Enterocele

A small bowel prolapse, sometimes called an enterocele, happens when part of your small intestine slides down into the lower part of your pelvis and pushes against the top of your vagina, creating a bulge. "Prolapse" just means something has slipped out of its normal position. This can happen because things like childbirth, getting older, or other factors that put pressure on the muscles and tissues supporting your pelvic organs can weaken them. This makes it easier for the small intestine to slip.

Many cases of small bowel prolapse can be managed effectively without surgery. Self-care measures, such as pelvic floor exercises and avoiding heavy lifting, are often helpful. Other non-surgical treatments, like supportive devices or physical therapy, might also be used. In more serious situations, surgery may be necessary to put the small intestine back in its proper place.

A small bowel prolapse might not cause any noticeable problems. However, if the prolapse is more severe, you may experience some symptoms. These include:

• A pulling or heavy feeling in your pelvis. This feeling often goes away when you lie down.

• A feeling of fullness, pressure, or pain in your pelvis. This can be a persistent discomfort.

• Lower back pain. This pain often lessens when you lie down.

• A noticeable bulge in your vagina. This is a physical sign that something is out of place.

• Vaginal discomfort or painful sex (dyspareunia). This can be a significant issue for some women.

It's important to remember that a small bowel prolapse can sometimes be accompanied by other pelvic organ prolapses, such as issues with the bladder, uterus, or rectum. If you experience any of these symptoms and they're causing you concern, it's essential to see a doctor. They can properly diagnose the problem and recommend the best course of action.

If you notice any symptoms of prolapse that are causing you discomfort, make an appointment with your doctor.

Pelvic organ prolapse happens when the tissues and muscles supporting the organs in your pelvis weaken and stretch, causing the organs to drop. A key factor is increased pressure on the pelvic floor. Several things can put extra pressure on these supports and lead to prolapse:

Common Causes:

• Pregnancy and childbirth: During pregnancy, the tissues and ligaments that hold your vagina and other pelvic organs stretch and weaken. Labor and delivery put even more strain on these supports. While many women give birth without issues, the increased pressure during these events can still cause weakness in some.

• Chronic constipation or straining: Pushing hard during bowel movements puts constant pressure on the pelvic floor. This can weaken the supporting tissues over time.

• Chronic cough or bronchitis: A persistent cough, like from bronchitis, puts ongoing pressure on the pelvic floor muscles.

• Heavy lifting: Lifting heavy objects repeatedly can put significant stress on the pelvic floor. This is especially true for heavy lifting without proper form or technique.

• Being overweight or obese: Extra weight puts extra pressure on the pelvic floor, similar to the effect of chronic straining.

It's important to note that not everyone who experiences these conditions will develop a prolapse. Some people have naturally stronger pelvic floor support systems, and some prolapses may develop gradually over time. Also, women who haven't had children can still develop pelvic organ prolapse.

Several factors can make you more likely to get a small bowel prolapse. Understanding these risks can help you take steps to protect yourself.

Pregnancy and Childbirth: Having babies, especially through vaginal delivery, can weaken the muscles and tissues supporting your pelvic organs. The more babies you have, the higher the risk of any type of pelvic organ prolapse, including small bowel prolapse. Women who deliver by Cesarean section are less prone to this problem.

Age: As people age, they often lose muscle strength and mass throughout their bodies, including the muscles in their pelvis. This can make them more vulnerable to small bowel prolapse and other pelvic organ prolapses.

Pelvic Surgeries: Operations like a hysterectomy (removing the uterus) or procedures for bladder control issues can sometimes weaken pelvic support structures, increasing the chance of a small bowel prolapse.

Increased Abdominal Pressure: A larger weight or size can put more pressure on your abdomen. This added pressure makes it more likely for organs to slip from their normal positions. Other things that raise pressure include persistent coughs (like from chronic conditions) and straining during bowel movements.

Smoking: Smoking often leads to frequent coughing, which, in turn, increases abdominal pressure and raises the risk of prolapse.

Genetics and Race: Sometimes, weaker connective tissues (the tissues that hold organs in place) make a person more prone to prolapses. Additionally, Hispanic and white women are statistically more likely to develop pelvic organ prolapses, for reasons that are still not fully understood.

It's important to remember that having one or more of these risk factors doesn't mean you will develop a small bowel prolapse. However, understanding these factors can help you talk with your doctor about strategies to minimize your risk and to recognize the warning signs if they arise.

Ways to Reduce the Risk of Small Bowel Prolapse

Small bowel prolapse happens when part of your small intestine bulges out of its normal place. Here are some steps you can take to lower your chances of getting it:

1. Maintain a Healthy Weight: Carrying extra weight puts extra pressure on your belly. If you're overweight, losing even a little weight can help reduce this pressure and decrease your risk. Aim for a healthy weight through a balanced diet and regular exercise. Talk to your doctor about a safe and effective weight loss plan for you.

2. Prevent Constipation: Constipation happens when you have trouble having bowel movements. This often happens when you don't eat enough fiber, don't drink enough water, or don't get enough exercise. Constipation also puts extra pressure on your abdomen.

• Eat high-fiber foods: Foods like fruits, vegetables, and whole grains are packed with fiber. Adding more of these to your diet can help keep your digestive system working smoothly.
• Drink plenty of fluids: Water, juice, and other fluids help keep your stool soft and easier to pass.
• Exercise regularly: Physical activity helps your digestion and can prevent constipation.

3. Manage a Chronic Cough: A persistent cough puts extra pressure on your stomach. If you have a chronic cough, it's important to see your doctor to find out what's causing it and get treatment. Untreated chronic coughs can become more serious and lead to complications.

4. Quit Smoking: Smoking can cause a chronic cough, which, as mentioned above, increases abdominal pressure. Quitting smoking is one of the best things you can do for your overall health, including reducing your risk of small bowel prolapse. If you need help quitting, talk to your doctor or find resources for support.

5. Avoid Heavy Lifting: Lifting heavy objects puts a lot of strain on your abdominal muscles, increasing the pressure inside your belly. When lifting, use proper lifting techniques, including bending your knees and keeping your back straight. If possible, ask for help when lifting heavy items.

By following these tips, you can take steps to help protect your digestive system and reduce your risk of small bowel prolapse. Remember to always consult with your doctor for personalized advice.

To figure out if you have a small bowel prolapse, your doctor will do a pelvic exam. During this exam, your doctor might ask you to take a deep breath and hold it while pushing down as if you were trying to have a bowel movement. This is called the Valsalva maneuver. Doing this can help the prolapsed bowel show more clearly by pushing it further down.

If your doctor can't see the prolapse while you're lying down, they might repeat the exam while you're standing up. This gives them a better view of the problem.

Mayo Clinic doctors are experienced in treating small bowel prolapse (also called an enterocele). They can provide the care you need.

Pelvic Organ Prolapse: Support Options and Treatments

Pelvic organ prolapse happens when tissues in the pelvis, like the vagina, bulge or drop. This can happen due to factors like pregnancy, childbirth, or aging. One way to support these tissues is with a pessary.

What is a Pessary?

A pessary is a device that fits inside the vagina. It's like a supportive cushion that helps hold the tissues in place. Pessaries come in different shapes and sizes, and a healthcare provider will help you choose the best one for you. They'll also show you how to insert, remove, and clean it. Finding the right pessary might take a few tries.

Other Treatment Options

• Observation: If the prolapse isn't causing significant problems, you might not need any treatment at all. Simple lifestyle changes, like doing Kegel exercises to strengthen pelvic muscles, can sometimes ease symptoms. Avoiding heavy lifting and straining during bowel movements can also help.

• Surgery: If symptoms are bothersome, surgery may be an option. There are different surgical techniques, including vaginal or abdominal surgery, sometimes with robotic assistance. During surgery, the prolapsed tissue is repositioned, and the pelvic floor tissues are strengthened. Sometimes, synthetic mesh is used to provide extra support. While recurrence is uncommon, further injury to the pelvic floor can happen with things like heavy lifting, straining, obesity, or chronic coughing.

Important Considerations:

• Small Bowel Prolapse: A small bowel prolapse is a type of pelvic organ prolapse. Often, it doesn't need treatment if symptoms are mild. If symptoms are severe and bothersome, surgery might be necessary.

• Choosing the Right Treatment: A healthcare provider will discuss your individual situation and help you decide the best course of action, considering your symptoms, overall health, and personal preferences. If you'd like to avoid surgery or if surgery poses too much risk, pessaries or other nonsurgical methods may be suitable options.

• Follow-up Care: Regardless of the chosen treatment, ongoing monitoring by a healthcare provider is important to ensure the best possible outcome. They can adjust your care plan as needed and address any new concerns that may arise.