Description

Small bowel prolapse, also called enterocele (EN-tur-o-seel), occurs when the bowel (small intestine) falls to the bottom of the 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 the pelvic floor can weaken the muscles and ligaments that support the organs of the pelvis, making the small intestine prolapse more likely to occur.

To manage the small intestine prolapse, self-care measures and other non-surgical options are often effective. In severe cases, surgery may be needed to correct the prolapse.

Symptoms

Mild prolapse of the small intestine can produce signs or symptoms. However, if you have a prolapse, you may experience:

  • A pulling sensation in your pelvis and relieves the bed
  • A feeling of fullness in the pelvis, pain or pressure in the
  • The low back pain that eases when you lie down
  • A soft bulge of tissue in your vagina
  • Vaginal discomfort and painful intercourse (dyspareunia)

Many women with prolapse of the small intestine also prolapse of the experience of other pelvic organs, such as the bladder, uterus or rectum.

When to see a doctor

Consult your doctor if they develop signs or symptoms of prolapse that bother you.

Causes

The increased pressure on the pelvic floor is the main reason for any type of prolapse of the pelvic organs. The conditions and activities that may cause or contribute to small bowel prolapse or other types of prolapse include:

  • Pregnancy and childbirth
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated lifting of heavy objects
  • Overweight or obesity

Pregnancy and childbirth

Pregnancy and childbirth are the most common causes of pelvic organ prolapse. The muscles, ligaments and fascia that hold and support your vagina to stretch and weaken during pregnancy, labor and delivery.

Not everyone who has had a baby develops the pelvic organ prolapse. Some women have very strong support to the muscles, ligaments, and fascia in the pelvic and never have a problem. It is also possible that a woman who has never had a baby to develop pelvic organ prolapse.

Risk factors

Factors that increase your risk of developing prolapse of the small intestine are:

  • Pregnancy and childbirth. Vaginal delivery of one or more of the children contributes to the weakening of the pelvic floor support structures, increasing the risk of prolapse. The greater number of pregnancies you have, the greater your risk of developing any type of prolapse of the pelvic organs. Women who have only births by c-section are less likely to develop prolapse.
  • Age. Small bowel prolapse and other pelvic organ prolapse is most likely to occur with increasing age. As you get older, you tend to lose muscle mass and muscle strength in the pelvic muscles as well as other muscles.
  • Surgery of the pelvis. The removal of the uterus (hysterectomy) or surgical procedures to treat incontinence can increase your risk of developing prolapse of the small intestine.
  • The increase in abdominal pressure. Being overweight increases the pressure inside your abdomen, which increases the risk of developing prolapse of the small intestine. Other factors that increase the pressure to include ongoing (chronic) cough and straining during defecation.
  • The habit of smoking. Smoking is associated with the development of prolapse because smokers often of a cough, increased abdominal pressure.
  • Of the race. For unknown reasons, Hispanic and white women are at higher risk of developing pelvic organ prolapse.
  • Connective tissue disorders. You may be genetically prone to prolapse due to the weakening of the connective tissues in the pelvic area, which, of course, more susceptible to the small bowel prolapse and other pelvic organ prolapse.

Prevention

You may be able to reduce your odds of small intestine prolapse with these strategies:

  • Maintain a healthy weight. If you are overweight, losing some weight can decrease the pressure on the inside of your abdomen.
  • Prevent constipation. Eat foods rich in fiber, drink plenty of fluids and exercise regularly to help avoid having to strain during bowel movements.
  • The treatment of chronic cough. Constant coughing increases the pressure in the abdomen. See your doctor to ask about treatment if you have an ongoing (chronic) cough.
  • Stop smoking. Smoking contributes to chronic cough.
  • Avoid lifting heavy objects. Heavy lifting increases the abdominal pressure.

Diagnosis

To confirm a diagnosis of prolapse of the small intestine, the doctor performs a pelvic exam. During the exam, your doctor may ask you to take a deep breath and hold it while bearing down as if you were having a bowel movement (Valsalva maneuver), which is likely the cause of the prolapse of the small intestine to bulge down. If your doctor is unable to verify that you have a prolapse while lying on the examination table, he or she may repeat the exam while you are standing.

Treatment

Small bowel prolapse, in general, do not need treatment if the symptoms do not bother you. The surgery can be effective if you have advanced prolapse with annoying symptoms. Non-surgical approaches are available if you want to avoid surgery, if the surgery would be too risky or if you want to become pregnant in the future.

Treatment options for prolapse of the small intestine are:

  • Of the observation. If the prolapse causes few or no obvious symptoms, no treatment is needed. Simple self-care measures, such as the realization of exercises, called Kegel exercises to strengthen the pelvic muscles may provide relief of symptoms. Avoid lifting heavy objects and constipation can reduce the likelihood of a worsening of their prolapse.
  • Pessary. A silicone, plastic or rubber device that is inserted into the vagina supports the protrusion of tissue. Pessaries come in a variety of styles and sizes. To find the right one involves a bit of trial and error. Your health care provider will measure and adjusts to the device, and you will learn how to insert, remove and clean up.
  • Surgery.A surgeon can perform surgery to repair the prolapse through the vagina or abdomen, with or without robotic assistance. During the procedure, the surgeon moves the prolapse of the small intestine back into place and tightens the connective tissue of your pelvic floor. Sometimes, small pieces of synthetic mesh can be used to help weakens the tissues. A small prolapse of the intestine, in general, are not repeated. However, further injury to the pelvic floor can occur with the increase of pressure in the pelvis, for example, with the constipation, cough, obesity, or lifting heavy objects.

Surgery. A surgeon can perform surgery to repair the prolapse through the vagina or abdomen, with or without robotic assistance. During the procedure, the surgeon moves the prolapse of the small intestine back into place and tightens the connective tissue of your pelvic floor. Sometimes, small pieces of synthetic mesh can be used to help weakens the tissues.

A small prolapse of the intestine, in general, are not repeated. However, further injury to the pelvic floor can occur with the increase of pressure in the pelvis, for example, with the constipation, cough, obesity, or lifting heavy objects.

Lifestyle and home remedies

Depending on the severity of your condition, these self-care measures may provide relief of the symptoms that you need:

  • To perform Kegel exercises to strengthen the pelvic muscles and the support weakens the vaginal tissues.
  • Avoid constipation by drinking plenty of fluids and eat foods rich in fiber, such as whole grains and fresh fruits and vegetables.
  • Avoid lifting heavy objects.
  • Try to control the cough.
  • Lose weight if you are overweight or obese.
  • To avoid that leads down to move the bowels. To trust your natural colorectal function to empty out your lower bowel.
  • Stop smoking.

Kegel exercises

Kegel exercises strengthen the pelvic floor muscles, which, in part, support the uterus, bladder and intestines. A strong pelvic floor provides a better support to your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with pelvic organ prolapse.

To perform Kegel exercises, follow these steps:

  • Tighten (contract) your pelvic floor muscles — the muscles you use to stop urinating.
  • Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start with the celebration of two seconds and relax for three seconds.)
  • Work up to holding the contraction for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

Ask your doctor for information on whether you are using the right muscles. Kegel exercises may be most successful when they are taught by a physical therapist and reinforced with biofeedback. Biofeedback involves the use of monitoring devices that help to make sure that you are squeezing the right muscles, with optimal intensity and duration of the time.

Once you have learned the correct method, you can do Kegel exercises discreetly just about any time, if you are sitting at your desk or relaxing on the couch.

Preparing for your appointment

Your first appointment may be with your primary care physician or a doctor who specializes in conditions affecting the female reproductive tract (gynecologist) or the reproductive tract and urinary system (urogynecologist, urologist).

What you can do

Here's some information to help you prepare for your appointment.

  • Make a list of the symptoms that you've had and for how long.
  • The list of your key medical information, including other conditions for which you are being treated and any medications, vitamins or supplements you are taking.
  • Have a friend or family member, if possible, to help you remember all the information that you're receiving.
  • Write down questions to ask your doctor, listing the most important first in the case of time runs short.

By prolapse of the small intestine, basic questions to ask your doctor include:

  • It is the prolapse causing my symptoms?
  • What treatment approach do you recommend?
  • What will happen if I choose not to have the prolapse treated?
  • What is the risk of this problem is repeated at any time in the future?
  • I need to follow all the existing restrictions to prevent the progression?
  • There are self-care measures I can take?
  • You should see a specialist?

Do not hesitate to ask questions during your appointment, as it will happen.

What to expect from your doctor

Your doctor may ask you questions such as:

  • What are the symptoms?
  • When did you first notice these symptoms?
  • The symptoms worsened over time?
  • Do you have pain in the pelvis? If yes, how severe is the pain?
  • Is there something that seem to trigger your symptoms, such as coughing or lifting heavy objects?
  • Do you have urine leakage (urinary incontinence)?
  • Has had an ongoing (chronic) or severe cough?
  • Do you often lift heavy objects during work or daily activities?
  • Do you strain during bowel movements?
  • Do you have any other medical condition?
  • What medications, vitamins or supplements do you take?
  • Have you been pregnant and had vaginal births?
  • Do you want to have children in the future?
Symptoms and treatment of prolapse of the small intestine (enterocele)