The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

An enterocele is a hernia or a weakness in the supporting tissues at the top of the vagina. This can result in pelvic discomfort and in some cases protrusion of the hernia sac through the opening of the vagina. The best way to picture an enterocele is to imagine the vagina to be a sock. If you were to reach up inside the sock, grasp the toe, and pull it towards the opening, that simulates an enterocele. A significant enterocele is more commonly seen after prior hysterectomy. It is also common after a "bladder tack" is performed without having a small enterocele repaired at the same time. Very frequently, but not always, the enterocele is associated with other pelvic support problems. These can include

vaginal prolapse or poor support of the vagina

cystourethrocele or poor support of the bladder and urethra / a "dropped" bladder

rectocele or a hernia of the rectum into the vagina

uterine prolapse or poor support of the uterus

Generally, it is best to treat all of the support problems simultaneously to get the best long-term results.

Factors that increase the chance of an enterocele forming include:

1. obesity
2. chronic coughing (such as with smoking or chronic bronchitis)
3. heavy lifting
4. frequent straining
5. estrogen deficiency – this is controversial

Lifestyle changes to reduce or eliminate these risk factors will reduce the chance you will develop an enterocele and decrease the chance the enterocele will reform if you have it surgically repaired.

The severity of the herniation and other problems that may coexist with the enterocele determines how surgical repair will be performed. The hernia sac (enterocele) in some cases is repaired through a vaginal incision, frequently at the same time a rectocele repair is done. In other situations, the repair is best completed at laparoscopy. The laparoscopic enterocele repair is performed under general anesthesia using a video laparoscope through a small incision, usually in the bellybutton (see Laparoscopy in Surgical Procedures). Several small incisions are made above the pubic hairline and several inches lateral to the bellybutton. These incisions are for insertion of other instruments needed to perform the procedure. The bladder and rectum are carefully separated from the area of the repair. The enterocele sac is then either removed or inverted into the top of the vagina. Permanent sutures connect a strong tissue (called fascia) to minimize the chance of the enterocele recurring. The top of the vagina is then usually sutured (with permanent suture) to supporting ligaments called the uterosacral ligaments. The incisions are closed and the procedure completed. Another surgical procedure call a sacral colpopexy (see Sacral Colpopexy in Surgical Procedures) may be the procedure of choice when there is an enterocele along with vaginal vault prolapse. Other surgical procedures, if appropriate, may be performed at the same time as the enterocele repair.

The likelihood of success of the laparoscopic enterocele procedure is reported to be 80-90% in most cases.

Alternatives to the laparoscopic enterocele repair include the following:

• medical (non-surgical) treatment: pessary use - usually a donut-shaped rubber or plastic device inserted into the vagina for support
• vaginal repair of the enterocele (see Vaginal Repair of Pelvic Prolapse in Surgical procedures)
• other surgical procedures including enterocele repair through a large abdominal incision

August 9, 2003