Enterocele - Diagnosis, Treatment, and Repair
Enterocele is a specific type of pelvic organ prolapse that occurs when the small intestine pushes on the vaginal walls causing a bulge or protrusion. It can often happen whether the cervix is present or not, but is most of the time seen after a hysterectomy. The word enterocele literally means “hernia of the small bowel.” This type of prolapse may occur on any of the vaginal walls, but happens most often at the apex (top) and posterior (back wall) of the vagina.
The easiest way to think about the vagina, and the hernia in this case, is to think about the vagina as a blind pouch – similar to a sock. Weakness at the toe of the sock (the apex) would allow protrusion or pushing of the small intestine (covered by vaginal skin) into the vaginal cavity.
Small Bowel Prolapse (Enterocele) Symptoms
Many women with enterocele don’t have any symptoms at all. Others might have feelings of pelvic pressure, pulling, discomfort in the lower pelvic cavity, low back pain, feeling of pelvic fullness, a sensation that something is coming out of the vagina, the ability to see or feel a tissue or bulge or ball at the vaginal opening, or painful intercourse. Rarely does an enterocele cause problems with the small intestine itself like obstruction or bloating. The symptoms of enterocele may be present constantly or intermittently and are often made worse with heavy lifting, straining with bowel movement (constipation), intercourse, or cough.
What are the Risk Factors for Enterocele?
When the connective tissues of the vagina become weak or injured, enterocele and other types of pelvic organ prolapse may occur. This weakness and injury can happen suddenly – as with pelvic surgery (hysterectomy) or vaginal delivery – or more slowly – as with connective tissue disorders, smoking, chronic cough, and pregnancy.
How is Enterocele (Small Bowel Prolapse) Diagnosed?
As with other forms of pelvic organ prolapse, the diagnosis of enterocele (small bowel prolapse) is made using a physical exam in which the outside and inside of the pelvis are examined. The internal pelvic exam is typically done with the assistance of a speculum. During this portion of the exam, your doctor may ask you to cough, bear down, or push during this exam. These actions help to accentuate the hernia, show the precise location of the bulge that you may see/feel, and can be extremely helpful in planning for a possible repair.
Treatment and Repair of Pelvic Organ Prolapse
There are various treatment options for enterocele including expectant management (watch and wait), home exercises, pelvic floor physical therapy, pessary, and enterocele repair surgery. Enterocele repair surgeries can be performed either through the vagina or through small (half-inch) laparoscopic incisions in the abdomen. Surgical procedures are typically customized after a conversation about goals of treatment and recovery between the patient and the surgeon.
Conclusion
Some form of pelvic organ prolapse occurs in as many as 90% of women and one in ten women will require surgery in her lifetime for prolapse. Enterocele is a type of pelvic organ prolapse in which the small intestine pushes on or against the vaginal wall and causes a bulge or protrusion of the vagina. Enterocele (and pelvic organ prolapse in general) is not typically dangerous, and thus we are able to offer a wide variety of available treatment options ranging from expectant management to surgical enterocele repair.
The enterocele treatment that is right for you depends on the severity of your symptoms, your goals for treatment and recovery (especially if considering enterocele repair), your risk factors, and your general health.
We’d love to have a conversation with you about your goals for treatment of enterocele or other types pelvic organ prolapse so that we can work together to develop a plan that is customized to meet your needs. Schedule an appointment or call us today and we’ll get started on a plan.