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İnce Bağırsak Sarkması (Enterosel)

Small bowel prolapse, also called an enterocele, occurs when the small intestine (small intestine) descends into the lower pelvic cavity and forces the upper part of the vagina to form a bulge. The word "prolapse" means slipping or drooping.

If the rectocele is large, it can produce significant tissue swelling from the vaginal opening. This swelling can be uncomfortable but is rarely painful. If needed, self-care measures and other non-surgical options are often effective. Rectocele may require surgical repair if the patient has many complaints.

Birth, aging, and other processes that put pressure on your pelvic floor can weaken the muscles and ligaments that support the pelvic organs and increase the likelihood of small bowel prolapse occurring. Self-care measures and other non-surgical options for managing small bowel prolapse usually effective. In severe cases, surgical repair may be required.

Symptoms in Small Intestine Prolapse

Mild small bowel prolapse may produce no signs or symptoms. However, if you have a significant prolapse, you may experience:

  • A feeling of traction on your pelvis that relaxes as you lie down
  • Feels of fullness, pressure or pain in the groin
  • Relieves lower back pain when lying down
  • A soft tissue bulge like an egg in your vagina
  • Vaginal discomfort and painful intercourse (dyspareunia)

Many women with small bowel prolapse experience prolapse of other pelvic organs such as the bladder, uterus, or last bowel.

When to see a doctor?

Consult your doctor if you develop signs or symptoms of sagging that bother you.

Reasons

Increased pressure on the pelvic floor is the main cause of any pelvic organ prolapse. Conditions and activities that can cause or contribute to small bowel prolapse or other types of prolapse include:

  • Pregnancy and childbirth
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repetitive heavy lifting
  • Being overweight or obese

Pregnancy and childbirth

Pregnancy and childbirth are the most common causes of pelvic organ prolapse. The muscles, ligaments, and fascia that hold and support your vagina stretch and weaken during pregnancy, labor, and delivery. Not everyone who has had a baby develops a pelvic organ prolapse. Some women have very strong supporting muscles, ligaments, and fascia in the pelvis and never have problems. Also, a woman who has never had a baby develops a pelvic organ prolapse. It is also possible to develop prolapse.

Risk factors

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

  • Pregnancy and childbirth: The vaginal delivery of one or more children contributes to weakening of your pelvic floor support structures, increasing your risk of prolapse. The more pregnancies you have, the greater your risk of developing any pelvic organ prolapse. Women who have had a cesarean-only delivery are less likely to develop a prolapse.
  • Advanced Age: Small bowel prolapse and other pelvic organ prolapse are more common with increasing age. As you get older, you tend to lose muscle mass and muscle strength in your pelvic and other muscles.
  • Having gynecological surgery: Removing your uterus (hysterectomy) or surgical procedures to treat incontinence can increase your risk of developing small bowel prolapse.
  • Increased abdominal pressure: Being overweight increases the pressure in your abdomen, which increases your risk of developing small bowel prolapse. Other factors that increase pressure include ongoing (chronic) coughing and straining during bowel movements.
  • Smoking: Smoking is associated with the development of prolapse because smokers cough frequently and increase abdominal pressure.
  • For unknown reasons, Hispanic and white women are at higher risk of developing pelvic organ prolapse.
  • Connective tissue disorders: You may be genetically prone to prolapse due to weak connective tissue in your pelvic area, which naturally makes you more susceptible to small bowel prolapse and other pelvic organ prolapses.

What can be done to prevent

You can reduce your chances of small bowel prolapse with the following strategies:

  • Be at a healthy weight. If you are overweight, losing some weight can reduce the pressure in your abdomen.
  • Prevent constipation. Eat high-fiber foods, drink plenty of fluids, and exercise regularly to avoid straining during bowel movements.
  • Treatment of chronic cough. Persistent coughing increases abdominal pressure. If you have an ongoing (chronic) cough, consult your doctor for information about treatment.
  • Quit smoking. Smoking contributes to chronic cough.
  • Avoid heavy lifting. Lifting heavy objects increases abdominal pressure.

Diagnosis

To confirm the diagnosis of small bowel prolapse, your doctor will perform a pelvic exam. During the exam, your doctor may ask you to take a deep breath and hold it while you have a bowel movement, which is likely to cause the prolapsed small intestine to bulge downward. If your doctor cannot confirm a prolapse while lying on the examination table, he or she may repeat the examination while standing.

Treatment

Small bowel prolapse usually doesn't need treatment unless symptoms bother you. Surgery may be effective if you have advanced sagging with bothersome symptoms. Non-surgical approaches are available if you want to avoid surgery, if the surgery is too risky, or if you want to become pregnant in the future.

Treatment options for small bowel prolapse

Observation in the treatment of small intestine prolapse (Enterocele).

If your prolapse is showing few or no obvious symptoms, you don't need treatment. Simple self-care measures such as doing exercises called Kegel exercises to strengthen your pelvic muscles can relieve symptoms. Avoiding heavy lifting and constipation can make your prolapse less likely to worsen. (If you want to learn about all these treatment modalities in detail, you can find them on my website)

The use of pessary in the treatment of small intestine prolapse (Enterocele).

A silicone, plastic, or rubber device inserted into your vagina supports the swollen tissue. Pessaries come in a variety of styles and sizes. Finding the right one takes some trial and error. Your doctor measures you for the device and fits it, and you learn how to put on, remove, and clean the device. Many of my patients regained their health without surgery with this method.

Surgery in the treatment of small intestine prolapse (Enterocele)

A surgeon through the vagina or abdomen; can perform surgery to repair it, with or without robotic assistance. During the procedure, your surgeon moves the prolapsed small intestine back into place and repairs the connective tissue of your pelvic floor. Sometimes, small amounts of synthetic mesh (mesh) may be used to help support the weakened tissues (Details on patches can be found on my website). A small bowel prolapse usually does not recur. However, further injury to the pelvic floor can occur with increased pelvic pressure, such as constipation, coughing, obesity, or heavy lifting.

Lifestyle and home remedies

Depending on the severity of your condition, these self-care measures may provide the symptom relief you need:

  • Do Kegel exercises to strengthen pelvic muscles and support weakened vaginal tissues.
  • Avoid constipation by drinking plenty of fluids and eating high-fiber foods such as whole grains, fresh fruit and vegetables.
  • Avoid heavy lifting.
  • Try to control the cough.
  • Lose weight if you are overweight or obese. Avoid bed to get your bowels moving. Rely on your natural colorectal function to empty your lower bowel.
  • Quit smoking.

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