There are four types of enterocele:

• ● Pulsion: Happens due to continual pressure in the abdomen.
• ● Congenital: Birth defect; extremely rare.
• ● Traction: Occurs due to childbirth, pregnancy, estrogen loss, additional pressure from other prolapsed organs.
• ● Iatrogenic: Caused due to surgical procedures like hysterectomy.

In the initial stages, you may not show any symptoms. But, when it progresses into a severe stage, you might experience the following symptoms:

 

• ● A soft bulge of tissue in your vagina
• ● A feeling of pressure, fullness in your pelvic area, and pain
• ● Feeling of not emptying your bowel properly
• ● A pulling sensation in your pelvis, which improves when you lie down
• ● Urinary issues like a slow stream, frequency, urgency, a feeling of incomplete bladder emptying, and stress urinary incontinence
• ● Pain in the lower back area that lessens when you lie down
• ● Vaginal discomfort
• ● Pain during having sexual intercourse (dyspareunia)

 

Many women who suffer from small bowel prolapse (enterocele) may also face prolapses of other pelvic organs, like the uterus, bladder, or rectum.

There can be multiple reasons like:

• ● Obesity or being overweight
• ● Pregnancy and childbirth
• ● Aging; growing age can weaken the muscles and ligaments that hold the pelvic organs in place
• ● Chronic constipation or strained bowel movement
• ● Lifting heavy objects repeatedly
• ● Bronchitis or chronic cough
• ● Low estrogen levels (more common in older patients)
• ● If you have had any pelvic surgery previously or have undergone radiation therapy in the pelvic area
• ● Have undergone surgery for urinary incontinence

Your doctor will do a thorough examination of your pelvic region to diagnose small bowel prolapse (enterocele).

• ● One technique is where your doctor asks you to take a deep breath. You need to lie down, hold your breath, and bear down like during your bowel movement. This causes the prolapsed small bowel to bulge in the downward direction. By doing this, if your doctor is unable to determine the problem, then the same process will be done in the standing position with one foot on a stool.
• ● Another way of diagnosing small bowel prolapse (enterocele) is through defecography (a non-invasive test to get images of rectal function).

• ● Observation – If you experience a few or no notable symptoms, then you don’t require treatment. There are self-care measures, like doing exercises called Kegels that can fortify your pelvic muscles and ligaments, which can provide respite from the existing symptoms. Also, by avoiding lifting heavy things and treating constipation, you can lower the chances of your prolapse getting worse.
• ● Estrogen therapy – If you are in a post-menopausal phase, then your doctor may advise using a vaginal gel, cream, or tablets to increase your estrogen levels. This helps in improving the vaginal lining after menopause.
• ● Vaginal pessary – In this, a removable plastic, silicone, or rubber ring is placed in your vagina to support the areas near the pelvic organ prolapse. Your doctor will measure, find, and fit the right pessary. You will need to remove and clean it regularly and visit the doctor every three months to get it replaced.

A small bowel prolapse (enterocele) repair surgery is performed under general anesthesia and can be performed either through the vagina or abdomen. In this surgery, the surgeon will push the prolapsed small bowel back to its original position. Then he or she will tighten the tissues connected to your pelvic floor. Occasionally, a small synthetic mesh may be used to sustain the weak tissues.

During a pelvic evaluation, if your doctor detects that you are also suffering from urethral prolapse or urethrocele, bladder prolapse, or cystocele, then this problem, too, can be handled in the same surgery.

Most of the patients do not face any complications, and there is no recurrence. However, a small bowel prolapse (enterocele) repair surgery will work best if you can avoid (treat) constipation, do not have plans for pregnancy, or do not suffer from any other pelvic organ prolapse.

While surgery for small bowel prolapse (enterocele) has a high success rate, factors like the following can affect it:

• ● Symptoms of constipation, low back pain, pain during intercourse might come back post-surgery
• ● Bladder injury
• ● Infection
• ● Development of an unusual opening or connection between two organs (fistula)

If your prolapse is not at a severe stage, then you can delay the surgery till you have no further plans to conceive.

You should avoid things like:

• ● Strenuous activities
• ● Lifting any heavy objects
• ● Pushing or pulling
• ● Smoking; because it often leads to coughing that can put pressure on your organs
• ● Weight gain
• ● Standing for a long time

Most patients can resume their usual routine after six weeks.

You must include sufficient sources of fiber in your diet, such as whole grains, vegetables, fruits, and try to drink 6-8 glasses of water daily.

You can try Kegel, pilates, yoga, and swimming. Indulging in aerobics, heavy abdominal exercises, running, or jogging is not advisable.

If you leave this untreated, it gets worse. In some severe cases of Small Bowel Prolapse (Enterocele), the patient may face obstruction in kidney functions or urinary retention, which can further lead to serious kidney infection and damage.

Usually, this condition does not recur. But, an injury to the pelvic floor, repeated constipation, and other factors putting pressure on the pelvic zone can aid it to recur.