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Prolapse of the Small Intestine (Enterocele)

Enterocele is a pelvic prolapse disorder that forms when the small intestine descends into the vaginal canal through the upper posterior (back) wall of the vagina, creating a bulge. It may also be known as a herniated small bowel or vaginal hernia. An enterocele often occurs after a hysterectomy, even years later, when the support structure of the uterus is removed. The condition is often accompanied by some degree of vaginal vault prolapse, when the top of the vagina loses its support and drops into the vaginal canal or rectocele, when the rectum descends.

Often patients who receive reparative enterocele surgery also need corrective intervention to suspend the anterior vaginal wall or vault. This surgery is performed with or without the use of synthetic or biological mesh. Surgery for enterocele repair may be performed robotically with laparoscopic techniques. If more than one pelvic prolapse condition exists, they may be corrected during the same surgery.

Causes of Enterocele

To remove the uterus during a hysterectomy, connective ligaments and tissues must be severed, leaving the upper vaginal wall vulnerable to the intestines pushing from above. Muscle weakness and the stretching of supportive pelvic tissues often occur with aging after childbirth. The reduction of estrogen production after menopause further weakens muscles and contributes to the risk of vaginal prolapse. Obesity, chronic coughing, heavy lifting or straining may also increase the risk.

Symptoms of Enterocele

  • Discomfort or pressure in the vagina
  • Lump or bulge at the vaginal opening
  • Urinary urge and/or stress incontinence
  • Difficulty voiding rectum
  • Incomplete voiding of bladder
  • Sexual dysfunction or painful intercourse
  • Frequent urinary tract infections (UTIs)
  • Pain in pelvis, lower abdomen, groin or lower back
  • Vaginal bleeding or excess discharge

Testing for Enterocele

  • Pelvic exam
  • Urodynamics
  • Cytoscopy
  • Voiding Cystourethrogram

Treatment for Enterocele

  • Diet/lifestyle modifications
  • Pelvic rehabilitation
  • Pessary placement
  • Pelvic organ prolapse surgery (sacrocolpopexy)
  • Anterior vaginal wall repair surgery with or without mesh augmentation
  • Robotic laparoscopic surgery

Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.