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Treatments and drugs
By Mayo Clinic staff
Mild cases of enterocele may require no treatment. Surgical repair may be most effective in more severe cases, particularly when an enterocele is accompanied by other types of pelvic organ prolapse. Nonsurgical approaches are also available if you're not interested in surgery, if surgery would be too risky for you or if you want to bear more children.
Nonsurgical treatments
Nonsurgical treatment options include:
- Vaginal pessary. A silicone, plastic or rubber ring or device inserted into your vagina supports the bulging tissue. Pessaries come in a variety of styles and sizes, and finding the right one for you may involve trial and error. Your doctor will measure and fit you for the device and teach you how to insert and remove it. You'll need to remove the pessary regularly and clean it. Or, if you leave the pessary in place, your doctor may have you come in periodically to remove and clean the pessary and examine your vagina.
- Estrogen therapy. If you're postmenopausal, your doctor may recommend estrogen therapy, such as a vaginal cream, gel or tablet, in combination with a vaginal pessary. Estrogen therapy corrects thinning of the vaginal lining that occurs after menopause and helps keep a pessary from irritating dry vaginal walls.
Surgery
A severe or extremely uncomfortable enterocele may require surgery. The surgery is designed to repair the hernia and relieve signs and symptoms of the enterocele.
In most cases, the surgical approach is through your vagina. In this procedure, your surgeon puts the prolapsed small bowel back into place and tightens the muscles and ligaments of your pelvic floor.
Surgical repair of an enterocele is more common when other prolapsed organs, such as the uterus, bladder or rectum, are involved. In those cases, hysterectomy and repairs of the cystocele and rectocele can be done at the same time as the enterocele repair.
With proper technique during surgical repair, an enterocele usually doesn't recur.
- Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: Abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: Diagnosis and management. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/199482088-2/0/1524/131.html?tocnode=53759383&fromURL=131.html#4-u1.0-B978-0-323-02951-3..50023-6_663. Accessed May 3, 2010.
- ACOG Committee on Practice Bulletins - Gynecology. Pelvic organ prolapse. Obstetrics & Gynecology. 2007;110:717.
- Park AJ, et al. Clinical manifestations, diagnosis, and nonsurgical management of posterior vaginal defects. http://www.uptodate.com/home/index.html. Accessed May 3, 2010.
- Hughes D, et al. Pelvic organ prolapse. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aid=3159899. Accessed May 4, 2010.
- Tarnay CM. Pelvic organ prolapse. In: DeCherney AH, et al. Current Diagnosis & Treatment Obstetrics & Gynecology. 10th ed. New York, N.Y.: McGraw-Hill Medical; 2007. http://www.accessmedicine.com/content.aspx?aid=2390520. Accessed May 4, 2010.
- DeLancey JOL. Epidemiology, pathophysiology, and evaluation of pelvic organ support. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:818.
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