Enterocele is a hernia in which a section of the small intestine swells and puts pressure on the vagina due to weak pelvic floor connective tissue. Symptoms range from mild pressure to constant pain and may require a support ring or surgery. Treatment depends on the severity of symptoms and may include rest, Kegel exercises, estrogen supplements, or a pessary.
An enterocele is a type of female hernia in which a section of the small intestine swells and puts pressure on the vagina. It occurs when the connective tissue in the pelvic floor is too weak or damaged to hold the bowel in place. Women of any age can experience an enterocele, but it’s most commonly seen after difficult deliveries and after menopause. Depending on the severity of the hernia, symptoms can range from mild pressure sensations in the pelvis to constant pain in the vagina and lower back. Minor enteroceles typically resolve on their own with rest and pain medication, but a persistent problem may require insertion of a support ring or invasive surgery.
The pelvic fascia is a band of elastic connective tissue that helps maintain the shape of the vagina, uterus, and rectum. Enteroceles typically occur when the fascia is weakened to the point that it can no longer support the weight of the small intestine and other internal structures. Many different factors can contribute to pelvic floor weakness, including age, low estrogen levels related to menopause, and acute pressure and strain from childbirth. Genetic connective tissue disorders can also predispose some people to hernias. Additionally, women who have had hysterectomies or other invasive surgeries have a higher risk of developing enteroceles.
When a bulge occurs, it may not be immediately apparent. The pressure and pain build up over several days or weeks, and the symptoms are usually worst while lying down or having sex. If a large enterocele develops, a woman may be able to feel the hernia in her vagina. Major enteroceles can be accompanied by a herniation of the bladder, rectum, or uterine tissue, which can lead to debilitating pain and additional symptoms.
A woman who believes she has an enterocele should visit her gynecologist right away. Your doctor may ask about your symptoms and do a careful pelvic exam. He or she may be able to see or feel a bulge in the vagina that is indicative of a hernia. Imaging tests are usually not needed to confirm the presence of an enterocele, but x-rays may be done if pelvic fractures or muscle tears are suspected.
Treatment measures depend on the severity of a woman’s symptoms. If the discomfort is mild, a doctor will usually suggest that the patient get plenty of rest and do Kegel exercises to strengthen the pelvic floor muscles. Postmenopausal women may need to take estrogen supplements to thicken the vaginal walls and pelvic fascia. One option for a larger enterocele is a removable ring-shaped device called a pessary that helps the vagina keep its shape. Finally, severe enteroceles are treated surgically by pushing the intestine into place and suturing the damaged fascial tissue.
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