What is an enterocele?
Enterocele is the descending of the small intestine into the lower pelvic cavity. When this occurs, the small intestine pushes on the top part of the vagina, creating a bulge. It is a form of pelvic organ prolapse.
Treatment and management of enterocele depends on the severity of the patient's condition. Cleveland Clinic physicians offer medical management and surgical correction of this condition.
What causes enterocele?
When the support system which holds pelvic organs in place become distressed, stretched, or torn, it allows pelvic organs to shift into new positions, thus causing a prolapse. Damage to these support systems can be caused by a number of different factors such as:
- Childbirth – Vaginal delivery causes stress on pelvic organs and support structures. Risk increases with number and size of children delivered vaginally.
- Surgery, such as a hysterectomy, or radiation treatment in the pelvic area.
- Menopause – A woman’s ovaries stop producing hormones that regulate her monthly cycle. The hormone estrogen, which helps keep pelvic muscles strong, is in lower supply.
- Extreme physical activity or lifting of heavy objects.
- Being overweight
- Chronic constipation
- Chronic cough (as seen in smokers or asthmatics)
- Genetic or hereditary factors – One person’s pelvic support system may be naturally weaker than another’s.
This shows the bladder which has herniated, or “dropped” into the vagina.
What are the symptoms of enterocele?
In many cases a woman will feel no symptoms from prolapse and will find out about it only during an normal pelvic exam.
In cases where symptoms do occur, the following are most common:
- A feeling of fullness, heaviness or pain in the pelvic area. Often this feeling gets worse as the day goes on or gets worse after standing, lifting or coughing.
- Lower back pain.
- Bulging in the vagina.
- Leakage of urine.
- Frequent bladder infections.
- Problems with sexual intercourse.
- Problems inserting tampons.
How are entroceles diagnosed?
Often a physical exam is all that is needed to diagnose prolapse. If additional information is needed, a number of tests may be done that measure how well each of the pelvic organs is working.
How are entroceles treated?
- Hysterectomy – Surgical removal of the uterus in cases of severe uterine prolapse.
- Uterine suspension – Putting the uterus back in its normal position, either by connecting support tissue to the lower part of the uterus, or by using a mesh material that forms a sling to hold it in place.
- Kegel exercises – Tightening and relaxing the muscles used to control the flow of urine in order to strengthen the muscles that support the pelvic organs.
- Taking the hormone estrogen – Helps prevent further weakening of pelvic support muscles but has a number of possible negative side effects.
- Vaginal pessary – A removable rubber or plastic device inserted into the vagina to provide support in the area of the prolapse. Pessaries are most often used when the patient wants to avoid surgery or has medical problems that make surgery too risky.