Aging, childbirth, and pressure on the pelvic organs can result in a condition called enterocele, or small bowel prolapse. This condition occurs when the small bowel (also referred to as the small intestine) is no longer supported by the pelvic floor muscles and droops into the vaginal canal. This creates a bulge that can be uncomfortable and embarrassing for women of any age.
While more mild cases of enterocele may result in no symptoms, patients with the following symptoms may be experiencing significantly severe prolapse:
- Pelvic pressure, pain, or fullness
- Lower back pain improved by lying down
- Tissue bulge in the vagina
- Pulling sensation in the pelvis when lying down
- Pain during intercourse
- Vaginal discomfort
Though the most common reason for small bowel prolapse is the weakening of the muscles of the pelvic floor, it can also be caused by obesity, chronic coughing, chronic constipation, and heavy lifting. These can all affect the muscles and ligaments of the pelvic floor and result in prolapse. Patients who are older, smoke, or have a family history of pelvic organ prolapse may be at a higher risk of developing this condition.
Enterocele is diagnosed by a physical examination and a review of the patient’s symptoms. Dr. Gandhi has his patients relax on the exam table and bear down in the pelvic region to see if the small bowel bulges through the vaginal cavity. This can also be done while the patient is standing and allows the doctor to see the condition and give an accurate diagnosis.
In most cases, mild enterocele will not need any treatment. However, if the symptoms are bothersome to the patient, or if the patient is self-conscious about the condition, they may be able to seek treatment with pelvic floor exercises to strengthen the pelvic muscles and ligaments. A pessary can be used to help support the pelvic organs and hold them in their proper location. More severe cases may benefit from surgical procedures in which connective tissues are tightened and a synthetic mesh is put in place to provide support for the small bowel and any other pelvic organs that are at risk of experiencing moderate to severe prolapse.