Generally speaking, enterocele is an abnormality in the intestinal tract that is caused by bacteria, viruses or parasites. If the disorder is not treated properly, it can lead to life-threatening complications. Fortunately, there are ways to prevent the disease and treat it if it does occur.
Symptoms
Symptoms of enterocele include pressure or pulling sensation in the pelvic region. Patients may also experience fullness in the rectum, vaginal discharge, and difficulty emptying the bowel. Depending on the severity of the condition, surgery may be needed.
The most common symptom of enterocele is obstructed defecation. If the sphincter muscles are not functioning properly, the small intestine may be able to prolapse.
Other symptoms may include pelvic pain and dyspareunia. The condition can be diagnosed with a physical exam. Imaging tests can be used to check for the presence of prolapsed organs. The most useful test for enterocele is the videoproctogram. This is a technique that allows the health care provider to see if a bulge is present in the vagina.
When the sphincter is not functioning correctly, the small intestine can slip between the top of the vagina and the rectum. This can create a bulge that can lead to obstructed defecation. This type of test can help determine if the sphincter is damaged.
In addition to the sphincter function test, the healthcare provider may perform other tests to determine if the patient has an obstructed bowel. These tests can detect infection, as well as blood urea nitrogen levels, which can rule out hematuria. Urine testing is another method that can help diagnose a urination problem.
To determine the extent of the enterocele, a urologist will provide the patient with a personalized treatment plan. Surgical procedures, such as anterior levatorplasty or Douglas’ pouch repair, can be used to treat the problem. The surgeon will tighten connective tissue in the pelvic floor to prevent further damage.
To decrease the risk of enterocele, individuals should exercise the muscles in the pelvic region. These exercises can help strengthen the pelvic floor and relieve the discomfort of the affliction. A urologist may recommend pelvic physical therapy.
The best way to reduce the chance of an enterocele is to avoid putting unnecessary strain on the abdominal muscles. Weight lifting or chronic coughing can put extra pressure on the abdominal muscles. Having a family history of enterocele puts the individual at greater risk.
Diagnosis
Several diagnostic methods have been used to diagnose enterocele. These include urodynamics, defecography, pelvic examination, fluoroscopy, and dynamic cystocolpoproctography. Although these methods are not conclusive, they may help in identifying the condition.
During a rectal examination, the physician should assess the patient for symptoms of an occult enterocele. Using Allis clamps, the peritoneum is grasped at the five-o’clock and seven-o’clock positions. The bowel can be packed away with moist tail sponges.
If a rectocele is detected, the physician should perform a Valsalva maneuver, a method of reorienting the bowel downward. The surgeon will then put the small bowel back into its normal position and tighten the connective tissues.
In the event of an acute enterocele, surgical repair is necessary. This procedure follows the general principles of hernia repair, such as reduction of the intra-abdominal contents, mobilization of the enterocele sac, and closing of the sac using circumferential purse-string sutures.
Patients with larger vault prolapses may experience symptoms of dyspareunia and lower back pain. In addition, they will also report symptoms of voiding dysfunction.
The diagnosis of enterocele is difficult, and the condition often occurs in older women. In addition, the incidence of enterocele is higher in multiparous women.
In the absence of a rectal examination, it is hard to differentiate an enterocele from a high rectocele. However, a combination of rectal and vaginal examination can be useful to distinguish an enterocele from a rectocele.
Surgical repair of apical or posterior prolapse is frequently associated with enterocele. In some gynecologists, this may be sufficient to cure the condition.
In patients with enterocele, the incidence of low backache is higher than that of patients without the defect. This difference does not appear to be statistically significant.
In addition, a large number of recurrences have been reported following a vaginal hysterectomy. The cause of the defect appears to be chronic cough. In addition, being overweight increases the risk of developing enterocele.
Performing Kegels exercises will strengthen the pelvic muscles and may help to resolve the condition. Additionally, patients with enterocele should avoid constipation. Maintaining a proper diet and staying hydrated are important to prevent constipation.
Treatment
Surgical enterocele treatment is available to patients who have symptoms of massive vaginal eversion and/or occult urinary incontinence. The surgery aims to repair the small intestine and restore its normal functioning. In some cases, the procedure is performed in conjunction with rectocele surgery.
A severe form of enterocele can cause pain and pressure on the pelvis. In such cases, a barium passage X-ray is prescribed. A CT scan of the abdominal cavity may also be used. In some cases, a synthetic mesh is used to support the weakened tissues.
The risk of enterocele increases with age. Several conditions can contribute to this, including heavy lifting, coughing, and obesity. The strength of the pelvic muscles is strongly linked to the levels of estrogen in women. It is important to have regular pelvic exams, especially if the patient is in menopause.
There are several nonsurgical enterocele treatment methods that include strengthening the pelvic floor muscles and improving the quality of bowel movements. Exercises such as Kegels can help.
In some cases, a silicone or rubber pessary is inserted into the vagina to provide support for the abdominal muscles. This can prevent constipation and make defecation easier for the patient.
Pelvic organ prolapse is a common health problem. It can cause complications, such as urinary retention, painful sensations during sexual intercourse, and chronic constipation. It can also result in a cystic lesion on the vagina.
If the condition is not serious, a nonsurgical treatment may be enough. Depending on the level of the prolapse, other tests may be performed. These tests can be used to detect infection, measure creatinine and blood urea nitrogen, and rule out other complications. A high fiber diet can also be recommended.
Some women prefer to strengthen the vaginal wall using their own tissues or synthetic mesh implants. In other cases, the surgeon will tighten connective tissue and reposition the intestine.
There are minimally invasive enterocele treatment options available at Loma Linda University Health. The process involves closing the rectovaginal septum, strengthening the pelvic floor, and reinforcing the rectovaginal wall. The recovery time from surgery can be 3-6 weeks.
Risks
Unlike other pelvic organ prolapses, enteroceles are relatively rare in children. However, it is possible to develop them, and in some cases, surgery may be required.
This condition occurs when the small bowel is pushed through a weak spot in the vaginal wall. If it is not treated right away, it can become infected and cause damage to the bladder, urethra and nerves. The risk of recurrence also increases. The best way to diagnose an enterocele is through a physical examination, and by watching for symptoms.
The symptoms of an enterocele include a bulge in the vagina, as well as pain in the abdomen or pelvis. This may be felt during a deep breath or when a bowel movement is incomplete. In severe cases, the bladder and kidneys can also be affected. The discomfort in the pelvic area is usually worse when a woman is lifting heavy objects or performing other strenuous activities.
In mild cases, enteroceles can be corrected with pessaries or other devices. These are tiny devices that support the pelvic organs. However, they are not a good option for women who are sexually active or who are pregnant.
Surgical techniques to correct enteroceles vary, depending on the size and location of the prolapse. Some surgeons use robotic methods or an open surgical procedure. Others use a biologic graft to reposition the small intestine. The technique is dependent on the other organs that may have also prolapsed.
Surgical procedures to correct enteroceles are often performed along with rectocele surgery. This allows the surgeon to tighten connective tissue and place a synthetic mesh to reinforce the rectovaginal septum. The surgery can be painful and may result in a blood clot or infection.
In severe cases, pelvic floor surgery may be necessary. In these cases, the surgeon will move the prolapsed small bowel back into the pelvic cavity. They will also tighten the pelvic floor connective tissue. These surgeries can be painful and can cause damage to the bladder, urethra, and nerves. The recovery period is very long, and the patient will be required to make certain lifestyle changes.