Rigi10™ Malleable Penile Prosthesis
Also Known As
Small bowel prolapse, Vaginal hernia, Intestinal hernia (vaginal), Peritoneal hernia
Definition
Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum, containing small intestine that protrudes into the vaginal canal.1 This condition occurs when the muscles and tissues that hold the intestines in place inside the pelvic cavity weaken, allowing the small bowel to descend into the lower pelvic cavity and push against the top part of the vagina, creating a bulge.2 The word “prolapse” means to slip or fall out of place. Enterocele typically results from disruption of the rectovaginal septum, causing the small intestine to herniate into the rectovaginal space.3 Depending on the specific contents of the hernia sac, it may be more precisely described as an enterocele (small bowel), peritoneocele (peritoneal fat), sigmoidocele (sigmoid colon), or less commonly, cecocele (cecum).3
Clinical Context
Enterocele is clinically significant in the context of pelvic organ prolapse disorders, affecting approximately 3% to 6% of women in the United States.4 It most commonly affects postmenopausal women who are white or Hispanic, with more than one-third of women with pelvic floor disorders being between 60 and 79 years old.4
The condition occurs when muscles, connective tissues, and ligaments in the pelvic region (pelvic floor) stretch or tear.4 Several factors increase the risk of developing enterocele, including pregnancy and childbirth,2 menopause (due to decreased estrogen levels which help maintain pelvic muscle strength),4 chronic coughing from conditions like bronchitis or asthma,2 smoking, connective tissue disorders like Ehlers-Danlos syndrome, constipation, lifting heavy items, obesity, pelvic surgeries such as hysterectomy, and radiation therapy to the pelvic area.2,4
Diagnosis typically involves physical examination, although this alone may be inadequate for enterocele detection.3 MR imaging enables differentiation between enterocele and rectocele (anterior herniation of the rectum), while evacuation proctography (EP) may also be used.1,3 Postdefecation strain dynamic images are particularly important as enteroceles typically manifest during the late stage of defecation after rectal emptying.3
Treatment approaches range from conservative to surgical interventions. Self-care measures and nonsurgical options like pessary devices and Kegel exercises (pelvic floor exercises) are often effective for mild to moderate cases.2,4 In severe cases, surgical repair may be necessary, with techniques such as obliteration of the pelvic inlet with a U-shaped Mersilene mesh showing effectiveness for anatomical correction, though long-term symptom recurrence may occur in approximately 25% of patients.1