Enterocele

Introduction

• Description: Enterocele is the loss of support for the apex of the vagina through either a rupture or attenuation of the pubovesicocervical fascia, manifested by the descent or prolapse of the vaginal wall and underlying peritoneum, most commonly after abdominal or vaginal hysterectomy. An enterocele may occur when the uterus is present, and tissue damage or weakness allows herniation behind the cervix and between the uterosacral ligaments.

• Prevalence: 10%–15% of women; 30%–40% after menopause.

• Predominant Age: 40 years and older, increasing with age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Loss or rupture of the normal support mechanisms in the pouch of Douglas. There is true herniation of the peritoneal cavity between the uterosacral ligaments and into the rectovaginal septum. Unlike a cystocele, urethrocele, or rectocele, the herniated tissue contains a true sac lined by parietal peritoneum.

• Risk Factors: Multiparity, obesity, chronic cough, heavy lifting, intrinsic tissue weakness, or atrophic changes resulting from estrogen loss. Some authors include smoking as a risk factor.

Signs and Symptoms

• Asymptomatic

• Pelvic pressure or “heaviness”

• Bulging of tissue at the vaginal opening

• Descent of the apical vaginal wall during straining

Diagnostic Approach