Introduction:
Ideally, the small intestine is located within the central and lower portions of the abdominal cavity between the stomach and the large intestine (colon). The primary function of the small intestine is to digest and absorb nutrients from ingested food. The pelvic cavity is a hollow space in the lower part of the abdominal cavity and is enclosed by the pelvic bones, including the hip bones (ilium, ischium, and pubis). The pelvic cavity houses various organs, including the bladder, rectum, and reproductive organs. Various muscles and tissues play a crucial role in maintaining these organs in place. Under certain circumstances, these muscles and tissues may become weak, and organs may get displaced.
What Is Enterocele?
Enterocele is a condition characterized by the displacement of the small intestine into the pelvic space due to weakening or damage to the muscles and tissues that normally support and maintain the pelvic organs in place. Enteroceles are commonly seen in women, particularly those who have gone through multiple pregnancies, experienced trauma to the pelvic area, or had previous pelvic surgeries. Enterocele is also known as small intestine prolapse.
What Causes Enterocele?
Several factors can contribute to the weakening or stretching of the tissues and muscles and increased pressure exertion on the pelvic floor that may cause the development of enterocele. Some of the common factors are as follows:
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Childbirth or pregnancy may cause physical stress, and stretching of the pelvic floor during pregnancy and vaginal delivery can weaken the supportive structures.
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Regularly straining during bowel movements due to chronic constipation or other digestive disorders.
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Persistent coughing, such as in chronic bronchitis or conditions like asthma, can create repeated episodes of increased abdominal pressure.
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Engaging in activities that involve lifting heavy weights regularly.
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Excess weight or obesity may put additional pressure on the pelvic floor.
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Surgeries such as hysterectomy (removal of the uterus) or other procedures that disrupt the normal anatomical support of the pelvic floor may weaken the tissues of the pelvic floor.
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Rarely, individuals may have weakened muscles and tissues due to certain connective tissue disorders (Ehlers-Danlos syndrome).
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Aging may cause the weakening of muscle fibers and tissues which may cause the development of enterocele.
What Are the Symptoms of Enterocele?
Symptoms and severity of enterocele may vary among individuals. Some of the common symptoms of enterocele include:
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A sensation of pull or pressure in the pelvic region that may worsen when standing or during activities that increase abdominal pressure and is relieved when lying down.
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Pelvic discomfort or pain may be dull, aching, or sharp in nature.
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Relief from low back pain when lying down.
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Constipation, or difficulty in emptying the bowels, or a feeling of obstruction during bowel movements.
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A noticeable bulge or protrusion may be felt in the area of the lower belly or the vaginal area. A soft bulge of tissue in the vagina.
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Pain or discomfort in the vagina during intercourse (dyspareunia).
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Prolapse or protrusion of other pelvic organs, such as the bladder, uterus, or rectum.
How to Diagnose Enterocele?
The diagnostic process of enterocele may include the following:
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Medical History: Includes symptoms, duration, and any factors that may contribute to pelvic organ prolapses, such as pregnancies or surgeries.
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Physical Examination: Physical examination of the pelvic area to assess the pelvic floor muscles, identify any protrusions or bulges in the vaginal area, and evaluate the position and support of pelvic organs.
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A procedure known as the Valsalva maneuver may be done where the individual is asked to lie down and take a deep breath and then exhale forcefully while closing the mouth and pinching the nose shut in order to create pressure in the abdomen, similar to what occurs during activities like heavy lifting, coughing, or straining during bowel movements. The doctor will then check for any visible or palpable changes or bulging in the vaginal area that may indicate enterocele or other pelvic floor disorders.
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Imaging Tests: Various imaging techniques may be used to assess the pelvic organs and confirm the presence of enterocele, such as:
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Ultrasound scan.
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Transvaginal ultrasound.
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Magnetic resonance imaging (MRI scan).
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Defecography- A procedure is done for imaging the rectum and pelvic area during bowel movements.
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How to Treat Enterocele?
Depending on the severity of the symptoms, the treatment modalities may vary. Some of the treatment measures for managing enterocele are:
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Enterocele Observation: Treatment may not be necessary for individuals with enterocele that presents with mild or no symptoms at all. One may be advised to observe the symptoms of the enterocele and practice certain measures at home, such as:
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Performing Kegel Exercises: Kegel exercise involves the following:
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After emptying the bladder, choose a comfortable position; one may sit or lie down.
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Pretend to hold from urinating; this will contract and tighten the muscles of the pelvic floor.
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Maintain the muscle contraction for a duration of five seconds.
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Relax for the next five seconds.
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Repeat the cycle a minimum of ten times each for morning, afternoon, and night.
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Repetition may make the exercise easy, which is when one should increase each hold by up to ten seconds.
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Eating fiber-rich food to avoid constipation.
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Avoid lifting heavy weights.
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Avoid smoking to prevent coughing and exertion of force on the pelvic floor.
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Try to lose weight if obese or overweight.
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Use of Pessary: A pessary is a medical device made of silicone, rubber, or plastic that is inserted into the vagina to provide support for pelvic organ prolapse. Individuals may choose the appropriate pessary from the variety of shapes and sizes available. The individual may learn how to use and clean it once the doctor ensures a suitable one.
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Surgery: Enterocele may sometimes require a surgical procedure to repair the weakened muscles and tissues. A doctor may use a surgical mesh for additional support or tighten the existing connective tissue and muscles after repositioning the prolapsed small intestine through a vaginal or abdominal approach.
Can Enterocele Be Prevented?
Enterocele may not be preventable completely. However, certain measures may help reduce the risk of the development or progression of enterocele.
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Maintain a healthy weight to avoid strain on the pelvic floor and contribute to the development of enterocele.
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Ensure to have a fiber-rich diet and stay hydrated to prevent constipation. Stool softeners or other methods to prevent constipation and promote regular bowel movements may also help.
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Minimize or avoid lifting heavy weights or such activities.
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Regularly performing kegel exercises can help maintain pelvic muscle strength and support the pelvic organs and may potentially help prevent or delay enterocele development.
Conclusion:
Although enterocele is not life-threatening, it does cause a bit of discomfort. Extra care must be taken to avoid worsening of the small intestine prolapse. Home measures and lifestyle modifications alone may help manage enterocele for most individuals. It is important to discuss treatment options with the doctor to determine the most appropriate course of action based on individual needs and preferences.
