Enterocele or small bowel prolapse is a condition in which the small bowel moves abnormally into the pelvic region. A rectocele or a posterior vaginal wall prolapse is a condition in which the rectal tissue droops downward into the vagina.

What is enterocele?

Definition:

Enterocele or small bowel prolapse is a condition in which the small bowel moves abnormally into the pelvic region. 

Causes:

An enterocele occurs when the fascia and muscles of the pelvic floor are overstretched or torn. An enterocele usually is accompanied by other organ prolapses like bladder prolapse, vaginal prolapse, urethral prolapse, and rectal prolapse. Conditions that increase the risk of getting an enterocele are pregnancy, constipation, chronic cough in smokers and certain respiratory disorders, connective tissue disorders, heavy weight lifting, obesity, and pelvic operations. 

Symptoms: 

Enterocele can be asymptomatic in some women. Common symptoms of enterocele are difficulty in defecating, a prominent bulge in the vagina, a feeling of fullness in the pelvic region especially on coughing, urinary leakage, and backache which fades away on lying down. 

Diagnosis:

A pelvic and rectal exam is essential to identify an enterocele. Imaging studies like ultrasound and MRI scans are needed to identify the intestinal tissue. Tests like cystoscopy and urodynamic studies are done to evaluate bladder function, in case of urinary incontinence.

Treatment:

Initially, pelvic floor exercises are encouraged to strengthen the pelvic muscles in case of enterocele. A pessary or ring is inserted in the vagina to hold the pelvic muscles in place. Lastly, surgery can be done to repair the prolapsed intestinal tissue and to sew any tears.

What is rectocele?

Definition:

A rectocele or a posterior vaginal wall prolapse is a condition in which the rectal tissue droops downward into the vagina.

Causes:

Weak pelvic floor tissue causes rectocele formation. This can occur due to pregnancy, multiple vaginal deliveries, chronic constipation, menopause, chronic cough as in bronchitis, repeated heavy weight lifting, obesity, and previous surgeries like hysterectomy.

Symptoms:

A rectocele is not always symptomatic. It can however cause a feeling of discomfort or fullness in the vagina or rectum. The most common symptoms of a rectocele are a soft bulge in the vagina, tenesmus, a feeling of incomplete bowel emptying, dyspareunia, and a feeling of loss of vaginal tone. 

Diagnosis:

A pelvic exam is essential to diagnose a rectocele. Imaging studies like transvaginal ultrasound are used to look for any small intestine prolapse. Defecography is a test that shows changes in the rectum during a bowel movement.

Treatment:

Treatment options for rectocele include pelvic floor exercises and the use of vaginal pessaries to hold the prolapsed muscles in place. A surgery known as posterior colporrhaphy is used to fix the rectocele.

Difference between Enterocele and Rectocele

Definition:

Enterocele or small bowel prolapse is a condition in which the small bowel moves abnormally into the pelvic region. A rectocele or a posterior vaginal wall prolapse is a condition in which the rectal tissue droops downward into the vagina.

Causes:

An enterocele occurs when the fascia and muscles of the pelvic floor are overstretched or torn. An enterocele usually is accompanied by other organ prolapses like bladder prolapse, vaginal prolapse, urethral prolapse, and rectal prolapse. Conditions that increase the risk of getting an enterocele are pregnancy, constipation, chronic cough in smokers and certain respiratory disorders, connective tissue disorders, heavy weight lifting, obesity, and pelvic operations. 

Weak pelvic floor tissue causes rectocele formation. This can occur due to pregnancy, multiple vaginal deliveries, chronic constipation, menopause, chronic cough as in bronchitis, repeated heavy weight lifting, obesity, and previous surgeries like hysterectomy.

Symptoms: 

Enterocele can be asymptomatic in some women. Common symptoms of enterocele are difficulty in defecating, a prominent bulge in the vagina, a feeling of fullness in the pelvic region especially on coughing, urinary leakage, and backache which fades away on lying down. A rectocele is not always symptomatic. It can however cause a feeling of discomfort or fullness in the vagina or rectum. The most common symptoms of a rectocele are a soft bulge in the vagina, tenesmus, a feeling of incomplete bowel emptying, dyspareunia, and a feeling of loss of vaginal tone. 

Diagnosis:

A pelvic and rectal exam is essential to identify an enterocele. Imaging studies like ultrasound and MRI scans are needed to identify the intestinal tissue. Tests like cystoscopy and urodynamic studies are done to evaluate bladder function, in case of urinary incontinence.

A pelvic exam is essential to diagnose a rectocele. Imaging studies like transvaginal ultrasound are used to look for any small intestine prolapse. Defecography is a test that shows changes in the rectum during a bowel movement.

Treatment:

Initially, pelvic floor exercises are encouraged to strengthen the pelvic muscles in case of enterocele. A pessary or ring is inserted in the vagina to hold the pelvic muscles in place. Lastly, surgery can be done to repair the prolapsed intestinal tissue and to sew any tears.

Treatment options for rectocele include pelvic floor exercises and the use of vaginal pessaries to hold the prolapsed muscles in place. A surgery known as posterior colporrhaphy is used to fix the rectocele.

Table of differences between enterocele and rectocele

FAQs

Can you have both a rectocele and an enterocele?

Yes.

What does an enterocele feel like?

An enterocele may present as a prominent bulge in the vagina, and with a feeling of fullness in the pelvic region especially on coughing.

What does a rectocele feel like to touch?

A rectocele feels like a soft bulge in the vagina.

How serious is an enterocele?

Enterocele does not usually cause serious problems.

How painful is enterocele surgery?

It is a painless surgery done with general anesthesia.

How do you repair a rectocele enterocele?

A surgery known as posterior colporrhaphy is used to fix the rectocele. Sacrocolpopexy is used to treat enterocele.

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