Enterocele

Enterocele is a type of pelvic organ prolapse in which a segment of the small intestine herniates into the vaginal canal. It occurs through a defect in the rectovaginal septum and the posterior vaginal wall, placing the enterocele in the posterior compartment of the pelvis. It is commonly associated with weakening of pelvic floor tissues and support ligaments, and it often follows childbirth, aging, or pelvic surgery such as hysterectomy.

Symptoms range from none to a noticeable vaginal bulge or fullness, pressure in the pelvis, and discomfort that worsens with standing or Valsalva maneuvers. Some individuals report bowel symptoms such as constipation or a sensation of incomplete evacuation. Enteroceles can occur with other pelvic organ prolapses, such as rectocele or cystocele.

Diagnosis is typically made by a pelvic examination, where a loop of small intestine is seen protruding into the posterior vaginal wall. Imaging studies, including defecography, pelvic MRI, or transvaginal ultrasound, may be used to delineate anatomy and identify coexisting prolapses.

Treatment depends on severity and symptoms. Mild cases may be managed with pelvic floor physical therapy, lifestyle modifications, or observation. A vaginal pessary can provide mechanical support. Surgical options aim to restore posterior vaginal wall support and reapproximate the rectovaginal septum, with approaches including posterior colporrhaphy and, in more extensive prolapse, abdominal or vaginal repairs that may be combined with sacrocolpopexy. Recurrence can occur, and rare complications include incarceration leading to bowel obstruction.