Enterocele Repair (Apical Suspension)
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The condition can be caused by a number of factors. It is common in women who have undergone a hysterectomy and have had their uterus removed. This form of enterocele is called vaginal vault prolapse or “apical” prolapse. Other factors include aging, childbirth, chronic constipation, pelvic surgery, smoking, race, family medical history, connective tissue disorders, and anything that puts pressure on the pelvic region including coughing, heavy lifting, or obesity.
When enterocele is mild, many patients are not aware that they have the condition as no significant symptoms are noticed. However, when the condition is severe, patients may notice bulging tissue in their vagina, discomfort during sexual intercourse, pelvic pain or pressure, and lower back pain that may decrease when lying down. This condition may also be present along with rectocele (posterior prolapse), uterine prolapse, or cystocele (anterior prolapse).
A simple examination of the pelvic region allows Dr. Gandhi of Partners in Pelvic Health North Shore Urogynecology to diagnose this condition properly. He asks his patients to take a deep breath and bear down on the area to determine if the small bowel bulges through the vaginal cavity. This is called the Valsalva maneuver. If confirmed, the diagnosis is made and solutions are discussed.
For enterocele, there are few non-invasive options available. With mild cases of enterocele, patients are encouraged to perform Kegel exercises daily to strengthen their pelvic muscles. Pessaries are devices that are inserted into the vaginal cavity to help support pelvic organs. A healthy diet to reduce weight may also help. However, there are many times in which surgical intervention is necessary for long-term relief. During surgery, Dr. Gandhi will repair the connective tissue that has weakened, and may install a vaginal mesh to support these tissues and the pelvic organs.