Small bowel prolapse, also called enterocele, is when the small intestine descends into the lower pelvic cavity and creates a bulge at the top of the vagina.
Symptoms of Enterocele/Intestinal Prolapse
Patients with mild intestinal prolapse may not experience any symptoms, while significant prolapse may cause:
- A soft bulge of tissue in the vagina
- A feeling of pelvic fullness, pressure, or pain
- A pulling sensation in the pelvis that eases when lying down
- Low back pain that eases when lying down
- Vaginal discomfort
- Painful intercourse
Women with intestinal prolapse may also experience prolapse of the bladder, uterus, or rectum.
Causes of Enterocele/Intestinal Prolapse
Pelvic organ prolapse is primarily caused by increased pressure on the pelvic floor. Contributing factors include:
- Pregnancy and childbirth
- Repeated heavy lifting
- Being overweight or obese
- Chronic cough or bronchitis
- Chronic constipation or straining with bowel movements
During pregnancy, labor, and delivery, the muscles, ligaments, and fascia that hold and support the vagina stretch and weaken. However, not every childbirth leads to pelvic organ prolapse and not every woman diagnosed with pelvic organ prolapse has delivered a child.
Risk Factors For Enterocele/Intestinal Prolapse
The following factors increase the risk of developing small bowel prolapse:
- Age. Over time, women lose muscle mass and muscle strength in the pelvic area and other muscles.
- Pregnancy and childbirth. Vaginal delivery of one or more children weakens the pelvic floor support structures and increases the risk of developing any type of pelvic organ prolapse.
- Smoking. Smokers frequently cough, increasing pressure on the abdomen.
- Pelvic surgery. Surgery to treat incontinence or to remove the uterus increases the risk of small bowel prolapse.
- Being overweight or obese. Extra weight increases pressure inside the abdomen, which increases the risk of small bowel prolapse.
- Ethnicity. Hispanic and White women are more likely to develop pelvic organ prolapse.
- Connective tissue disorders. Weaker connective tissues in the pelvic area make a woman naturally more likely to develop small bowel prolapse and other types of pelvic organ prolapse.
Diagnosing Intestinal Prolapse
To diagnose intestinal prolapse, the physician will perform a pelvic exam during which the patient will be asked to take a deep breath and hold it while straining as if they’re having a bowel movement. This exercise, called a Valsalva maneuver, will cause a prolapsed small bowel to bulge downward. If the physician is unable to detect a prolapse while the patient is lying on the exam table, the maneuver may be repeated while the patient is standing.
Treatment Options For Enterocele/Intestinal Prolapse
Women who aren’t experiencing any troubling symptoms may not need treatment. But women who need treatment, may choose one or more of the following options:
- Pessary. A silicone, plastic, or rubber device will be inserted into the vagina to provide support. The pessary will be fitted for optimal support.
- Surgery. The surgeon may repair the prolapse through the vagina or abdomen. The prolapsed small bowel will be moved back into place and the connective tissue of the pelvic floor will be tightened. In some cases, synthetic mesh may be used to support the weakened tissue.