Small Bowel Prolapse (Enterocele) and Vaginal Vault Prolapse

What is small bowel prolapse?

Small bowel prolapsed also known as enterocele is a medical condition characterized by entry of a portion of the small bowel into the lower part of the pelvic cavity. It pushes the upper portion of the vagina leading to bulging of the area. In women with a history of surgical removal of the uterus (hysterectomy), this condition is also known as apical or vaginal vault prolapse. It usually involves part of the bladder and rectum besides the small intestine.

With progression of age and childbirth the muscles of the pelvic floor that support the pelvic organs become weak. In mild to moderate cases surgery is not essential but in severe cases surgical correction of the prolapse is essential.

Small Bowel Prolapse Symptoms

In case of mild prolapse there may not be any symptom. As the severity of the condition increase, there are a number of symptoms that becpme evident like :

  • Pulling sensation in the pelvic area which relieves only with lying down.
  • Abnormal feeling of fullness.
  • Pressure and pain in the pelvic area.
  • Pain in the lower back region.
  • Bulging of soft tissue in the upper part of the vagina.
  • Discomfort or pain during sexual intercourse.

In many women, along with prolapse of small bowel there may also be other pelvic organs which slip down.

  • Rectocele, also known as a posterior prolapse. where the rectum pushes the vaginal wall from back.
  • Cystocele, also known as anterior prolapsed, when the bladder pushes the vaginal wall from the front.
  • Uterine prolapse when the uterus tends to slip down from above.

Causes of Small Bowel Prolapse

The muscles of the pelvic floor maintain the proper position of different pelvic organs. With progression of age the muscles gradually become weak resulting in gradual decline of support for the pelvic organs. Common causes of weakening of the muscles of pelvic floor include :

  • Pregnancy and repeated childbirth.
  • Excessive straining in patients with chronic constipation.
  • Chronic cough.
  • Frequent lifting of heavy weights.
  • Being overweight or obese.

Pregnancy is one of the most common reasons for weakening of the pelvic muscle support. The muscles, ligaments and other tissue of the pelvic floor become stretched during pregnancy and childbirth thereby increasing the chance of downward movement of the pelvic organs in the future.

Risk factors

Common risk factors include :

  • Vaginal delivery of more than one babies, although not all the women with multiple pregnancy suffer from small bowel prolapse.
  • Progressive age leads to weakening of the pelvic floor muscles.
  • History of surgery in the pelvic region like surgical removal of the uterus (hysterectomy).
  • Increased intra-abdominal pressure due to chronic constipation, overweight and cough.
  • Smoking leads to a chronic cough and weakens the connective tissue of the pelvic floor over time.
  • Family history of small bowel prolapse especially in mothers of patients.
  • Connective tissue disorder leading to inherent deterioration of the strength of the pelvic floor.

Small Bowel Prolapse Treatment

Mild to moderate cases do not require surgical intervention. However, close monitoring for worsening of symptoms and introduction of pessary to prevent slipping of the small bowel downward is necessary. In severe cases, surgery is done to strengthen the pelvic floor along with repositioning of small bowel at its original position.

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