An enterocele is a condition where the small intestine falls into the deep pelvis and pushes on the vagina or rectum creating a bulge.
What causes an enterocele?
Weakening of the pelvic floor ligaments and muscles due to aging, lifelong constipation with straining to have bowel movements, childbirth, chronic cough or bronchitis, repeat heavy lifting, obesity, genetics, connective tissue disorders, and gynecologic surgery (hysterectomy) predisposes patients to enterocele. Enterocele may be associated with other pelvic floor disorders such as rectal prolapse, other pelvic organ prolapse, rectocele or cystocele.
What are the symptoms of enterocele?
Small enteroceles may cause no symptoms. If the enterocele is more significant, you may experience a feeling of pelvic or rectal fullness or a pulling sensation in your pelvis that eases when you lie down. You may also have the urge to have a bowel movement with the inability to evacuate any stool despite repeated attempts. You may have a soft bulge in your vagina or pain with intercourse.
Women with enterocele may also have related conditions such as rectocele where the rectum bulges into the back wall of the vagina, cystocele where the bladder bulges into the front wall of the vagina, or uterine prolapse where the uterus bulges into the vagina.
How is enterocele diagnosed?
Enterocele is diagnosed by a thorough history and physical exam by your physician or colorectal surgeon. A bulge may be felt on rectal or vaginal exam with straining or valsalva. If your physician suspects an enterocele, a special x-ray test called defecography where you ingest a contrast material to visualize your small intestine followed by x-rays taken while you are straining may be necessary to visualize the enterocele.
How is enterocele treated?
If the enterocele is not causing symptoms it does not need to be treated. Avoiding constipation, straining to have bowel movements and heavy lifting can help prevent worsening of the problem. For mild symptoms treatment may include a pessary (a silicone, plastic or rubber device inserted into your vagina to help support the bulging tissue). Your gynecologist can help get your measurements to fit you for the device.
If symptoms are severe or associated with other pelvic floor disorders such as rectal prolapse surgery may be recommended. Surgery can be performed through the vagina or abdomen. Abdominal surgery can generally be performed through minimally invasive techniques including laparoscopy or robotic-assisted surgery. To avoid recurrence of the enterocele and further weakening of your pelvic floor musculature, avoid constipation, heavy lifting, and straining during bowel movements.