Small bowel prolapse (enterocele)

Diagnosis

Your doctor will perform a pelvic exam to confirm the diagnosis of small bowel prolapse. To better visualize the prolapsed small bowel during the examination, your doctor could ask you to perform the Valsalva technique, which involves taking a deep breath, holding it, and bearing it down as if you had a bowel movement. The examination may be repeated while you are standing if your doctor cannot confirm that you have a prolapse while you are laying on the examination table.
You may also get one or more of these tests:

• Cystoscopy, examining and locating the bladder with a lit scope equipment (cystoscope).
• Imaging tests, such as a computed tomography (CT) scan, ultrasound, or pelvic floor magnetic resonance imaging (MRI), to evaluate for prolapsed organs and assess the pelvic floor muscles.
• Urodynamic testing to assess bladder capacity and investigate the root causes of urine incontinence.

Treatment

In most cases, small bowel prolapse does not require therapy if the symptoms do not bother you. If you have advanced prolapse and persistent symptoms, surgery might be helpful. If you want to avoid surgery, if surgery is too risky, or if you want to get pregnant, nonsurgical treatments are an option.
Small bowel prolapse can be treated in various ways, including:

• Observation. You do not need therapy if your prolapse produces few or no noticeable symptoms. Simple self-care techniques, including Kegel exercises to strengthen your pelvic muscles, may help relieve symptoms. Constipation and heavy lifting should be avoided to prevent your prolapse from worsening.
• Pessary. The protruding tissue is supported by a silicone, plastic, or rubber device that is inserted into your vagina. Pessaries are available in a range of designs and sizes. There will be some trial and error in selecting the best one. You are measured and fitted for the device by your doctor, and you are taught how to put it in, take it out, and clean it.
• Surgery. With or without robotic help, a surgeon can undertake surgery to repair the prolapse through the vagina or abdomen. Your surgeon will tighten the connective tissue in your pelvic floor and bring the prolapsed small bowel back into its proper position during the treatment. Small pieces of artificial mesh may occasionally be employed to bolster weaker tissues.

In most cases, a minor bowel prolapse is one-time only. However, increased pelvic pressure, such as that caused by constipation, coughing, obesity, or heavy lifting, can further damage the pelvic floor.