Small Bowel Prolapse Enterocele – Symptoms and Causes

Overview

Small bowel prolapse, or enterocele, happens when the small intestine drops into the lower pelvic area and pushes against the top of the vagina. This creates a bulge in the vaginal wall.

Several factors can weaken the pelvic floor muscles and ligaments that normally keep organs in place:

• Childbirth
• Aging
• Chronic pressure on the pelvic area

The weakened support structures make it easier for the small bowel to slip from its normal position.

Most people with small bowel prolapse can manage their condition with non-surgical approaches. These include lifestyle changes and special exercises.

For severe cases that cause significant symptoms or discomfort, surgical repair may be necessary to restore the proper position of the organs.

Signs You May Notice

Small bowel prolapse might not cause any noticeable problems if it’s mild. For more serious cases, you might experience several symptoms.

You may feel a pulling in your pelvic area that gets better when you lie down. Some people describe a feeling of fullness or pressure in the pelvis.

Pain in the lower back that improves when lying down is another common sign.

You might also notice a soft tissue bulge in your vagina. Many women experience discomfort in the vaginal area and pain during sex.

People with small bowel prolapse often have other pelvic organs that prolapse too, such as the bladder, uterus, or rectum.

When Medical Help Is Needed

Contact your doctor if you notice any symptoms of prolapse that cause you discomfort or concern. A healthcare professional can properly diagnose your condition and recommend appropriate treatment options.

Why Does It Happen?

Pregnancy and childbirth often put extra pressure on the pelvic floor, which can lead to pelvic organ prolapse. When a woman is pregnant, the weight of the growing baby presses down on the pelvic organs.

During labor and delivery, the muscles, ligaments, and tissues that support the vagina stretch significantly.

These supporting structures may not always return to their original strength after childbirth. The stretching and weakening can cause organs to shift from their normal positions.

Not all women who have children will develop prolapse. Some have naturally stronger pelvic floor muscles and supporting tissues that withstand these changes better. Women who have never been pregnant can also experience pelvic organ prolapse for other reasons.

Common risk factors during pregnancy and childbirth:

• Long labor, especially the pushing stage
• Large babies (over 8.5 pounds)
• Multiple vaginal deliveries
• Use of forceps or vacuum during delivery
• Tears or episiotomies

Risk Factors

Several factors can increase the chances of developing small bowel prolapse:

Pregnancy and Childbirth

• Vaginal deliveries weaken pelvic floor support structures
• Risk increases with each pregnancy
• Women with only cesarean deliveries have a lower risk

Aging Process

• Risk increases as you get older
• Age-related loss of muscle mass and strength affects pelvic muscles

Surgical History

• Hysterectomy (uterus removal) may increase risk
• Previous incontinence surgeries can weaken pelvic support

Increased Abdominal Pressure

• Excess weight puts more pressure on abdominal organs
• Chronic coughing creates recurring pressure
• Straining during bowel movements stresses pelvic structures

Tobacco Use

• Smokers often develop chronic cough
• Repeated coughing increases abdominal pressure

Genetic and Demographic Factors

• White and Hispanic women face higher risk
• Family history may play a role
• Some people have naturally weaker connective tissues in the pelvic area

Connective Tissue Disorders

• Some individuals have genetically weaker support tissues
• This weakness makes them more susceptible to multiple types of pelvic organ prolapse

Prevention

Ways to reduce your risk of small bowel prolapse include:

• Maintain a Healthy Weight: Extra pounds increase pressure inside your abdomen. Losing weight if needed can help lower this pressure and reduce strain on your pelvic organs.
• Prevent Constipation: Straining during bowel movements puts pressure on your pelvic floor. Try these strategies:
  • Eat foods high in fiber (fruits, vegetables, whole grains)
  • Drink plenty of water throughout the day
  • Exercise regularly
  • Use bathroom when you first feel the urge
• Treat Chronic Cough: A persistent cough increases abdominal pressure over time. If you have a cough that won’t go away, see your doctor for proper treatment options.
• Stop Smoking: Smoking often leads to chronic coughing and damages tissue. Quitting can reduce coughing and improve overall tissue health.
• Avoid Heavy Lifting: When you lift heavy objects, pressure builds in your abdomen. If you must lift something heavy:
  • Bend at the knees, not the waist
  • Keep the object close to your body
  • Tighten your pelvic floor muscles before lifting
  • Avoid holding your breath
• Do Pelvic Floor Exercises: Kegel exercises strengthen the muscles that support your pelvic organs. These exercises involve tightening the muscles you use to stop urination, holding for a few seconds, then releasing.
• Manage Conditions that Increase Abdominal Pressure: Some health problems can put extra strain on your pelvic floor, including:
  • Chronic lung conditions
  • Allergies that cause frequent sneezing
  • Digestive disorders that cause straining