Living with Enterocele: What You Need to Know About Symptoms and Treatment
According to the American Urogynecologic Society, pelvic organ prolapse is a condition that 50% of women experience after their 50th birthday. There are various types of pelvic prolapse; the most common is cystocele, which involves the bladder pushing down against the front vaginal wall, followed by rectocele, which involves the rectum pressing up against the posterior vaginal wall. Enterocele prolapse is less common; it refers to the small intestine pushing down on the vagina.
Although pelvic prolapse conditions are not life-threatening, they can cause significant discomfort, pain, and stress. Thankfully, women who live with these conditions have treatment options, including non-invasive management through lifestyle changes.
What is Enterocele?
Prolapse conditions are defined by organs slipping or falling out of place. As mentioned above, pelvic organ prolapse happens to many women as they ease into middle age; it can be caused by the bladder, intestine, uterus, or vagina. Essentially, pelvic prolapse conditions are caused by weak or damaged connective tissue that fails to support the pelvic organs, thus leaving them at the mercy of gravity.
An enterocele is a prolapse of the small intestine, or small bowel, pushing into the vagina. When the condition is mild to moderate during its first and second stages, patients feel a soft lump at the vaginal apex. In later stages of enterocele prolapse, the mass of intestinal tissue feels like a bulge protruding at the perineum (between the vulva and the anus), or against the rectal wall. In the most severe cases, part of the small bowel reaches the vaginal opening.
Enterocele Symptoms
For women who recover from vaginal hernias after childbirth, the initial enterocele symptoms feel almost identical. This can be problematic when they incorrectly assume the symptoms will go away through the natural healing process that alleviates many postpartum umbilical hernias.
The most common symptom is a persistent sensation of heaviness or pulling in the pelvic region. It often feels like abdominal strain and the sensation of something descending towards the vaginal opening. The feeling of pelvic pressure worsens after long periods of standing, walking, or lifting heavy objects; it is alleviated by lying down and allowing gravity to push the small bowel back into the abdominal cavity.
Enterocele symptoms after Stage 2 are more painful; they can be felt in the pelvis and lower back. Some patients describe feeling as if the bulge is pulling and dragging their reproductive organs down. Some patients suffer interference with their bowel movements, which feel more intense and incomplete when inflammation affects the intestinal tissue and presses it against the rectum. When this happens, patients spend more time in the bathroom because they feel as if they can’t empty their bowels completely.
For many patients who live with this condition, sexual intercourse can feel uncomfortable or painful. As the intestinal tissue continues descending, it can change the anatomy of the vaginal canal, thus causing patients to feel internal pressure during penetration.
Treatment and Repair
If diagnosed early through a gynecological examination, an enterocele is one of the most manageable and treatment-friendly pelvic prolapse conditions. The invariable treatment goal is to restore the pelvic organs to their correct positions and alleviate the pressure on the vaginal wall. To this effect, enterocele repair options can be invasive or non-invasive.
Invasive
This treatment option is recommended when patients experience external protrusions and severe pain in later stages. The most common surgical repair strategy involves eliminating the Pouch of Douglas at the bottom of the pelvic floor, near the perineum, while pushing the small intestine back into place. Some post-hysterectomy patients can benefit from a vaginal vault suspension procedure. In the most critical cases, a colpocleisis (shortening of the vaginal canal) is recommended.
Non-Invasive
Stage 1 and 2 patients can modify their lifestyles to alleviate the prolapse and reinforce the muscles that support the pelvic floor. This non-surgical approach includes Kegel exercises and physical therapy to strengthen the lower core. Many patients increase their hydration and fiber intake to manage their bowel movements, and pessaries can be inserted to provide intestinal support and prevent protrusions.
Pelvic Health Management
Pelvic prolapse conditions can be alleviated, improved, and treated. Patients don’t have to live with prolapse discomfort; they can regain comfort and confidence with non-invasive or surgical treatments. Early diagnosis is crucial.
