16966 Enterocele

Overview

An enterocele is a type of pelvic organ prolapse. It happens when the small intestine (also called the small bowel) pushes downward into the space of the vagina. This can cause a feeling of pressure, a bulging sensation, or discomfort in the pelvic area.

Enterocele is less common than some other types of prolapse, such as a cystocele (bladder prolapse) or rectocele (bowel prolapse), but it is not rare. Many people experience only mild symptoms that do not need special treatment.

It mostly affects women and people assigned female at birth, especially after childbirth, hysterectomy, or later in life when pelvic tissues naturally become weaker. Transgender men who have had a hysterectomy may also be affected.

Symptoms

Common symptoms

• A feeling of fullness, pressure, or heaviness in the pelvis or vagina
• A visible bulge or a feeling that something is coming down through the vaginal opening
• Lower backache that eases when you lie down
• A pulling, aching, or stretching sensation
• Difficulty starting to urinate or feeling that the bladder is not empty after going
• A frequent need to urinate or a sudden strong need to go
• Trouble having a bowel movement, or feeling of incomplete emptying
• Discomfort during sexual intercourse

Causes

Main causes

• Weakness of the pelvic floor muscles and connective tissue that support the pelvic organs
• Increased pressure in the abdomen (such as from heavy lifting, chronic coughing, or straining on the toilet) that pushes the small bowel downward
• A previous hysterectomy, which removes the uterus and can leave the upper vaginal area less supported
• Childbirth, especially difficult or multiple vaginal deliveries, which can stretch and weaken the pelvic floor

Risk factors

• Giving birth vaginally, especially to a large baby or more than once
• Having had a hysterectomy
• Being overweight or obese, which adds extra pressure on the pelvic floor
• Chronic constipation and regular straining during bowel movements
• Heavy lifting or high-impact activities at work or in daily life
• Chronic cough from smoking, asthma, bronchitis, or other conditions
• Older age and menopause, which lower estrogen levels and can weaken tissues

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pelvic pain, vomiting, cannot pass gas or stool, or a bulge that becomes very swollen and painful, call your local emergency number right away.

Book a routine appointment if:

• Ask for an appointment with your doctor or nurse if you notice a persistent feeling of fullness, a bulge, or any other symptom of enterocele.
• If symptoms are getting worse or affecting your daily life, such as work, exercise, or intimacy, mention this at your next check-up.

Diagnosis

Your doctor will start by asking about your symptoms and medical history, then perform a pelvic exam. During the exam, the doctor looks and feels inside the vagina to check for a bulge. They may also ask you to cough or bear down to see if the bulge becomes more visible.

Tests that may be done

• Pelvic examination with a speculum (a small instrument that gently holds the vaginal walls open)
• A manual examination with a gloved finger to feel the bulge and its size
• Testing the strength of your pelvic floor muscles
• Imaging tests, such as an MRI scan, if the diagnosis is uncertain or if your doctor wants to see exactly which organs are involved
• Tests to check for bladder or bowel problems, such as a urogynecological assessment

What to expect at your appointment

The exam is usually quick and not painful, though it may feel a little uncomfortable. Your doctor will explain what they are doing and let you know what they find. You may be referred to a specialist, such as a urogynecologist or a pelvic floor physical therapist, for further evaluation and care.

Treatment

Treatment for enterocele depends on how much it affects your daily life. For mild cases, self-care and pelvic floor exercises may be enough. For more bothersome symptoms, options include a support device placed in the vagina (pessary), physical therapy, or surgery to repair the pelvic floor. Your doctor will help you choose the safest and most appropriate plan for you.

Self-care at home

• Do pelvic floor muscle exercises (also called Kegel exercises) every day to strengthen the muscles that support the pelvic organs
• Avoid heavy lifting, strenuous exercise, or prolonged standing that increases strain
• Prevent constipation by eating enough fiber, drinking plenty of water, and going to the toilet when you first feel the urge
• Maintain a healthy weight to reduce pressure on the pelvic floor
• If you have a chronic cough, ask your doctor about ways to manage it
• Try lying down for a few minutes several times a day if you feel pressure, as it eases the weight on the pelvic area

Medical treatments

Your doctor may recommend a vaginal pessary, a flexible silicone ring that you insert into the vagina to support the pelvic organs. A healthcare provider can fit it for you and show you how to clean and replace it. For people who have gone through menopause, topical estrogen therapy (a cream, tablet, or ring inserted into the vagina) may help strengthen the tissues, but this is only used when it is safe and appropriate for you. Medical treatments are always discussed individually with your healthcare provider.

When is surgery considered?

Surgery may be considered if the enterocele is severe, does not improve with self-care or a pessary, or if it causes significant bowel, bladder, or pelvic problems. The surgery aims to repair the weakened tissues and return the small intestine to its normal position. Your doctor will explain the benefits and risks, and you will decide together if surgery is the right option for you.

Living with this condition

Many people with a mild enterocele live comfortably without special treatment. Small changes, such as wearing loose clothing, sitting down for frequent breaks, and being mindful about lifting, can really help. It may also help to lie down to rest if pressure builds during the day.

Lifestyle tips

• Try to do pelvic floor exercises regularly, as guided by a physical therapist or doctor
• Avoid lifting objects heavier than about 5 kilograms (11 pounds) if you can, or ask for help and use good technique
• Eat a high-fiber diet and drink enough fluids to keep your bowels soft
• Make time for low-impact activities like walking, swimming, or cycling, and stop if you feel pain
• If you smoke, talk to your doctor about support to quit, as a chronic cough makes prolapse worse

Diet and exercise

A diet rich in fruits, vegetables, whole grains, and legumes will help prevent constipation and reduce straining. Try to drink around 6 to 8 glasses of water a day unless your doctor advises differently. For exercise, low-impact activities that do not put heavy pressure on the pelvic floor, like walking, swimming, or gentle yoga, are usually safe. A pelvic floor physical therapist can give you specific advice.

Mental health and emotional wellbeing

Living with an enterocele can sometimes lead to feelings of embarrassment, anxiety, or worry about your body. These feelings are normal, and it is important to talk about them. Your doctor can provide reassurance, and asking for a referral to a counselor or a continence/pelvic health specialist may help. Remember that many people manage this condition well.

Prevention

It is not always possible to prevent an enterocele, especially if you have certain risk factors like a previous hysterectomy. However, you can lower your chance of developing one by staying at a healthy weight, doing pelvic floor exercises during and after pregnancy, avoiding regular heavy lifting, and treating constipation early. Managing a chronic cough or quitting smoking also reduces pressure on the pelvic floor.

Vaccines

Not applicable. There is no vaccine that prevents enterocele.

Screening programmes

There is no routine screening test for enterocele. If you have symptoms, see your doctor for a pelvic exam. Routine pelvic exams during check-ups can sometimes detect a prolapse even before symptoms are noticeable.

Complications

If left untreated

• The bulge may gradually become larger and cause more noticeable pressure, pain, or a visible bulge through the vaginal opening
• It may contribute to difficulty urinating, which can increase the risk of bladder infections
• It can make constipation worse because the small bowel is pushed into the pelvis, interfering with normal bowel function
• Rarely, the small intestine can become trapped (incarcerated), which is a surgical emergency

Long-term outlook

The outlook for an enterocele is very good. Most people find that symptoms can be managed with pelvic floor therapy, lifestyle changes, or a pessary. When surgery is needed, it is usually successful in relieving symptoms and improving quality of life. An enterocele does not shorten life, and with the right support, you can continue doing the activities that matter to you.

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