Definition:
Enterocele is a condition among women in which the muscles and tissues that hold the small bowel in place stretch or weaken, causing the small bowel to drop from its original position and protrude through the vaginal wall, and creating a bulge. Vaginal hernia is the result of enterocele.
Diagnosis:
A pelvic exam is needed to confirm a diagnosis of enterocele. The doctor would require the patient to take a deep breath and hold it while bearing down. Also called the Valsalva maneuver, it will likely cause the prolapsed small bowel to bulge downward. If the doctor can't verify the condition in the said position, he or she may repeat the exam while the patient stand with one foot on a short stool.
Treatment:
Treatment may not be required for mild cases of enterocele. Nonsurgical treatments or approached to treat the condition include vaginal pessary and estrogen therapy. Severe cases that cause discomfort to the affected individual may require surgery. This approach however, poses risks and needs careful consideration among women who still want to bear more children.
Symptoms and Signs:
Mild enterocele may not produce signs or symptoms but patients with the more sever case will experience a pulling sensation in the pelvis that eases when lying down, a feeling of pelvic fullness, pressure, or pain, low back pain, a soft bulge of tissue in the vagina, vaginal discharge and bleeding, and vaginal discomfort and painful intercourse.
Related conditions such as rectocele, cystocele, and uterine prolapse may also occur due to the weakening of the pelvic floor muscles.
Causes:
The four categories of enterocele are determined by the cause. The first category is traction enterocele, which is caused by pregnancy, childbirth, and loss of estrogen. Congenital enterocele meanwhile is very rare and some women are born with it. Iatrogenic enterocele meanwhile may result from surgical removal of the uterus and some surgical procedures used to put a prolapsed bladder back into position to treat urinary incontinence but the cause of this category is not really fully known. Pulsion enterocele meanwhile may be caused by pressure inside the abdomen, such as chronic cough or extreme physical exertion.
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