Enterocele

An enterocele is when part of your small intestine drops (prolapses) into your pelvic area. Your small intestine (also called your small bowel) pushes against the top of your vagina, causing a bulge. Another name for an enterocele (pronounced “EN-ter-uh-seel”) is a small bowel prolapse.

Childbirth, aging and anything that puts pressure on your pelvic floor can weaken the muscles and ligaments that support your pelvic organs. When these muscles and ligaments lose strength, your small intestine can drop out of its normal position.

Treatment involves reinforcing your pelvic muscles and ligaments. Mild cases may improve with nonsurgical treatments. But if you have a more severe case, you may need surgery to repair the prolapse.

Symptoms of an enterocele

Some prolapses don’t cause symptoms. If you have symptoms, they may include:

• Feeling of pressure, achiness or fullness in your pelvic area — especially during sex or physical activity, after standing for a long time, or when coughing
• Bulge inside your vagina
• Lower back pain or a tugging feeling in your pelvis that improves when lying down
• Trouble pooping
• Leaking pee

An enterocele may occur with other pelvic organ prolapses, like bladder prolapse or vaginal prolapse.

Enterocele causes

An enterocele occurs when muscles, connective tissues and ligaments in your pelvic floor become weak. Typically, these structures hold your small intestine in your lower abdomen (belly). But weak tissues allow your small intestine to slip down and press on your vagina.

These factors can cause your pelvic floor area to weaken:

• Pregnancy and giving birth
• Constipation or straining to poop
• Aging and menopause
• Increased pressure on your pelvic floor from obesity, chronic coughing or heavy lifting
• Prior pelvic surgeries, like hysterectomy

Risk factors

Your risk of developing an enterocele increases after menopause, when estrogen levels drop. It’s more common if you’ve had multiple vaginal births.

Certain factors can weaken pelvic floor muscles and increase your risk for an enterocele. These include:

• Conditions that cause coughing, like bronchitis and asthma 
• Smoking
• Connective tissue disorders, like Ehlers-Danlos syndrome
• Radiation therapy to your pelvic area

How to lower your risk

These steps may help lower your risk of an enterocele:

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

Complications of this condition

Left untreated, an enterocele can affect your quality of life. It can cause complications, including:

• Severe constipation or bowel obstruction
• Worsening symptoms
• Ongoing (or chronic) low back and pelvic pain

How doctors diagnose this condition

You may find out you have an enterocele when your healthcare provider performs a pelvic exam. Your provider can feel the bulge in your vagina. They may ask you to cough or bear down during the exam so they can feel the bulge. They may also perform a rectal exam.

You may get one of these tests:

• Cystoscopy
• MRI, ultrasound or CT scan of your pelvis
• Fluoroscopic defecography
• Urodynamic testing

How is it treated?

There are nonsurgical and surgical treatments for an enterocele. You may not need treatment if your symptoms are mild. Your provider can discuss treatment options with you based on your situation.

Treatments for an enterocele include:

• Lifestyle changes: Your provider may suggest ways to reduce pressure on your pelvic floor. For example, they might advise you on how to avoid straining or offer tips for losing weight.
• Pelvic floor exercises: Your provider may recommend exercises, like Kegels, to strengthen your pelvic floor muscles.
• Vaginal pessary: This device supports your vaginal walls. You insert it into your vagina. It doesn’t fix the enterocele, but it can help with symptoms.
• Surgery: Enterocele repair involves fixing stretched or torn tissue and moving your small intestine back into place. Surgeons can repair it through your vagina or abdomen.

When should I see my healthcare provider?

You should call your healthcare provider if you have symptoms like pressure in your pelvic region or a bulge in your vagina. Seek medical care if your symptoms are getting worse, causing you pain or affecting your daily life.

What can I expect if I have this condition?

What you can expect depends on your symptoms and the severity of the prolapse. An enterocele rarely causes serious problems. Nonsurgical treatments often relieve symptoms. If this doesn’t work, surgery is an option. Your healthcare provider will explain your options.