue with sutures or a mesh patch (similar to those used for hernia repair).

I urge you to speak with your gynecologist regarding available options and which one he or she recommends for your particular case.

Dr. Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook."