Learn more about this condition also called a vaginal hernia that happens when the small bowel pushes down onto the top of the vagina.
Small bowel prolapse, also called enterocele (EN-tur-o-seel), occurs when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge. The word "prolapse" means to slip or fall out of place.
Childbirth, aging and other processes that put pressure on your pelvic floor may weaken the muscles and ligaments that support pelvic organs, making small bowel prolapse more likely to occur.
To manage small bowel prolapse, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgery to fix the prolapse.
Small bowel prolapse (enterocele) occurs when muscles and tissues that hold the intestines (small bowel) in place inside the pelvic cavity weaken, causing the small bowel to descend and bulge into the vagina.
Mild small bowel prolapse may produce no signs or symptoms. However, if you have significant prolapse, you might experience:
Many women with small bowel prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus or rectum.
See your doctor if you develop signs or symptoms of prolapse that bother you.
Increased pressure on the pelvic floor is the main reason for any form of pelvic organ prolapse. Conditions and activities that can cause or contribute to small bowel prolapse or other types of prolapse include:
Pregnancy and childbirth are the most common causes of pelvic organ prolapse. The muscles, ligaments and fascia that hold and support your vagina stretch and weaken during pregnancy, labor and delivery.
Not everyone who has had a baby develops pelvic organ prolapse. Some women have very strong supporting muscles, ligaments and fascia in the pelvis and never have a problem. It's also possible for a woman who's never had a baby to develop pelvic organ prolapse.
Factors that increase your risk of developing small bowel prolapse include:
You may be able to lower your chances of small bowel prolapse with these strategies:
To confirm a diagnosis of small bowel prolapse, your doctor performs a pelvic exam. During the exam, your doctor may ask you to take a deep breath and hold it while bearing down like you're having a bowel movement (Valsalva maneuver), which is likely to cause the prolapsed small bowel to bulge downward. If your doctor can't verify that you have a prolapse while you're lying on the exam table, he or she may repeat the exam while you're standing.
Small bowel prolapse typically doesn't need treatment if the symptoms don't trouble you. Surgery may be effective if you have advanced prolapse with bothersome symptoms. Nonsurgical approaches are available if you wish to avoid surgery, if surgery would be too risky or if you want to become pregnant in the future.
Treatment options for small bowel prolapse include:
Surgery. A surgeon can perform surgery to repair the prolapse through the vagina or abdomen, with or without robotic assistance. During the procedure, your surgeon moves the prolapsed small bowel back into place and tightens the connective tissue of your pelvic floor. Sometimes, small portions of synthetic mesh may be used to help support weakened tissues.
A small bowel prolapse usually doesn't recur. However, further injury to the pelvic floor can happen with increased pelvic pressure, for instance with constipation, coughing, obesity or heavy lifting.
Pessaries come in many shapes and sizes. The device fits into the vagina and provides support to vaginal tissues displaced by pelvic organ prolapse. A health care provider can fit a pessary and help provide information about which type would work best.
Depending on the severity of your condition, these self-care measures may provide the symptom relief you need:
Kegel exercises strengthen your pelvic floor muscles, which, in part, support the uterus, bladder and bowel. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with pelvic organ prolapse.
To perform Kegel exercises, follow these steps:
Ask your doctor for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles, with optimal intensity and length of time.
Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.
Your first appointment may be with your primary care doctor or with a doctor who specializes in conditions affecting the female reproductive tract (gynecologist) or the reproductive tract and urinary system (urogynecologist, urologist).
Here's some information to help you prepare for your appointment.
For small bowel prolapse, basic questions to ask your doctor include:
Don't hesitate to ask other questions during your appointment as they occur to you.
Your doctor may ask questions such as: