Enterocele

An enterocele is a type of hernia that occurs when the intestine bulges into the vagina, often causing discomfort and other symptoms. This condition typically affects women, especially those who have undergone hysterectomy or have a history of pelvic surgery.

Causes and Risk Factors

The primary cause of an enterocele is the weakening of the muscles and tissues that support the intestines and vagina. This can occur due to various factors, including:

• Pregnancy and childbirth: The strain on the pelvic floor during pregnancy and delivery can weaken the supporting tissues.
• Hysterectomy: Removal of the uterus can disrupt the normal anatomy of the pelvis, leading to an enterocele.
• Pelvic surgery: Other surgical procedures in the pelvic area can also contribute to the development of an enterocele.
• Aging: Weakening of the muscles and tissues with age can increase the risk of an enterocele.
• Chronic constipation or straining during bowel movements: This can put additional pressure on the pelvic floor, leading to an enterocele.

Symptoms

The symptoms of an enterocele may include:

• A bulge or lump in the vagina
• Discomfort or pain in the vagina or pelvis
• Pain during sex
• Difficulty emptying the bowels
• Constipation
• Urinary symptoms, such as frequency or urgency

Diagnosis

An enterocele is typically diagnosed through a physical examination and medical history. The doctor may perform a pelvic exam to feel for the bulge in the vagina. Additional tests, such as:

• Imaging studies (e.g., ultrasound, MRI, or CT scan) to visualize the intestines and vagina
• Defecography: A special type of X-ray that shows the movement of the intestines during bowel movements

Treatment Options

The treatment for an enterocele depends on the severity of the condition and the individual's overall health. Conservative management may include:

• Pelvic floor exercises (Kegel exercises) to strengthen the muscles
• Bowel habits modification, such as increasing fiber intake and avoiding straining during bowel movements
• Supportive devices, such as a pessary, to help hold the intestine in place

In more severe cases, surgery may be necessary to repair the enterocele. The type of surgery will depend on the individual's specific condition and may include:

• Sacral colpopexy: A procedure that attaches the vagina to the sacrum (a bone in the pelvis) using mesh or sutures
• Enterocele repair: A procedure that involves removing the herniated intestine and repairing the weakened tissues

Prevention

To reduce the risk of developing an enterocele, it is essential to:

• Maintain a healthy weight
• Avoid constipation by eating a high-fiber diet and staying hydrated
• Avoid heavy lifting or straining during bowel movements
• Perform pelvic floor exercises regularly

Frequently Asked Questions (FAQs)

What is an enterocele?
A herniation of the intestine into the vagina.

What causes an enterocele?
Weakening of pelvic floor muscles and tissues.

What are the symptoms of an enterocele?
Vaginal bulge, discomfort, and bowel movement difficulties.

How is an enterocele diagnosed?
Physical exam and imaging tests like ultrasound or MRI.

Can an enterocele be treated without surgery?
Yes, with pelvic floor exercises and pessary devices.

What is the surgical treatment for an enterocele?
Vaginal or abdominal repair of weakened tissues.

Are there different types of enteroceles?
Yes, including high, low, and combined enteroceles.

Can an enterocele occur in men?
No, it is a condition that affects women.

Is an enterocele related to other pelvic floor disorders?
Yes, often associated with rectocele and cystocele.

Can an enterocele be prevented?
Possibly, with maintaining strong pelvic floor muscles.