Enterocele

An enterocele, also called a small bowel prolapse, occurs when the small intestine (small bowel) pushes downward into the pelvic area and bulges into the upper vaginal wall. While the condition is far more common in people assigned female at birth, enterocele can also affect people assigned male at birth. On these rare occasions, the small bowel pushes into the rectoprostatic space, the area behind the prostate. An enterocele can occur on its own or along with other types of pelvic organ prolapse, such as cystocele (bladder prolapse) or rectocele (rectal prolapse).

At Penn Medicine, specialists in urogynecology and pelvic floor disorders are highly experienced in diagnosing and treating enterocele and related conditions. Using advanced techniques and a personalized approach, we work to relieve symptoms, restore pelvic support, and improve your quality of life.

Some people with an enterocele have no symptoms. When symptoms do occur, they may include:

• A feeling of pressure or fullness in the pelvis
• A bulge or heaviness in the vaginal area
• A pulling or aching sensation in the pelvis
• Lower back pain that improves when lying down
• Discomfort during standing, lifting, or other physical activity

Enterocele symptoms may become more noticeable as the day goes on or after long periods of standing.

An enterocele develops when the pelvic floor muscles and supporting tissues become weakened or stretched. This allows the small intestine to shift downward into the pelvic space. Common causes and risk factors include:

• Vaginal childbirth
• Aging and menopause
• Prior pelvic surgery or hysterectomy 
• Chronic straining from constipation
• Heavy lifting over time
• Obesity or increased abdominal pressure

Treatment for an enterocele depends on the severity of symptoms and how much the prolapse affects daily activities. Some people may not need treatment right away, while others benefit from supportive therapies or surgery.

Nonsurgical options may include pelvic floor therapy to strengthen supporting muscles, a removable device called a pessary placed in the vagina to support pelvic organs, and lifestyle changes such as managing constipation and losing excess weight.

For cases of enterocele that require surgery, dedicated specialists in urogynecologic surgery have expertise in minimally invasive approaches to reposition the small intestine and reinforce weakened tissues.

• Pelvic reconstructive surgery: We repair the underlying pelvic structures using biologic grafts (donor tissue), synthetic surgical mesh, or dissolvable stitches to support your pelvic organs and hold them in place.
• Robotic sacrocolpopexy: A procedure that utilizes robotic technology and surgical mesh to lift the pelvic organs back into their natural position, providing long-term reinforcement.

There are steps you can take to strengthen your pelvic floor and reduce the pressures that can weaken it over time, making you less vulnerable to the condition. These measures also help manage your symptoms and reduce the risk of recurrence:

• Practice pelvic floor exercises (Kegels)
• Avoid heavy lifting when possible
• Treat and prevent constipation
• Maintain a healthy weight
• Manage chronic coughing or conditions that increase abdominal pressure