Small Bowel Prolapse (Enterocele)

What is Small Bowel Prolapse?

A small bowel prolapse, or enterocele, is tissue from the small intestine that falls out of place and bulges into the pelvic cavity and the wall of the vagina. While this kind of hernia can be present at birth, it is rare, and there are many other causes  For instance, an enterocele can be very common during a vaginal birth as a woman labors. If a woman has had surgery, like a hysterectomy, that may have previously weakened the vaginal wall, making a hernia more likely to appear.

Enteroceles can also be prevalant in those who smoke or those with chronic respiratory issues, since excess coughing can cause the pelvic floor to strain; and, it is commonly seen in diseases that affect connective tissues, like Ehlers-Danlos syndrome. If a person tries to lift heavy items coninually, or they themselves are obese, then the extra pressure and weight can cause a prolapse. Lastly, enteroceles can be hereditary in nature and are mainly seen in certain races—like caucasion women.

What are the Symptoms of Small Bowel Prolapse ?

Signs of enteroceles include painful sexual intercourse, pelvic pressure, swollen vaginal tissue, and pelvic bloating. A person may also experience low pack pain or a feeling that the pelvis is tuggin downward—both of which are only relieved once a person lies down.

Small Bowel Prolapse (Enterocele) Causes

Enterocele usually occurs as a result of pelvic floor weakness, when the muscles in the pelvic region become too weak to adequately support the small bowel and vagina. Usually, pregnancy and childbirth are the biggest contributors to pelvic floor weakness because they cause the pelvic muscles to severely stretch; however, there are other factors involved.

Chronic coughing, chronic constipation, frequent heavy lifting, and obesity can all put added pressure on the pelvic floor. Women who have had another prolapsed pelvic organ previously are also more at risk of developing enterocele since this will exert more pressure on the pelvic cavity. Surgery such as hysterectomy or surgical treatment for urinary incontinence could also contribute to an enterocele.

Age has a role in small bowel prolapse too, with older women being more likely to experience it. This is because as we age we naturally lose muscle mass and strength, particularly after going through menopause. For this reason, women may not realize that their pelvic floor has been under pressure over many years until they get older and enterocele develops.

How is Small Bowel Prolapse Treated?

A woman should first talk to her doctor about managing any illnesses or respiratory issues that could be causing prolapse as a symptom. If a woman’s enterocele is caused by obesity, then she may want to work with a doctor on an exercise and diet plan. If a woman is chronically constipated or straining while passing a stool, she may want to work on a diet that includes more fiber and taking time while in the restroom.

Kegel exercises can help strengthen the muslces in the pelvis and provide some relief. While rubber, silicone, or plastic pessaries can be used for contraceptive means, they can also be inserted into the vagina to support any collapsing tissues. For serious hernias, surgery may be recommended to repair any stretches or tears in vaginal tissue.

Small Bowel Prolapse (Enterocele) Prevention

The best way to prevent small bowel prolapse is to strive to maintain a strong, healthy pelvic floor. Daily Kegel exercises are important for all women, but particularly those who are pregnant or have had a baby, as it will help their pelvic floor to recover more successfully after childbirth and reduce weakness when they get older.

It’s also important to avoid things which could gradually lead to pelvic floor weaknesses. Chronic coughing should be investigated by a doctor, not only because treatment will benefit the pelvic floor but also to rule out any serious health conditions. Maintaining a healthy weight is also very important. Those who lift heavy objects on a regular basis should learn correct form and try to engage their pelvic floor with each lift to avoid repeatedly straining the muscles.

Chronic constipation is also a risk factor for enterocele and should be avoided. Eating a diet that is rich in fiber and drinking plenty of liquids will help to keep stools soft and easy to pass. Doing regular exercise also helps to keep the bowel movements regular and reduces the risk of constipation.

Last Reviewed:
October 10, 2016
Last Updated:
November 09, 2017