Enterocele (Small Bowel Prolapse)

What is an enterocele?

An enterocele (EN-ter-uh-seel) occurs when part of the small intestine drops (prolapses) into the pelvic area. The small intestine (or small bowel) pushes against the top of the vagina, causing a bulge. Another name for enterocele is small bowel prolapse. It’s a type of pelvic organ prolapse that affects the female reproductive system.

How common are enteroceles?

Approximately 3% to 6% of women in the United States experience some type of pelvic organ prolapse. It most commonly affects postmenopausal women who are white or Hispanic.

What causes an enterocele?

An enterocele occurs when muscles, connective tissues and ligaments in the pelvic region (pelvic floor) stretch or tear. These muscles and tissues support the bowels, uterus and vagina.

The small intestine is part of the digestive system. Typically, muscles and ligaments hold the small intestine in the lower abdomen (belly) and upper pelvis. Weak tissues allow the organ to slip lower into the pelvic area between the vagina and rectum. The small intestine then presses against the upper wall of the vagina.

An enterocele, or small bowel prolapse, may occur along with other pelvic organ prolapses, such as:

• Bladder prolapse (cystocele).
• Rectal prolapse (rectocele), a hernia that presses against the back wall of the vagina.
• Urethra prolapse (urethrocele).
• Uterine prolapse.
• Vaginal prolapse.

Who is at risk for getting an enterocele?

Your risk of developing an enterocele increases during and after menopause when estrogen levels drop. Estrogen helps keep pelvic muscles strong. More than 1 in 3 women with pelvic floor disorders like enteroceles are between 60 and 79 years old. About half are older than 80.

Other conditions that weaken pelvic floor muscles and cause enteroceles include:

• Pregnancy and childbirth.
• Chronic coughing from conditions like bronchitis or asthma or smoking.
• Connective tissue disorders like Ehlers-Danlos syndrome.
• Constipation.
• Lifting heavy items.
• Obesity.
• Pelvic surgeries, such as a hysterectomy.
• Radiation therapy to the pelvic area.

What are the symptoms of an enterocele?

Some women don’t have symptoms. When symptoms occur, they may include:

• Bulge inside the vagina.
• Difficulty completing a bowel movement (getting poop out).
• Feeling of pressure, achiness or fullness in the pelvic area, especially during sex or physical activity, after standing for a long time or when coughing.
• Leaking urine (urinary incontinence).
• Lower back pain that improves when lying down.

How are enteroceles diagnosed?

You may find out you have an enterocele when your healthcare provider performs a pelvic exam. Your provider can feel the bulge caused by the intestine pressing into your vagina. Your provider may ask you to cough or press down during the exam so they can feel the bulge. They may also perform a rectal examination.

You may also get one or more of these tests:

• Cystoscopy, using a lighted scope device (cystoscope) to examine the bladder and check its position.
• Imaging tests, such as a pelvic floor MRI, ultrasound or CT scan, to examine pelvic floor muscles and look for prolapsed organs.
• Urodynamic testing to check bladder function and look for causes of urinary incontinence.

How are enteroceles managed or treated?

There are nonsurgical and surgical treatments for enteroceles. Your healthcare provider can discuss treatment options with you. Your age, overall health and symptoms may determine the best treatment.

Treatments for an enterocele include:

• Pessary to support the pelvic floor muscles. You insert this removable rubber (latex) or plastic (silicone) device into the vagina. A pessary can help while you are waiting for surgery. It doesn’t eliminate the enterocele.
• Pelvic floor exercises like Kegels to strengthen the pelvic floor muscles. Your provider may recommend working with a physical therapist who specializes in pelvic floor therapy. This specialist may use biofeedback and other techniques to help you learn how to perform the exercises correctly.
• Surgery to move the small intestine back into place and repair stretched or torn tissues. Surgeons typically perform a minimally invasive procedure through the vagina.

How can I prevent an enterocele?

These steps may help lower your risk of an enterocele or another pelvic floor problem:

• Eat a high-fiber diet and stay hydrated to prevent constipation.
• Get help when lifting heavy items.
• Reach or maintain a healthy weight.
• Treat chronic coughs.
• Quit smoking if you smoke.

What is the prognosis (outlook) for people who have enteroceles?

Nonsurgical treatments often relieve enterocele symptoms. Some women who aren’t having problems don’t need any treatment. An enterocele rarely causes serious problems.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Bladder control issues.
• Blood in urine.
• Painful urination or frequent urination.
• Severe constipation or difficulty having a bowel movement.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What caused the enterocele?
• What’s the best treatment for me?
• Am I at risk for other problems?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Postmenopausal women and those who have given birth are most at risk of developing an enterocele or small bowel prolapse. Many women don’t have symptoms and don’t need treatment. If the prolapse causes problems, your healthcare provider can discuss treatment options. Most women get symptom relief through nonsurgical treatments. You may learn how to do pelvic floor exercises (Kegels) or use a removable support device called a pessary. Rarely, a woman needs surgery.