Repair of rectal prolapse (rectocele) or small bowel prolapse (enterocele)
October 1, 2009

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A rectocele (rectal prolapse) occurs when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina. An enterocele (small bowel prolapse) occurs when the small bowel presses against and moves the upper wall of the vagina. Rectoceles and enteroceles develop if the lower pelvic muscles become damaged by labor, childbirth, or a previous pelvic surgery or when the muscles are weakened by aging. A rectocele or an enterocele can be present at birth (congenital), though this is rare.

A rectocele or an enterocele may become large or more obvious when you strain or bear down (for example, during a bowel movement). Rectocele and enterocele formation may occur together, especially if you have had surgery to remove the uterus (hysterectomy).

Because rectocele and enterocele are defects of the pelvic supporting tissue and not the bowel wall, they are treated most successfully with surgery that repairs the vaginal wall. This surgery pulls together the stretched or torn tissue in the area of prolapse. Surgery will also strengthen the wall of the vagina to prevent prolapse from recurring. Unless there is another health problem that would require an abdominal incision, rectoceles and enteroceles are usually repaired through the vagina.

What To Expect After Surgery
General anesthesia is usually used for repair of a rectocele or enterocele. You may stay in the hospital from 1 to 2 days. Most women can return to their normal activities in about 6 weeks. Avoid strenuous activity for the first 6 weeks and increase your activity level gradually.

Normal bowel function returns within 2 to 4 weeks. It is important to avoid constipation during this time. Your doctor will give you special bowel care instructions, but it is important to include sources of fiber and an adequate fluid intake in your diet. Try to drink about 6 to 8 glasses of water a day.

Most women are able to resume sexual intercourse in about 6 weeks.

Why It Is Done
Surgical repair of rectoceles and enteroceles is used to manage symptoms such as movement of the intestine that pushes against the wall of the vagina, low back pain, and painful intercourse. An enterocele may not cause symptoms until it is so large that it bulges into the midpoint of the vaginal canal.

Rectocele and enterocele often occur with other pelvic organ prolapse, so tell your health professional about other symptoms you may be having. If your health professional finds a bladder prolapse (cystocele), urethral prolapse (urethrocele), or uterine prolapse during your routine pelvic exam, that problem can also be repaired during surgery.

How Well It Works
Rectoceles and enteroceles seldom recur following surgical repair if the woman is able to avoid constipation, does not go through pregnancy and delivery, and does not have or develop any other pelvic organ prolapse.1

Risks
Risks of rectocele and enterocele repair are uncommon but include:

  • Urinary retention.
  • Bladder injury.
  • Bowel or rectal injury.
  • Infection.
  • Painful intercourse.
  • Formation of an abnormal connection or opening between two organs (fistula).

What To Think About
Since pelvic organ prolapse is strongly linked to labor and vaginal delivery, you may want to delay surgical repair of a rectocele or enterocele until you have finished having children.

Surgical repair may relieve some, but not all, of the problems caused by a rectocele or enterocele.

  • If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may persist after surgery.
  • Symptoms of constipation may return following surgery.
  • The success rate is lower if you have had previous pelvic surgery or radiation therapy to the pelvis.

You can control many of the activities that contributed to your rectocele or enterocele or made it worse. After surgery:

  • Avoid smoking.
  • Maintain a healthy weight for your height.
  • Avoid constipation.
  • Avoid activities that put strain on the lower pelvic muscles, such as heavy lifting or long periods of standing.

 

A small bowel prolapse (enterocele) occurs when the tissues and muscles that hold the small bowel in place are stretched or weakened. This can cause the small bowel to move from its natural position and press against the wall of the vagina.

 

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