7 Key Signs and Symptoms of Enterocele (Small Bowel Prolapse)

Enterocele, also known as small bowel prolapse, is a type of pelvic organ prolapse that occurs when the small intestine descends into the lower pelvic cavity and pushes against the upper part of the vaginal wall. This condition primarily affects women and often develops due to weakened pelvic floor muscles and supporting tissues. While some women with enterocele may experience no symptoms at all, others may have significant discomfort that affects their daily activities and quality of life.

Understanding the symptoms of enterocele is crucial for early detection and appropriate medical intervention. This condition can develop gradually over time, and symptoms may worsen with activities that increase abdominal pressure, such as standing for long periods, lifting heavy objects, or straining during bowel movements. In this comprehensive guide, we’ll explore the most common signs and symptoms of enterocele to help you recognize when it’s time to seek medical attention.

1. Pelvic Pressure and Heaviness

One of the most frequently reported symptoms of enterocele is a persistent sensation of pressure or heaviness in the pelvic region. This feeling is often described as something “bearing down” or “falling out” from within the pelvis. The sensation typically becomes more pronounced as the day progresses and may worsen after prolonged periods of standing or physical activity.

This pressure occurs because the small intestine is descending into an abnormal position, creating tension on the vaginal wall and surrounding pelvic structures. Many women compare this feeling to the sensation experienced during late pregnancy. The heaviness may temporarily improve when lying down, as gravity no longer pulls the intestine downward. This symptom can significantly impact daily activities, making it uncomfortable to stand for extended periods or engage in physical exercise.

2. Vaginal Bulging or Protrusion

A noticeable bulge in the vaginal area is a hallmark symptom of enterocele, particularly in moderate to severe cases. Women may feel a soft, bulging mass when touching the vaginal opening or notice something protruding from the vagina. This bulge represents the upper vaginal wall being pushed down by the prolapsed small intestine.

The bulge may not be constantly present in early stages of enterocele. It might only appear during activities that increase intra-abdominal pressure, such as coughing, sneezing, straining during bowel movements, or lifting heavy objects. As the condition progresses, the bulge may become more persistent and visible. Some women discover this symptom during bathing or when using the toilet. The size and prominence of the bulge can vary throughout the day, typically becoming more noticeable toward evening after hours of upright activity.

3. Lower Back Pain and Discomfort

Chronic lower back pain is a common but often overlooked symptom of enterocele. The discomfort typically manifests as a dull, aching sensation in the lower back and sacral region. This pain results from the altered pelvic anatomy and the strain placed on supporting ligaments and muscles as they attempt to hold the prolapsed organs in place.

The back pain associated with enterocele has distinctive characteristics that differentiate it from other causes of backache. It usually improves when lying down and worsens with prolonged standing or sitting. The pain may radiate to the buttocks or upper thighs and is often accompanied by the sensation of pelvic pressure. Unlike muscular back pain from injury or strain, this discomfort is related to the position of pelvic organs and the stress on pelvic support structures. Many women find that their back pain is relieved temporarily when they lie flat, as this position reduces the gravitational pull on the prolapsed intestine.

4. Discomfort During Sexual Intercourse

Dyspareunia, or painful sexual intercourse, is a significant symptom that affects many women with enterocele. The pain can occur during penetration or deep intercourse and may be accompanied by pressure sensations or general discomfort. This symptom occurs because the prolapsed small intestine alters the normal anatomy of the vaginal canal, and the bulging tissue can be sensitive or uncomfortable when compressed.

Women may describe the sensation as a feeling of something being “in the way” during intercourse, or they may experience sharp or aching pain in specific positions. The discomfort can lead to decreased sexual satisfaction and may cause anxiety or avoidance of sexual activity, which can strain intimate relationships. Some women also report feeling self-conscious about the bulge, adding psychological distress to the physical discomfort. The severity of this symptom can vary depending on the size of the enterocele and the degree of prolapse.

5. Bowel Movement Difficulties

Enterocele can significantly affect bowel function, leading to various symptoms related to defecation. Women may experience a sensation of incomplete bowel evacuation, feeling as though they cannot fully empty their bowels even after a bowel movement. This occurs because the prolapsed small intestine can create a pocket or obstruction that interferes with the normal passage of stool through the rectum.

Additionally, some women develop constipation or need to strain excessively during bowel movements. In some cases, women discover that applying pressure to the vaginal wall or perineum (a technique called splinting or digitation) helps facilitate bowel evacuation. This need for manual assistance during defecation is a telling sign of pelvic organ prolapse. The bowel symptoms can create a frustrating cycle, as straining during bowel movements can further weaken pelvic floor muscles and worsen the prolapse over time. Some women may also experience a sense of obstruction or blockage during bowel movements.

6. Pelvic or Vaginal Pain

Generalized pelvic pain or specific vaginal discomfort is another common symptom of enterocele. The pain may be constant or intermittent and can range from mild discomfort to severe, debilitating pain. The pain typically originates from the stretching of pelvic ligaments and tissues, irritation of the vaginal wall from the bulging intestine, and nerve compression from the displaced organs.

The character of the pain can vary widely among individuals. Some women describe it as a dull ache, while others experience sharp, stabbing sensations. The pain may be localized to the vaginal area or radiate throughout the pelvis. Activities that increase intra-abdominal pressure typically exacerbate the pain, while rest and lying down usually provide relief. In advanced cases, the prolapsed tissue may become irritated from rubbing against underwear or from exposure if it protrudes beyond the vaginal opening, leading to additional soreness and sensitivity.

7. Urinary Symptoms

Although enterocele primarily involves the small intestine, it can affect urinary function due to the interconnected nature of pelvic organs and their support structures. Women with enterocele may experience various urinary symptoms, including urinary frequency (needing to urinate more often than normal), urgency (sudden, strong urges to urinate), difficulty emptying the bladder completely, or urinary incontinence.

These urinary symptoms occur because the prolapsed intestine can compress the bladder or urethra, interfering with normal urinary function. Some women notice that they need to urinate more frequently at night or experience a weak urine stream. The sensation of incomplete bladder emptying is particularly common, as the prolapsed organs can kink or obstruct the urethra. In some cases, women may develop recurrent urinary tract infections due to incomplete bladder emptying, which allows bacteria to multiply in retained urine. The urinary symptoms may fluctuate in severity and often correlate with the degree of prolapse and the woman’s activity level throughout the day.

Main Causes of Enterocele

Understanding the underlying causes of enterocele can help identify risk factors and potentially prevent its development. The condition results from weakness in the pelvic floor muscles and connective tissues that normally support the pelvic organs. Several factors contribute to this weakening:

• Childbirth: Vaginal delivery, especially multiple births or deliveries of large babies, is one of the primary risk factors. The stretching and potential tearing of pelvic tissues during childbirth can compromise pelvic support structures.
• Age and Menopause: As women age, natural weakening of muscles and connective tissues occurs. The decline in estrogen levels during menopause further reduces tissue strength and elasticity, making prolapse more likely.
• Chronic Increased Abdominal Pressure: Conditions or activities that repeatedly increase pressure in the abdomen can contribute to enterocele. These include chronic constipation with straining, chronic coughing from lung conditions, obesity, and repetitive heavy lifting.
• Prior Pelvic Surgery: Hysterectomy and other pelvic surgeries can disrupt the normal support structures of the pelvis, potentially leading to enterocele. The removal of the uterus, in particular, eliminates a key structure in pelvic organ support.
• Genetic Factors: Some women have inherently weaker connective tissue due to genetic conditions affecting collagen production. This predisposition makes them more susceptible to all types of pelvic organ prolapse, including enterocele.
• Obesity: Excess body weight creates chronic increased pressure on the pelvic floor, gradually weakening the support structures over time.

Prevention Strategies

While not all cases of enterocele can be prevented, especially those related to genetic factors or necessary medical procedures, several strategies can reduce the risk of developing this condition or prevent its progression:

• Pelvic Floor Exercises: Regular Kegel exercises strengthen the pelvic floor muscles, providing better support for pelvic organs. These exercises involve contracting and relaxing the muscles used to stop urination and should be performed daily for maximum benefit.
• Maintain a Healthy Weight: Keeping body weight within a healthy range reduces chronic pressure on the pelvic floor. Even modest weight loss can significantly decrease stress on pelvic support structures.
• Prevent and Treat Constipation: Ensuring regular, soft bowel movements reduces the need for straining. This can be achieved through adequate fiber intake, proper hydration, and regular physical activity. When constipation does occur, address it promptly rather than allowing chronic straining to develop.
• Proper Lifting Techniques: When lifting heavy objects, use proper body mechanics by bending at the knees rather than the waist, keeping the object close to the body, and avoiding holding your breath (which increases abdominal pressure). Whenever possible, avoid lifting very heavy items.
• Manage Chronic Coughing: If you have a chronic cough due to smoking, asthma, or other lung conditions, seek appropriate medical treatment. Persistent coughing creates repeated increases in abdominal pressure that can damage pelvic support structures.
• Hormone Therapy Consideration: For postmenopausal women, discussing the potential benefits and risks of hormone therapy with a healthcare provider may be worthwhile, as estrogen helps maintain tissue strength and elasticity.

Frequently Asked Questions

Can enterocele go away on its own?

No, enterocele typically does not resolve without intervention. Once pelvic support structures are weakened, they generally do not spontaneously regain their strength. However, mild cases may not worsen if risk factors are addressed and pelvic floor exercises are performed consistently. Medical evaluation is important to determine the appropriate management approach.

How is enterocele different from other types of prolapse?

Enterocele specifically involves the small intestine pushing against the upper vaginal wall, whereas other types of prolapse involve different organs. Cystocele involves the bladder bulging into the front vaginal wall, rectocele involves the rectum bulging into the back vaginal wall, and uterine prolapse involves the uterus descending into the vaginal canal. Multiple types of prolapse can occur simultaneously.

At what age does enterocele typically occur?

Enterocele most commonly develops in postmenopausal women, typically after age 60, though it can occur at any age. Women who have had multiple vaginal deliveries, pelvic surgery, or chronic conditions causing increased abdominal pressure may develop enterocele at younger ages. The risk increases significantly after menopause due to decreased estrogen levels and natural tissue weakening.

Can I exercise if I have enterocele?

Exercise is generally beneficial, but certain modifications may be necessary. Low-impact activities such as walking, swimming, and yoga are usually well-tolerated. However, high-impact exercises, heavy weightlifting, and activities involving jumping or intense straining may worsen symptoms. Pelvic floor physical therapy can help determine appropriate exercises. Always consult with your healthcare provider before starting a new exercise program.

Will my enterocele get worse over time?

Enterocele is generally a progressive condition, meaning it may worsen over time if underlying risk factors are not addressed. However, the rate of progression varies significantly among individuals. Some women experience rapid worsening, while others remain stable for years. Factors affecting progression include continued childbearing, persistent constipation, obesity, chronic coughing, and heavy lifting. Early intervention with pelvic floor exercises and lifestyle modifications may slow progression.

Can enterocele affect pregnancy or fertility?

Enterocele itself typically does not affect fertility or the ability to conceive. However, if significant prolapse is present, it could potentially make conception more difficult and may complicate pregnancy. Pregnancy can also worsen existing enterocele due to increased weight and pressure on the pelvic floor. Women with known enterocele who are planning pregnancy should discuss their condition with their healthcare provider for appropriate management recommendations.

Is enterocele a serious medical condition?

While enterocele is not typically life-threatening, it can significantly impact quality of life and should not be ignored. In rare cases, the prolapsed intestine can become trapped or have its blood supply compromised, creating a medical emergency. Most cases cause chronic discomfort and functional problems rather than acute danger. Any symptoms of prolapse warrant medical evaluation to prevent progression and ensure appropriate management.

References:

• Mayo Clinic – Pelvic Organ Prolapse
• Johns Hopkins Medicine – Enterocele
• American College of Obstetricians and Gynecologists – Pelvic Support Problems
• NHS – Pelvic Organ Prolapse
• Urology Care Foundation – Pelvic Organ Prolapse