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Enterocele

Definition


Disease: Enterocele Enterocele
Category: Gynecological diseases

Disease Definition:

The muscles and ligaments (pelvic floor) that support the bladder, uterus, colon and small intestine could be weakened due to childbirth and aging, causing one or more of these organs to drop or prolapse. One of the conditions that results from this is an enterocele.

 

When the small intestine, also called small bowel, drops into the lower pelvic cavity and protrudes into the vagina creating a bulge, an enterocele occurs, which is a vaginal hernia.

 

In order to help relieve symptoms for a mild or moderate enterocele, some non-surgical treatments are available, such as exercises to strengthen the pelvic floor muscles. However, surgical repair may be necessary if the enterocele is more severe.
 

Work Group:


Symptoms, Causes

Symptoms:

A person may experience no signs or symptoms in case of a mild enterocele. But when the enterocele is severe, a person might experience some of these signs and symptoms:

 

  • Vaginal discharge and bleeding
  • A soft bulge of tissue in the vagina
  • A feeling of pelvic fullness, pressure or pain
  • Low back pain that eases when lying down
  • Dyspareunia, which means painful intercourse, and vaginal discomfort.
  • A pulling sensation in the pelvis that eases when lying down.

 

The small bowel, in addition to some other organs, could descend in case the pelvic floor muscles lose tone. Some of the related conditions that could occur with enterocele are:

 

  • Cystocele, a condition in which the bladder bulges into the vagina.
  • Rectocele, a condition in which the rectum bulges into the vagina
  • Uterine prolapse, a condition in which the uterus descends into the vagina.
     

Causes:

Enterocele has four categories and the cause of enterocele determines which type it is.

 

Congenital enterocele:

In a very small number of females, an enterocele could be present at birth.

 

Traction enterocele:

This is the most common type of enterocele, and it could be caused by pregnancy, childbirth and loss of estrogen. An enterocele could also be caused when other prolapsed organs exert pressure within the pelvic cavity.

 

Pulsion enterocele:

Chronic cough and extreme physical exertion, which are conditions that continually cause pressure inside the abdomen, could result in this type of enterocele.

 

Latrogenic enterocele:

Certain types of surgery for urinary incontinence or surgical removal of the uterus could cause this type of enterocele.
 

Complications

Complications:

None

Treatments:

No treatment is required in the case of mild enterocele. In severe cases of enterocele or when enterocele is accompanied by other types of pelvic organ prolapse, surgical repair could be the most effective option. In case surgery is risky or if the patient wants to have more children, there are some non-surgical approaches available. Some of the non-surgical approaches are:

 

Estrogen therapy:

Estrogen therapy may be recommended, such as a vaginal cream, gel or tablet in case the patient postmenopausal. Estrogen therapy helps keep a pessary from irritating dry vaginal walls, and corrects thinning of the vaginal lining that occurs after menopause.

 

Vaginal pessary:

In order to support the bulging tissue, a silicone, plastic or rubber ring or device could be inserted into the vagina. Usually, finding the right pessary involves trial and error, because they come in a variety of styles and sizes. The doctor will measure and fit the patient for the device and teach her how to insert and remove it. The doctor could also have the patient come in periodically to remove and clean the pessary and examine her vagina in case the pessary is left in place.

 

Surgery may be required in case enterocele is severe or extremely uncomfortable. During the surgery, the hernia is repaired, and the signs and symptoms of the enterocele are relieved. Mostly, the surgical approach is through the vagina. During this, the prolapsed small bowel is put back into place and the muscles and ligaments of the pelvic floor are tightened.

 

When other prolapsed organs are involved, such as the bladder, uterus or rectum, surgical repair of an enterocele is more common. In that case, enterocele repair, hysterectomy and repairs of the cystocele and rectocele could be done at the same time.
 

Prognosis:

Not available

Expert's opinion

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Clinical Trials:

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Consultants Corner

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician
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