Small bowel prolapse (enterocele)

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Risk factors

By Mayo Clinic staff

Factors that increase your risk of developing small bowel prolapse include:

  • Pregnancy and childbirth. Vaginal delivery of one or more children contributes to the weakening of your pelvic floor support structures, increasing your risk of prolapse. The more pregnancies you have, the greater your risk of developing any type of pelvic organ prolapse. Women who have only cesarean deliveries are less likely to develop prolapse.
  • Age. Small bowel prolapse and other types of pelvic organ prolapse occur more often with increasing age. As you get older, you tend to lose muscle mass and muscle strength — in your pelvic muscles as well as other muscles.
  • Pelvic surgery. Removal of your uterus (hysterectomy) or surgical procedures to treat incontinence may increase your risk of developing small bowel prolapse.
  • Increased abdominal pressure. Being overweight increases pressure inside your abdomen, which increases your risk of developing small bowel prolapse. Other factors that increase pressure include ongoing (chronic) cough and straining during bowel movements.
  • Smoking. Smoking is associated with developing prolapse because smokers frequently cough, increasing abdominal pressure. Also, smokers may have problems with healing of damaged connective tissues in the pelvic area, which can contribute to prolapse.
  • Race. For unknown reasons, Hispanic and Caucasian women are at higher risk of developing pelvic organ prolapse. Black women seem to have the lowest risk of all groups of women.
  • Family history. If your mother experienced small bowel prolapse or prolapse of other pelvic organs, your chances of having prolapse are greater than that of a woman with no family history of prolapse.
  • Connective tissue disorders. You may be genetically prone to prolapse due to weaker connective tissues in your pelvic area, making you naturally more susceptible to small bowel prolapse and other types of pelvic organ prolapse.
References
  1. Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed Oct. 30, 2012.
  2. Park AJ, et al. Clinical manifestations, diagnosis, and nonsurgical management of posterior vaginal defects. http://www.uptodate.com/index. Accessed Oct. 30, 2012.
  3. Rogers RG, et al. An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women. http://www.uptodate.com/index. Accessed Oct. 30, 2012.
  4. Hoffman BL, et al. Williams Gynecology. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com/resourceTOC.aspx?resourceID=768. Accessed Oct. 31, 2012.
  5. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstetrics & Gynecology. 2012;119:852.
  6. Hagen S, et al. Conservative management of pelvic organ prolapse. Obstetrics, Gynaecology and Reproductive Medicine. 2012;22:118.
  7. Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2008. http://www.danforthsobgyn.com. Accessed Oct. 31, 2012.
  8. Lightner DJ (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 15, 2012.
DS00765 Nov. 27, 2012

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