Enterocele is a form of pelvic organ prolapse in which part of the small bowel and its peritoneal sac descends into the lower pelvis and bulges toward the upper vagina. It may occur alone or together with other forms of pelvic support weakness. The condition can cause a sensation of pelvic pressure, vaginal bulging, heaviness, and discomfort that often worsens with standing or straining. ^[1][2][3]

Overview

Pelvic support depends on muscles, ligaments, fascia, and prior surgical or obstetric history. When those supports weaken, different organs may prolapse. Enterocele is distinct because the prolapsing content involves small bowel, but it is often part of a broader pelvic floor problem rather than an isolated structural defect. ^[1][2]

Symptoms

Symptoms may include pelvic pressure, a feeling of fullness, a visible or palpable vaginal bulge, lower back discomfort, worsening pressure later in the day, and symptoms during bowel movements or intercourse. Not every enterocele is equally symptomatic; the degree of bother matters as much as the anatomic finding. ^[1][2]

Causes and risk factors

Risk factors include childbirth, aging, menopause-related tissue changes, chronic straining, constipation, obesity, prior pelvic surgery—especially hysterectomy in some patients—and generalized pelvic floor weakness. These factors do not guarantee prolapse, but they can increase the likelihood. ^[1][2][3]

Diagnosis

Diagnosis often begins with pelvic examination, sometimes in both lying and standing positions and with straining maneuvers. In selected cases, imaging or specialized pelvic floor studies may help define associated prolapse compartments or guide surgery. The aim is to understand not only whether an enterocele is present but also whether other prolapse types coexist. ^[1][2]

Treatment options

Treatment depends on symptom severity, associated prolapse, overall health, and patient preference. Options may include pelvic floor physical therapy, bowel habit optimization, pessary use in selected patients, and surgery when symptoms are significant or conservative measures are insufficient. ^[1][2][3]

Complications and follow-up

Complications tend to relate more to symptoms, quality of life, and coexisting prolapse than to emergency danger. However, untreated bothersome prolapse can affect comfort, mobility, bowel function, and sexual well-being. After treatment, follow-up may focus on symptom relief, recurrence, and pelvic floor support. ^[1][2]

When should a doctor be consulted?

Medical review is appropriate when there is bothersome vaginal bulging, pelvic heaviness, worsening pressure, bowel difficulty, or uncertainty about the cause of pelvic symptoms. Sudden severe pain or inability to reduce a prolapse should be assessed urgently. ^[1][2]

Living with the condition and monitoring

Many patients benefit from avoiding chronic straining, treating constipation, learning pelvic floor strategies, and understanding that prolapse symptoms can fluctuate throughout the day. Symptom burden—not embarrassment—should drive the decision to seek help. ^[1][2]

Prognosis and follow-up

Some patients do well with conservative management, while others require surgery for durable symptom improvement. Recurrence is possible, especially when multiple support defects are present or pelvic floor strain continues over time. ^[1][2][3]

FAQ

What is enterocele?

It is a type of pelvic organ prolapse in which the small bowel descends into the pelvic space and bulges toward the vagina. ^[1][2]

Does enterocele occur by itself?

Not always. It may coexist with other pelvic organ prolapse such as cystocele or rectocele. ^[1][2]

Does every enterocele require surgery?

No. Treatment depends on symptoms, associated prolapse, and patient preference. ^[1][2][3]

What is the most common complaint?

Pelvic pressure, heaviness, or a vaginal bulge are among the most common symptoms. ^[1][2]

Can it come back?

Yes. Recurrence is possible even after treatment, which is why follow-up and pelvic floor support remain important. ^[1][2]