Enterocele (Small Bowel Prolapse): Symptoms, Causes, Treatment

What are the symptoms of enterocele?

Enterocele is a condition where the small intestine bulges into the vaginal canal. It often occurs as a result of weakening of the pelvic floor muscles and tissues. Symptoms of enterocele can vary, but may include:

1. A bulge in the vagina, which may feel like sitting on a small ball or pillow
2. A feeling of pelvic pressure or fullness
3. Lower backache
4. Problems with bowel movements, such as constipation or feeling like the rectum is not completely empty after a bowel movement
5. Problems with urinary function, such as frequent urination or difficulty emptying the bladder completely
6. Discomfort or pain during sexual intercourse

These symptoms can be similar to those of other pelvic floor disorders, so it’s important to see a healthcare provider for an accurate diagnosis and appropriate treatment.

What are the causes of enterocele?

Enterocele is typically caused by weakening of the pelvic floor muscles and tissues that support the organs in the pelvis, including the uterus, bladder, and rectum. This weakening can occur due to various factors, including:

1. Childbirth: The stress of childbirth, particularly multiple or difficult deliveries, can stretch and weaken the pelvic floor muscles and tissues.
2. Age: As women age, the pelvic floor muscles can weaken naturally, leading to conditions like enterocele.
3. Chronic Constipation: Straining during bowel movements over a long period of time can weaken the pelvic floor muscles.
4. Heavy Lifting: Regularly lifting heavy objects can strain the pelvic floor muscles and contribute to weakening over time.
5. Obesity: Excess weight can put pressure on the pelvic floor, leading to weakening of the muscles and tissues.
6. Hysterectomy: Removal of the uterus can sometimes lead to changes in pelvic floor support and increase the risk of enterocele.
7. Connective Tissue Disorders: Conditions that affect the strength and integrity of connective tissues, such as Ehlers-Danlos syndrome, can increase the risk of pelvic floor disorders like enterocele.
8. Pelvic Surgery: Previous pelvic surgeries can weaken the pelvic floor muscles and increase the risk of developing enterocele.
9. Genetics: Some studies suggest there may be a genetic component to pelvic floor disorders, including enterocele.

It’s important to note that not all women with risk factors will develop enterocele, and the condition can also occur in women without any apparent risk factors.

How is the diagnosis of enterocele made?

The diagnosis of enterocele typically involves a combination of medical history review, physical examination, and sometimes imaging studies. Here’s how it’s typically done:

1. Medical History: Your healthcare provider will ask about your symptoms, medical history, and any factors that may contribute to pelvic floor disorders, such as childbirth, chronic constipation, or previous pelvic surgeries.
2. Physical Examination: A pelvic exam will be performed to assess for any bulging in the vaginal canal or other signs of pelvic organ prolapse. You may be asked to bear down as if having a bowel movement to help with the diagnosis.
3. Dynamic Pelvic Floor Assessment: This may involve imaging studies such as a defecating proctogram or dynamic MRI to assess the movement of pelvic organs during bowel movements. These tests can help confirm the diagnosis and determine the extent of the enterocele.
4. Cystoscopy or Sigmoidoscopy: In some cases, your healthcare provider may recommend a cystoscopy (to look inside the bladder) or sigmoidoscopy (to look inside the rectum) to evaluate for any other potential issues contributing to your symptoms.
5. Urodynamic Testing: If you have urinary symptoms, urodynamic testing may be done to assess bladder function and rule out other causes of urinary symptoms.

Based on the findings of these tests, your healthcare provider can confirm the diagnosis of enterocele and recommend appropriate treatment options.

What is the treatment for enterocele?

The treatment for enterocele depends on the severity of symptoms and the extent of the prolapse. Here are some common approaches:

1. Observation: If the enterocele is small and not causing significant symptoms, your healthcare provider may recommend regular monitoring without any specific treatment.
2. Pelvic Floor Exercises (Kegel exercises): Strengthening the pelvic floor muscles can help improve support for the pelvic organs and reduce symptoms. A physical therapist specializing in pelvic floor rehabilitation can provide guidance on how to perform these exercises correctly.
3. Pessary: A pessary is a device inserted into the vagina to support the prolapsed organs and reduce symptoms. It can be a temporary or long-term solution, depending on the individual.
4. Surgery: If conservative measures are ineffective or if the enterocele is severe, surgery may be recommended. The type of surgery will depend on the extent of the prolapse and may involve repairing the pelvic floor and supporting structures, often with the use of mesh or other materials.
5. Lifestyle Changes: Maintaining a healthy weight, avoiding heavy lifting, and treating conditions like chronic constipation can help prevent further weakening of the pelvic floor muscles and reduce the risk of recurrence.

The choice of treatment depends on various factors, including the severity of symptoms, the impact on quality of life, and individual preferences. It’s important to discuss your options with your healthcare provider to determine the most appropriate treatment plan for you.