What is Enterocele? Symptoms, Causes, & Treatment

An enterocele is a type of pelvic organ prolapse where part of your small intestine bulges down into your pelvis, often pushing against the back wall of your vagina. Think of it as your pelvic floor muscles and tissues becoming weakened, allowing organs to shift from their normal position.

This condition happens when the supportive tissues in your pelvis stretch or tear over time. While it might sound concerning, enterocele is a treatable condition that affects many women, particularly after menopause or childbirth.

What are the symptoms of enterocele?

Many women with enterocele experience a feeling of pressure or fullness in their pelvis, especially when standing or walking. This sensation often improves when you lie down and rest.

The symptoms you might notice can vary depending on how severe the prolapse has become. Here are the most common signs to watch for:

• A bulging sensation in your vagina or feeling like something is "falling out"
• Pelvic pressure that worsens throughout the day
• Lower back pain or aching
• Difficulty with bowel movements or feeling like you can't empty completely
• Discomfort during sexual intercourse
• A visible or felt bulge at the vaginal opening
• Urinary problems like frequent urination or difficulty starting urination

Some women also experience bloating or abdominal discomfort. The symptoms typically become more noticeable after physical activity, prolonged standing, or heavy lifting.

What are the types of enterocele?

Enteroceles are generally classified based on when and how they develop. Understanding these types can help you better grasp what might be happening in your specific situation.

The main types include primary enterocele, which occurs naturally due to weakness in your pelvic floor, and secondary enterocele, which develops after pelvic surgery. There's also a rare type called congenital enterocele that some women are born with.

Primary enteroceles typically develop gradually over time due to factors like aging, childbirth, or genetic predisposition. Secondary enteroceles can occur after procedures like hysterectomy when the normal support structures are altered during surgery.

What causes enterocele?

Enterocele develops when the tissues that normally support your pelvic organs become weakened or damaged. This typically happens gradually over time rather than suddenly.

Several factors can contribute to this weakening of your pelvic support system:

• Pregnancy and vaginal childbirth, especially multiple deliveries or difficult births
• Aging and the natural weakening of connective tissues
• Hormonal changes during menopause that affect tissue strength
• Previous pelvic surgeries, particularly hysterectomy
• Chronic coughing from conditions like asthma or smoking
• Chronic constipation and straining during bowel movements
• Heavy lifting or jobs requiring repetitive heavy lifting
• Genetic factors that affect connective tissue strength

Sometimes enterocele can also result from increased pressure in your abdomen due to obesity or chronic coughing. In rare cases, it may be associated with connective tissue disorders like Ehlers-Danlos syndrome.

When to see a doctor for enterocele?

You should schedule an appointment with your healthcare provider if you notice persistent pelvic pressure, discomfort, or any bulging sensation in your vaginal area. These symptoms warrant medical evaluation even if they seem mild.

Don't wait to seek care if you experience severe symptoms or if the condition is affecting your daily activities. Early evaluation can help prevent the condition from worsening and provide you with more treatment options.

Contact your doctor promptly if you have difficulty with urination, severe constipation, or if you can see or feel a bulge at your vaginal opening. You should also seek medical attention if you have pelvic pain that interferes with your sleep or daily activities.

What are the risk factors for enterocele?

Certain factors can increase your likelihood of developing enterocele, though having these risk factors doesn't guarantee you'll develop the condition. Understanding these can help you take preventive steps where possible.

The most significant risk factors include:

• Age over 50, as tissues naturally weaken with time
• Previous vaginal deliveries, especially multiple children or difficult births
• Menopause and decreased estrogen levels
• Family history of pelvic organ prolapse
• Previous pelvic surgery, particularly hysterectomy
• Chronic constipation or straining
• Chronic cough from smoking or lung conditions
• Obesity or significant weight gain
• Jobs requiring heavy lifting or prolonged standing

Some women may also have a genetic predisposition to weaker connective tissues. Rarely, certain connective tissue disorders can increase the risk of developing enterocele at a younger age.

What are the possible complications of enterocele?

While enterocele is generally not a life-threatening condition, it can lead to several complications if left untreated, particularly as it progresses over time. Understanding these potential issues can help you make informed decisions about treatment.

The most common complications you might experience include:

• Worsening bowel function problems, including chronic constipation
• Urinary difficulties such as incomplete bladder emptying
• Increased risk of urinary tract infections
• Sexual dysfunction or pain during intercourse
• Skin irritation or ulceration if the prolapse becomes severe
• Complete prolapse where organs protrude outside the body

In rare cases, severe enterocele can lead to bowel obstruction, which requires immediate medical attention. Very rarely, the protruding tissue can become trapped and lose its blood supply, creating a medical emergency.

The good news is that these severe complications are uncommon, especially with proper medical care and treatment. Most women with enterocele can manage their symptoms effectively with appropriate treatment.

How can enterocele be prevented?

While you can't prevent all risk factors for enterocele, especially those related to aging or genetics, there are several steps you can take to reduce your risk and protect your pelvic floor health.

Maintaining good pelvic floor muscle strength through regular exercise is one of the most effective preventive measures. Kegel exercises, which involve contracting and relaxing your pelvic floor muscles, can help maintain support for your pelvic organs.

Here are key prevention strategies:

• Practice regular Kegel exercises to strengthen pelvic floor muscles
• Maintain a healthy weight to reduce pressure on your pelvic floor
• Avoid heavy lifting or use proper lifting techniques
• Treat chronic constipation with fiber, fluids, and regular exercise
• Quit smoking to reduce chronic coughing
• Consider hormone replacement therapy during menopause if appropriate

If you're planning future pregnancies, discuss delivery options with your healthcare provider. In some cases, cesarean delivery might be recommended if you have significant risk factors for pelvic floor damage.

How is enterocele diagnosed?

Diagnosing enterocele typically begins with your doctor taking a detailed medical history and performing a physical examination. Your healthcare provider will ask about your symptoms, pregnancy history, and any previous pelvic surgeries.

During the physical exam, your doctor will perform a pelvic examination to check for any bulging or prolapse. They may ask you to bear down or cough to see how your pelvic organs move with increased pressure.

Additional tests your doctor might recommend include:

• Defecography, an X-ray test that shows how your rectum and surrounding organs function during bowel movements
• MRI or CT scan to get detailed images of your pelvic organs
• Cystoscopy to examine your bladder if urinary symptoms are present
• Colonoscopy to rule out other bowel problems

Sometimes your doctor might refer you to a specialist, such as a urogynecologist or colorectal surgeon, for further evaluation. These specialists have additional training in pelvic floor disorders and can provide specialized care.

What is the treatment for enterocele?

Treatment for enterocele depends on the severity of your symptoms and how much the condition affects your daily life. Your doctor will work with you to develop a treatment plan that fits your specific needs and preferences.

For mild cases, conservative treatments are often tried first. These non-surgical approaches can be very effective for many women and may include pelvic floor physical therapy, lifestyle modifications, and supportive devices.

Conservative treatment options include:

• Pelvic floor physical therapy to strengthen supporting muscles
• Pessary insertion, a device that supports prolapsed organs
• Hormone replacement therapy to improve tissue strength
• Dietary changes to prevent constipation
• Weight management if obesity is a contributing factor

If conservative treatments don't provide adequate relief, surgical options may be considered. Surgical procedures can involve repairing the weakened tissues through the vagina or abdomen, depending on your specific situation.

Your surgeon might recommend procedures like posterior colporrhaphy, where the back wall of the vagina is repaired and strengthened. In some cases, mesh materials may be used to provide additional support, though this approach requires careful consideration of risks and benefits.

How to manage enterocele at home?

There are several things you can do at home to help manage your enterocele symptoms and prevent the condition from worsening. These home management strategies work best when combined with medical treatment.

Start by incorporating pelvic floor exercises into your daily routine. Kegel exercises can help strengthen the muscles that support your pelvic organs and may reduce symptoms over time.

Here are effective home management strategies:

• Perform Kegel exercises 3 times daily, holding contractions for 5-10 seconds
• Maintain regular bowel habits with adequate fiber and water intake
• Avoid heavy lifting or use proper lifting techniques
• Wear a supportive abdominal binder during physical activities
• Practice good posture to reduce pressure on your pelvic floor
• Take breaks from prolonged standing when possible

Managing constipation is particularly important since straining can worsen enterocele. Include plenty of fruits, vegetables, and whole grains in your diet, and consider a fiber supplement if recommended by your doctor.

If you're experiencing discomfort, lying down with your hips elevated can help reduce pressure and provide relief. This position allows gravity to help move your organs back into their normal position temporarily.

How should you prepare for your doctor appointment?

Preparing for your appointment can help ensure you get the most accurate diagnosis and effective treatment plan. Taking time to organize your thoughts and symptoms beforehand will make the visit more productive.

Start by keeping a symptom diary for a week or two before your appointment. Note when symptoms occur, what makes them better or worse, and how they affect your daily activities.

Here's what to prepare:

• List all your symptoms, including when they started and how severe they are
• Write down your complete medical history, including pregnancies and surgeries
• Bring a list of all medications and supplements you're taking
• Prepare questions about treatment options and what to expect
• Consider bringing a trusted friend or family member for support

Don't be embarrassed to discuss intimate details about your symptoms. Your healthcare provider needs complete information to help you effectively, and they're trained to discuss these issues professionally and compassionately.

What's the key takeaway about enterocele?

Enterocele is a treatable condition that affects many women, particularly after childbirth or menopause. While it can be uncomfortable and concerning, you have many effective treatment options available.

The most important thing to remember is that seeking medical care early can prevent the condition from worsening and provide you with more treatment choices. Many women find significant relief through conservative treatments like pelvic floor therapy and lifestyle modifications.

Don't let embarrassment or fear prevent you from getting the help you need. Healthcare providers are experienced in treating pelvic floor disorders and can offer compassionate, professional care to help you feel better and maintain your quality of life.