Medical & Surgical Urology
Open Access

Enterocele: A Lesser-Known Pelvic Floor Disorder Demystified

AR Zwaans Willem^{* *}Correspondence: AR Zwaans Willem, Department of Nephrology, Máxima Mecial Center, Eindhoven, The Netherlands, Email:

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About the Study

Pelvic floor disorders are often shrouded in silence and misconceptions. While conditions like urinary incontinence and pelvic organ prolapse receive significant attention, there's a lesser-known pelvic floor disorder called enterocele that deserves our understanding. The pelvic floor is a complex network of muscles, ligaments, and connective tissues that provide support to the organs within the pelvis, including the bladder, uterus (in females), and rectum. It plays a vital role in maintaining continence, supporting the pelvic organs, and ensuring overall pelvic stability. Enterocele is a type of Pelvic Organ Prolapse (POP) that occurs when the small intestine (ileum) or other abdominal contents protrude into the vaginal space.

This displacement often causes a noticeable bulge or herniation in the vaginal wall. Enterocele typically develops as a result of weakened pelvic floor muscles and ligaments.

Causes and risk factors

Several factors can contribute to the development of enterocele, including:

Childbirth: Vaginal childbirth, especially if accompanied by traumatic or prolonged labor, can weaken the pelvic floor muscles and increase the risk of enterocele.

Aging: The natural aging process can lead to the weakening of pelvic structures, making older individuals more susceptible to enterocele.

Hysterectomy: Women who have undergone a hysterectomy, particularly if it involved the removal of supporting ligaments, may be at an increased risk of enterocele.

Chronic constipation: Straining during bowel movements over an extended period can weaken the pelvic floor muscles and contribute to the development of enterocele.

Symptoms of enterocele

The symptoms of enterocele can vary in severity and may include:

Vaginal bulge: The most common symptom of enterocele is a noticeable bulge or pressure in the vaginal wall, which may become more pronounced when standing or straining.

Pelvic discomfort: Many individuals with enterocele report a sensation of fullness or discomfort in the pelvis.

Lower backache: Some individuals experience lower back pain, which may be exacerbated by prolonged periods of standing or physical activity.

Difficulty with bowel movements: Enterocele can cause constipation and difficulty emptying the rectum completely.

Diagnosis

Diagnosing enterocele typically involves a thorough medical history, physical examination, and sometimes imaging studies like pelvic ultrasound or Magnetic Resonance Imaging (MRI). During the physical examination, healthcare providers may ask individuals to bear down, cough, or strain to assess the presence and severity of the vaginal bulge.

Treatment options

The treatment approach for enterocele depends on the severity of symptoms and the impact on an individual's quality of life. Treatment options may include:

Lifestyle modifications: Mild cases of enterocele can often be managed through lifestyle changes such as dietary adjustments to prevent constipation and pelvic floor exercises to strengthen the muscles.

Pessaries: A pessary is a device inserted into the vagina to provide support and alleviate symptoms. It is a non-surgical option that can be effective for many individuals.

Physical therapy: Pelvic floor physical therapy, including exercises and biofeedback, can help strengthen the pelvic floor muscles and improve symptoms.

Surgical intervention: In severe cases or when conservative measures are ineffective, surgery may be necessary to repair the enterocele and provide support to the pelvic organs. Surgical options can range from traditional open procedures to minimally invasive techniques like laparoscopy.

The importance of awareness

Despite being less well-known than some other pelvic floor disorders, enterocele can significantly impact an individual's quality of life. Awareness of this condition is essential among both healthcare providers and the general public to ensure timely diagnosis and appropriate treatment. Regular pelvic examinations and open communication with healthcare providers are crucial steps in addressing enterocele and other pelvic floor disorders effectively. Enterocele may not be as widely recognized as some other pelvic floor disorders, but it can significantly affect an individual's well-being. Understanding its causes, symptoms, and available treatment options is essential for early diagnosis and intervention.