An enterocele is a type of female hernia in which a section of the small intestine bulges and puts pressure on the vagina. It occurs when the connective tissue of the pelvic floor is too weak or damaged to hold the intestine in place. Women of any age can experience an enterocele, but it is most commonly seen following difficult childbirths and after menopause. Depending on the severity of the hernia, symptoms can range from mild feelings of pressure in the pelvis to constant pain in the vagina and lower back. Minor enteroceles typically heal on their own with rest and pain relieving medications, but a persistent problem may require the insertion of a supportive 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 arise when the fascia is weakened to the point that is can no longer support the weight of the small intestine and other internal structures. Many different factors can contribute to pelvic floor weakening, including age, low estrogen levels related to menopause, and acute pressure and stretching due to childbirth. Genetic connective tissue disorders can also predispose some people to hernias. In addition, women who have had hysterectomies or other invasive surgeries are at an increased risk of developing enteroceles.
When a bulge occurs, it may not be noticeable right away. Pressure and pain build up over several days or weeks, and symptoms are usually the worst while lying down or having intercourse. If a large enterocele develops, a woman may be able to feel the hernia in her vagina. Major enteroceles may be accompanied by herniation of bladder, rectum, or uterine tissue, which can lead to debilitating pain and additional symptoms.
A woman who believes she may have an enterocele should visit her gynecologist right away. The doctor can ask about symptoms and perform a careful pelvic exam. He or she may be able to see or feel a bulge in the vagina that is indicative of herniation. Diagnostic imaging tests are not usually needed to confirm the presence of an enterocele, but x-rays may be taken if pelvic fractures or muscle tears are suspected.
Treatment measures depend on the severity of a woman's symptoms. If discomfort is mild, a doctor usually suggests that the patient get plenty of rest and perform Kegel exercises to strengthen pelvic floor muscles. Postmenopausal women may need to take estrogen supplements to thicken the vaginal walls and pelvic fascia. An option for a larger enterocele is a removable ring-shaped device called a pessary that helps the vagina maintain its shape. Finally, severe enteroceles are treated surgically by pushing the intestine back into place and suturing damaged fascia tissue.
