Diseases & Conditions

Enterocele

Childbirth and aging may weaken the muscles and ligaments (pelvic floor) that support your bladder, uterus, colon and small intestine. The weakening may cause one or more of these organs to drop (prolapse). One resulting condition is an enterocele.

An enterocele occurs when your small intestine (small bowel) drops into the lower pelvic cavity and protrudes into your vagina, creating a bulge. An enterocele is a vaginal hernia.

For a mild or moderate enterocele, nonsurgical treatments — particularly, exercises to strengthen your pelvic floor muscles — may help relieve symptoms. More severe cases of enterocele may require surgical repair.

You'll need a pelvic exam to confirm a diagnosis of an enterocele. Your doctor may ask you to take a deep breath and hold it while bearing down (Valsalva maneuver), which is likely to cause the prolapsed small bowel to bulge downward. If your doctor can't verify that you have an enterocele while you're lying on the examining table, he or she may repeat the exam while you're standing.

Mild cases of enterocele may require no treatment. Surgical repair may be most effective in more severe cases, particularly when enterocele is accompanied by other types of pelvic organ prolapse. Nonsurgical approaches are also available if surgery would be risky for you or if you want to bear more children.

Nonsurgical treatments
These approaches include:

• Vaginal pessary. A silicone, plastic or rubber ring or device inserted into your vagina supports the bulging tissue. Pessaries come in a variety of styles and sizes, and finding the right one for you usually involves trial and error. Your doctor will measure and fit you for the device and teach you how to insert and remove it. You'll need to remove the pessary regularly and clean it. Or, if you leave the pessary in place, your doctor may have you come in periodically to remove and clean the pessary and examine your vagina.
• Estrogen therapy. If you're postmenopausal, your doctor may recommend estrogen therapy, such as a vaginal cream, gel or tablet. Estrogen therapy corrects thinning of the vaginal lining that occurs after menopause and helps keep a pessary from irritating dry vaginal walls.

Surgery
A severe or extremely uncomfortable enterocele may require surgery. The surgery is designed to repair the hernia and relieve signs and symptoms of the enterocele.

In most cases, the surgical approach is through your vagina. In this procedure, your surgeon puts the prolapsed small bowel back into place and tightens the muscles and ligaments of your pelvic floor.

Surgical repair of an enterocele is more common when other prolapsed organs, such as the uterus, bladder or rectum, are involved. In those cases, hysterectomy and repairs of the cystocele and rectocele can be done at the same time as the enterocele repair.