Intestinal prolapse, or enterocele, occurs when the small intestine descends into the lower pelvic cavity, creating a bulge at the top of the vagina.
Symptoms of Enterocele
Patients with mild intestinal prolapse may not notice symptoms, but significant prolapse can cause:
- A sense of pelvic fullness, pressure, or pain
- A pulling sensation in the pelvis that lessens when lying down
- Low back pain that eases when lying down
- A soft bulge of tissue in the vagina
- Vaginal discomfort
- Painful intercourse
Intestinal prolapse may also accompany bladder, uterus, or rectum prolapse.
Causes of Enterocele
Pelvic organ prolapse results from increased pressure on the pelvic floor. Factors that increase the risk of enterocele include:
- Overweight or obesity
- Pregnancy and childbirth
- Repeated heavy lifting
- Bronchitis or chronic cough
- Chronic constipation or straining with bowel movements
During pregnancy, labor, and delivery, the support structures of the vagina stretch and weaken. However, not every childbirth results in pelvic organ prolapse, and not every woman with the condition has had children.
Risk Factors for Enterocele
The risk of developing intestinal prolapse increases with:
- Age, due to loss of muscle mass and strength in the pelvic area
- Pregnancy and childbirth, particularly vaginal delivery, which weakens pelvic floor support
- Smoking, which often leads to frequent coughing and increased abdominal pressur
- Pelvic surgery, such as procedures for incontinence or hysterectomy
- Being overweight or obese, as extra weight adds pressure to the abdomen
- Ethnicity, with Hispanic and white women being more prone to pelvic organ prolapse
- Connective tissue disorders, which make weaker pelvic tissues more susceptible to prolapse
Diagnosing Intestinal Prolapse
To diagnose intestinal prolapse, a physician conducts a pelvic exam, asking the patient to take a deep breath and hold it while straining as if having a bowel movement. This Valsalva maneuver causes the prolapsed small bowel to bulge. If prolapse is not detected while lying down, the test may be repeated while standing.
Treatment Options for Enterocele
Women without troublesome symptoms might not need treatment. Those requiring treatment have options, including:
- Pessary: A silicone, plastic, or rubber device inserted into the vagina for support, custom-fitted for optimal assistance.
- Surgery: The surgeon can repair the prolapse through the vagina or abdomen, repositioning the small bowel and tightening the pelvic floor’s connective tissue. In some cases, synthetic mesh may be used to reinforce weakened tissues.
Choose UCI Pelvic Health Center
If you are experiencing symptoms of intestinal prolapse, such as pelvic pressure, discomfort, or a bulge in the vaginal area, UCI Pelvic Health Center is here to help. Our expert team specializes in diagnosing and treating conditions like enterocele, ensuring you receive the best care tailored to your needs. We offer comprehensive evaluations and a range of treatment options, from non-surgical solutions like pessaries to advanced surgical procedures.