Enterocele

Enterocele or small bowel prolapse takes place when the small bowel pushes down to the lower pelvic cavity and on the top part of the vagina, which can create a bulge. Prolapse generally means to fall out of place.

This condition usually occurs when the muscles and ligaments supporting the pelvic organs become weak. The weakening may be due to childbirth or aging. While self-care options usually take care of the problem, surgical repair may be needed for severe cases.

A mild case of small bowel prolapse (enterocele) may have no obvious signs or symptoms. If you have an advanced case, however, you may notice the following:

• Pulling sensation in the pelvis, which eases out when lying,
• Feeling of fullness on the pelvic area,
• Pain or pressure around the pelvis,
• Lower back pain, which eases when lying,
• A soft bulge in the vagina,
• Painful intercourse,
• Vaginal discomfort.

A great percentage of women with small bowel prolapse have pelvic organ prolapse, as well.

The main cause of small bowel prolapse (enterocele) is the increased pressure on the pelvic floor.

The following factors may contribute to having small bowel prolapse:

• Pregnancy,
• Childbirth,
• Chronic bronchitis,
• Chronic constipation,
• Repeated heavy lifting,
• Excessive weight and obesity.

If you suspect a small bowel prolapse (enterocele), it is best to visit your gynecologist or a urologist to receive a diagnosis. Before going to the appointment, it is ideal to make a list of the important things about your condition. Write down your symptoms, the medications and supplements you are taking, and any questions you want to ask your doctor regarding your condition.

To make a diagnosis, the doctor usually performs a pelvic exam, in which the doctor examines your pelvic floor for any abnormalities. You are likely to be asked to lie down and do the Valsalva maneuver (or like when you are moving your bowels). The examination may also be repeated and taken while you are standing.

Mild to moderate cases of small bowel prolapse (enterocele) do not typically require treatment. But there are some things that you may need to do, particularly when the symptoms become bothersome.

Treatment options may include:

• Observation: If the prolapse causes a few to no symptoms, treatment may not be needed. Self-care measures like Kegel exercises can be done to strengthen the muscles of the pelvic floor, thus providing symptom relief. It is also advised to avoid heavy lifting and treat constipation right away, in order to prevent the condition from worsening.
• Pessary: Pessary is a device inserted into the vagina in order to support the bulging tissue. This device is usually made of silicone, rubber or plastic and comes in various styles and sizes.
• Surgery: In more severe cases, a prolapse can be treated by surgery, in which the slipped out small bowel is moved back into place. While at it, the doctor may also tighten the pelvic floor’s connective tissues.