Do you sometimes feel a heaviness, fullness, or pressure in your vagina? Does this discomfort increase, especially when you stand, laugh, or cough? If so, this may be important to you. Today we are going to talk about a condition that is somewhat common among women, but not many people know about it. That is enterocele, or simply put, a prolapsed small intestine.
What is Enterocele?
Simply put, an enterocele is a condition where part of our small intestine pushes into the pelvic area, that is, the upper part of the vagina. Think about it, the organs inside our abdomen should be in their proper places. So this small intestine comes down a little from where it should be and pushes against the wall of the vagina. This is also called Small Bowel Prolapse . This is a type of pelvic organ prolapse that can occur in the female reproductive system.
How common is this condition?
In fact, there are women in Sri Lanka who have pelvic organ prolapse problems. According to some data from the world, a small percentage of women (about 3% - 6%) may experience this condition. This is especially common among women after menopause , that is, women who have stopped having monthly periods. Also, some reports say that it is more common among white and Hispanic women. However, anyone can experience this condition.
Why does enterocele occur?
Okay, now let's see why this happens. Our pelvic floor is made up of muscles, connective tissues, and ligaments. These are what hold our organs like our uterus, intestines, and vagina in place. They support these organs like a net.
So, if these muscles and tissues become weak, stretched, or sometimes torn, that lifting doesn't happen properly. That's when these problems arise.
Our small intestine is an important part of our digestive system. Normally, this small intestine is located in the lower abdomen and upper pelvis, held in place by the muscles and ligaments mentioned above. But when these tissues weaken, the small intestine gradually slides down and falls into the gap between the vagina and rectum. This is when pressure is created on the upper wall of the vagina.
Another thing is that this condition called enterocele can occur alone, or it can occur together with other pelvic organ prolapse. That is:
- Bladder prolapse (Bladder prolapse or Cystocele)
- Rectal prolapse or Rectocele (a hernia of the rectum that protrudes into the back wall of the vagina)
- Urethra prolapse or Urethrocele
- Uterine prolapse
- Vaginal prolapse
Who is at higher risk of developing this?
Now let's see who is most likely to experience this situation.
One of the most important things is menopause . During and after menopause, our bodies produce less estrogen. This hormone helps keep the pelvic floor muscles strong. So when estrogen levels drop, these muscles can weaken. Studies show that more than a third of women with pelvic floor disorders are between the ages of 60 and 79. And about half are over 80.
Apart from that, there are other reasons that can weaken the pelvic floor muscles and cause an enterocele:
- Pregnancy and childbirth: Carrying a baby in the womb and giving birth puts a lot of pressure on the pelvic muscles. This risk can be increased especially during difficult labors, large babies, or when the baby is delivered using instruments (forceps, vacuum).
- Persistent cough: For example, someone who coughs continuously, whether due to a disease like asthma, bronchitis, or smoking, puts constant pressure on the pelvic muscles. This can also weaken the muscles.
- Connective tissue disorders: For example, people with genetic conditions like Ehlers-Danlos syndrome are also at risk because their body's connective tissue is weaker than normal.
- Constipation: If you are constantly constipated, you may have to strain when you go to the bathroom. This also puts unnecessary pressure on the pelvic floor.
- Weight lifting: This risk is higher for those who lift weights regularly, especially those who lift weights incorrectly. You need to be careful about this when doing household chores and at work.
- Obesity: As body weight increases, the load on the pelvic floor muscles increases. This can also weaken the muscles in the long run.
- Pelvic surgery: After surgery, such as a hysterectomy, the supporting structures of the pelvic floor can sometimes become weakened.
- Radiation therapy to the pelvic area: Radiation therapy to the pelvic area for conditions such as cancer can also damage and weaken the tissues.
What are the symptoms of an enterocele?
Some women may not have any symptoms at all. That is, they may not feel it even if they have an enterocele. However, when symptoms do appear, they may experience the following:
- A feeling like something like a ball has come down from inside the vagina (Bulge inside the vagina): You may even catch it yourself.
- Difficulty completing a bowel movement: It can feel like you have difficulty passing stool, or like you haven't completely passed it. Some people may need to use a finger to help them pass a bowel movement.
- Pressure, heaviness, aching, or fullness in the pelvic area: This discomfort may increase, especially during sex, exercise, standing for long periods, or coughing.
- Urinary incontinence: You may unintentionally leak a small amount of urine when you cough, laugh, sneeze, or lift something heavy.
- Lower abdominal and back pain: This pain may seem to ease a little when you lie down.
Imagine, after working hard all day, in the evening, you feel a heaviness in your vagina, as if something is coming out from inside. It feels a little better when you sit or lie down. If you have this kind of experience, be careful about it.
How do you diagnose an enterocele?
If you have these symptoms, it's best to see a doctor. A gynecologist is usually the one who treats these conditions.
When your doctor examines you, they will do a pelvic exam. The doctor may feel a lump that is caused by the small intestine pushing into the vagina. The doctor may ask you to cough or press down. The lump can then be seen and felt better. They may also do a rectal examination.
In addition, one or more of the following tests may be performed:
- Cystoscopy: In this, a thin tube with a camera (cystoscope) is inserted through the urethra to examine the bladder, its location, and its position.
- Imaging tests: An MRI, ultrasound scan, or CT scan may be done to look at the pelvic floor muscles and to see exactly which organs have prolapsed.
- Urodynamic testing: These tests help determine how the bladder is functioning and what is causing the problem with urination.
What are the treatments for this?
The good news is that there are treatments for enterocele. There are both non-surgical and surgical treatments. Your doctor will determine the best treatment for you based on your age, overall health, and the nature of your symptoms.
There are three main treatment methods:
1. Inserting a pessary: This is a device made of rubber (latex) or plastic (silicone) that can be inserted into the vagina. It works by supporting the pelvic floor muscles. It acts as a support for the lower part of the vagina. It can be used while waiting for surgery, or it can be used continuously for those who cannot have surgery. However, it does not eliminate the enterocele, it only controls the symptoms. Your doctor will show you how to insert it, remove it, and keep it clean.
2. Pelvic floor exercises: These are also called Kegels . These exercises strengthen the muscles of the pelvic floor. Your doctor may also refer you to a physical therapist. There are physical therapists who specialize in treating pelvic floor problems. They will teach you how to do these exercises. They may also use techniques like biofeedback to help you identify and exercise the muscles.
3. Surgery: If other methods have not worked, or if the condition is more severe, surgery may be necessary. Surgery involves putting the small intestine back in place and repairing the torn tissue. Most of the time, this surgery is done through the vagina, without making a large incision, as a minimally invasive procedure. Sometimes it can also be done through the abdomen. Your doctor will explain the surgical procedure that is best for you.
Can enterocele be prevented?
While it's not completely preventable, there are things we can do to reduce our risk. These things can help prevent not only enterocele, but also other pelvic floor problems:
- Eat a high-fiber diet and drink plenty of water: This can help prevent constipation. This will reduce straining. Include greens, vegetables, fruits, and whole grains in your diet.
- Get help when lifting weights, and lift weights correctly: Don't lift weights that you can't handle alone. If you are lifting a heavy object, keep your back straight and bend your knees.
- Reach or maintain a healthy weight: Obesity is a major risk factor for this.
- Treat a persistent cough: If you have a cough, find the cause and treat it.
- If you smoke, stop: Smoking not only causes coughing, but it can also damage tissues.
What is the prognosis for people with enterocele? (Prognosis)
In most cases, symptoms can be well controlled with non-surgical treatments. Some women may not need any treatment if they have no symptoms. Serious complications from an enterocele are rare, so there is no need to worry unnecessarily. The most important thing is to seek medical advice if you have symptoms.
When should you see a doctor?
If you have any of these symptoms, definitely see a doctor:
- Bladder control issues.
- Blood in urine.
- Painful urination or frequent urination.
- Severe constipation or difficulty having a bowel movement.
- If you feel an unusual heaviness, pressure, or lump in your vagina.
Don't ignore these things. Getting treatment early can prevent the condition from getting worse.
What questions should you ask the doctor?
When you go to see the doctor, don't hesitate to ask questions that are on your mind. For example, you can ask things like:
- Why did I develop this enterocele?
- What treatment method is best for me?
- Am I at risk of developing other problems because of this?
- What complications should I be concerned about?
- What changes do I need to make to my lifestyle after treatment?
It is very important to ask questions like these and gain a better understanding of your situation.
Remember as a summary (Take-Home Message)
Enterocele, or prolapse of the small intestine, is a condition that most often occurs in postmenopausal women and women who have had more than one child. However, many people will have no symptoms and may not need treatment.
However, if you have symptoms such as vaginal heaviness, pressure, or difficulty passing stool, it's best to talk to a doctor about it. Often, symptoms can be controlled by using a pessary or doing pelvic floor exercises like Kegels. Surgery is rarely necessary.
The most important thing is to understand that this is not just your problem and not be afraid to ask for help. Your doctor will help you.
` Enterocele, small bowel prolapse, pelvic organ prolapse, vagina, women's health, menopause, Kegel exercises
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