Skip to content
Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Pelvic Floor

Enterocele

An enterocele, or small bowel prolapse, is a condition where the small intestine descends into the lower pelvic cavity, creating a bulge in the vagina.

Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-10

Overview

What is an Enterocele?

An enterocele, also known as a small bowel prolapse, is a type of pelvic organ prolapse where the small intestine herniates downward, pushing on the top of the vagina and creating a noticeable bulge. This occurs when the pelvic floor muscles, ligaments, and connective tissues that normally hold the pelvic organs in place become weak or damaged. While any woman can develop an enterocele, it is most common in postmenopausal women and those who have had children. Often, an enterocele occurs along with the prolapse of other pelvic organs, such as the bladder (cystocele) or rectum (rectocele).

Symptoms

Common Symptoms

Many women with a mild enterocele have no symptoms. However, as the prolapse becomes more significant, you might experience:

  • A pulling or heavy sensation in the pelvis that often improves when you lie down.
  • A feeling of fullness, pressure, or pain in the lower back or pelvis.
  • A soft, reducible bulge of tissue within the vagina.
  • Pain or discomfort during sexual intercourse (dyspareunia).
  • Difficulty with bowel movements, such as constipation or a feeling of incomplete emptying.

Causes & risk factors

What Causes an Enterocele?

The primary cause of any pelvic organ prolapse, including an enterocele, is increased and prolonged pressure on the pelvic floor, which weakens the supportive muscles and tissues.

Common causes and risk factors include:

  • Pregnancy and Childbirth: Vaginal delivery is the most common cause. The strain of labor and delivery can stretch and weaken pelvic floor structures. The risk increases with the number of pregnancies.
  • Age: As women age, especially after menopause, lower estrogen levels can lead to a natural loss of muscle mass and strength in the pelvic floor.
  • Pelvic Surgery: Procedures like a hysterectomy (removal of the uterus) can increase the risk by altering the support structures in the pelvis.
  • Increased Abdominal Pressure: Chronic conditions that increase pressure in the abdomen can contribute to an enterocele. This includes:
    • Chronic constipation and straining during bowel movements.
    • Chronic coughing (from bronchitis, asthma, or smoking).
    • Obesity or being overweight.
    • Repeated heavy lifting.
  • Genetics: Some women may have inherited weaker connective tissues, making them more susceptible to pelvic organ prolapse.

When to see a doctor

You should schedule an appointment with your doctor if you experience any signs or symptoms of an enterocele that are bothersome or interfere with your daily activities. While the condition is not usually life-threatening, it can significantly impact your quality of life. It's also important to seek care as an enterocele often coexists with other forms of pelvic organ prolapse that may require evaluation and treatment.

Urgent — get care now

Not applicable.

Diagnosis & tests

How is an Enterocele Diagnosed?

Diagnosing an enterocele typically begins with a physical examination.

  • Pelvic Exam: Your doctor will perform a pelvic exam while you are lying down and possibly while standing. You may be asked to bear down as if having a bowel movement (a Valsalva maneuver) or to cough. This increases pressure in the abdomen and can make the enterocele bulge more apparent, allowing the doctor to see and feel it.
  • Imaging Tests: In some cases, imaging tests may be used to get a clearer picture of the prolapse and to check for other pelvic floor issues.
    • Defecography: This test uses X-rays or Magnetic Resonance Imaging (MRI) to create images of the rectum and pelvic floor during a bowel movement. It is very useful for identifying enteroceles, rectoceles, and internal rectal prolapse.

Treatment

Treatment Options

Treatment depends on the severity of your symptoms and how much they affect your quality of life. Many women with mild symptoms do not require treatment.

Nonsurgical Treatment

  • Pessary: A pessary is a removable silicone or plastic device inserted into the vagina to provide support for the bulging tissues. It can be an effective way to manage symptoms, especially for women who wish to avoid surgery or are not good surgical candidates.
  • Pelvic Floor Muscle Therapy: A physical therapist specializing in pelvic floor health can teach you exercises (like Kegels) to strengthen your pelvic floor muscles. Biofeedback may be used to ensure you are doing the exercises correctly.

Surgical Treatment

Surgery may be recommended for severe, symptomatic enteroceles. The goal is to move the small intestine back to its proper position and repair the weakened pelvic floor tissues. This is often done at the same time as repairing a coexisting rectocele or vaginal prolapse. The procedure can be performed through the vagina or the abdomen, often using minimally invasive laparoscopic or robotic techniques. Sometimes, a small piece of synthetic mesh is used to reinforce the weakened tissues.

Self-care

Lifestyle and Home Remedies

To help prevent an enterocele from getting worse and to relieve symptoms, you can try the following strategies:

  • Maintain a Healthy Weight: Losing excess weight can reduce the pressure on your abdominal and pelvic organs.
  • Prevent Constipation: Eat a high-fiber diet, drink plenty of fluids, and get regular exercise to avoid straining during bowel movements.
  • Avoid Heavy Lifting: Repetitive heavy lifting increases abdominal pressure and can worsen prolapse.
  • Control Chronic Coughing: If you have a chronic cough due to smoking, bronchitis, or allergies, seek treatment to reduce the strain on your pelvic floor.
  • Perform Kegel Exercises: Regularly performing pelvic floor muscle exercises can strengthen the muscles that support your pelvic organs.

Frequently asked questions

Can an enterocele happen after a hysterectomy?

Yes, having a hysterectomy can increase the risk of developing an enterocele. The uterus provides support for the top of the vagina, and its removal can sometimes lead to a weakening of the pelvic floor, allowing the small intestine to prolapse.

Is an enterocele the same as a rectocele?

No. An enterocele involves the small intestine pushing on the top part of the vagina. A rectocele involves the rectum bulging into the back wall of the vagina. However, it is common for both conditions to occur at the same time.

Does an enterocele always require surgery?

No. Surgery is typically reserved for women who have significant, bothersome symptoms that affect their quality of life. Many women with mild enteroceles can manage their condition with nonsurgical options like a pessary or pelvic floor exercises.

References

Watch: Pelvic Bulges Explained: Rectum or Small Intestine?

Play: Pelvic Bulges Explained: Rectum or Small Intestine?

This resource addresses pelvic bulges (pelvic organ prolapse), which affect up to half of women who have had children. It focuses on two conditions: Rectocele (the rectum bulges forward into the vagina, a problem from the side) and Enterocele (the small intestine pushes down into the space, a type of internal hernia, a problem from above). Diagnosis relies on symptoms, as small rectoceles can be present in up to 93% of asymptomatic women. The gold standard test is Defecography, a specialized X-ray video that records the pelvic floor in action while the patient simulates a bowel movement to check the size of the bulge and if it traps stool. Surgery is recommended based on severe symptoms (e.g., needing to press on the vaginal wall to empty the bowels). Rectocele repair strengthens the weakened wall. Enterocele often requires a different procedure, such as a Sacrocolpopexy, to lift and secure the pelvic organs.

Full description and more videos →

CallBook