Enteroecele

Small bowel prolapse (enterocele) occurs when muscles and tissues that hold the intestines (small bowel) in place inside the pelvic cavity weaken, causing the small bowel to descend and bulge into the vagina.

Symptoms

Mild small bowel prolapse may produce no signs or symptoms. However, if you have significant prolapse, you might experience:

• A pulling sensation in your pelvis that eases when you lie down
• A feeling of pelvic fullness, pressure or pain
• Low back pain that eases when you lie down
• A soft bulge of tissue in your vagina
• Vaginal discomfort and painful intercourse (dyspareunia)

Many women with small bowel prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus or rectum.

Treatment

Non-Surgical

The goal is to have good daily bowel habits and softer stools. Avoiding constipation and straining with bowel movements will reduce the risk of a bulge associated with a rectocele.

Surgical

The surgical management of rectoceles and enteroceles should only be considered when non-surgical methods have not resolved or improved symptoms and the condition interferes with daily living. This can be done through laparoscopic, robotic or vaginal surgery. The choice of procedure depends on the size of the rectocele and its symptoms. The goal of surgery is:

• To remove the extra tissue caused by the rectocele
• To strengthen the wall between the rectum and vagina, usually now performed by using your own tissues to do this (native tissue repair)
• Rarely, mesh may be used in this repair. This has been controversial in recent years and I recommend speaking with your gynaecological surgeon more about this