Treatment. Small bowel prolapse (enterocele)

Diagnostics of small bowel prolapse

Your doctor will conduct a pelvic exam during the appointment to determine whether you have a small bowel prolapse. In order to perform the pelvic exam, the doctor will ask you to take a deep breath and then hold it while bearing down. In this way, you will imitate like you have a bowel movement which may cause the small intestine to prolapse downward. It may be necessary to repeat the exam while you stand if your prolapse is not visible while you’re lying on the exam table.

Small bowel prolapse treatment

The mild asymptomatic small bowel prolapse usually doesn’t require treatment. However, if you have advanced bowel prolapse with disturbing symptoms, you will probably need surgery. In addition, non-surgical methods are applied if you want to become pregnant in the future, if you would like to escape surgery, or if the surgical treatment will be too risky for you.
The small bowel prolapse treatment methods include:

1. Observation. As was mentioned above, if your bowel prolapse is asymptomatic, you don’t require the treatment. It’ll be beneficial to practice Kegel exercises for strengthening your pelvic muscles. Also, you need to avoid constipation and lifting heavy objects to decrease the risk of worsening your bowel prolapse.
2. Pessary. It is a device that the doctor inserts into your vagina to support the bulging tissue. A pessary can be plastic, silicon, or rubbed. Also, there are many different types and sizes of pessaries. By measurement, your physician selects the device for you and then helps you learn how to insert, remove and clean it. However, It takes some trial to find a suitable device.
3. Surgery. It is possible to repair prolapse through the abdomen or vagina during the surgery. Also, the surgeon can perform it with or without robotic assistance. As part of the procedure, your surgeon returns the prolapsed bowel to its normal position and tightens the pelvic floor tissues. Also, in some cases, the surgeon may use small pieces of special synthetic mesh in order to support weakened tissues.

Typically a bowel prolapse doesn’t reoccur. Though, the pelvic floor can be injured repeatedly with elevated pressure in the pelvis. Constipation, obesity, coughing or lifting heavy objects may lead to increased pelvic pressure.

Lifestyle and home remedies to relieve bowel prolapse symptoms

If you’re suffering from bowel prolapse symptoms, there may be some benefit to self-care measures for you depending on your condition:

• Avoid lifting heavy objects.
• Practice Kegel exercises. It may help you to make your pelvic muscles more robust and support your weakened vaginal tissues.
• Try to keep your cough under control.
• Try to escape bearing down during bowel movement. Your lower bowel should be emptied naturally by your colorectal function.
• Avoid smoking.
• Try to prevent constipation. You can do it by including high-fibre food in your diet (whole grain food and fresh vegetables and fruits contain fibre). Also, drinking enough liquid may be beneficial.
• If you have excess weight, try to reduce it gradually.

Kegel exercises

Kegel exercises are beneficial in the strengthening of pelvic muscles. In turn, muscles of the pelvis support the bladder, uterus and bowel. A strong pelvic floor gives good support for your pelvic organs. In this way, strengthening your pelvic muscles may relieve the prolapse symptoms and reduce the risk of prolapse worsening.

You will have a higher chance of success in Kegel exercises if you learn the technique with a physical therapist. Also, reinforcing your progress with biofeedback is beneficial. Biofeedback helps you to ensure that you’re doing exercises correctly. Via special monitors, biofeedback shows if you contract the right muscles with optimal intensity and periods of time.

Kegel exercises: how to do them

To perform Kegel exercises, you need to contract your pelvic floor muscles and hold the contraction for five seconds. Then relax your muscles for 5 seconds. Pelvic floor muscles are the muscles that you use to stop urinating.
Eventually, you should be able to hold a contraction for 10 seconds at a time. Your goal is to do these exercises at least three sets of 10 repetitions each day.

After you’ve mastered the proper method, you can do Kegel exercises just about anywhere, whether you’re sitting on the chair or relaxing on the couch.

What can I do to prepare for the appointment?

You have three options for your first appointment:

1. To see a primary care doctor who can further direct you to a specialist according to your symptoms.
2. Have an appointment with a physician specializing in the urinary system and reproductive tract (urologist, urogynecologist).
3. To see a doctor specializing in the female reproductive tract (gynecologist).

You can prepare for the appointment by making a list of your symptoms, write a record of questions for the doctor, prepare the inventory of your key medical information. Also, if possible, you can bring a family member or friend to help you remember all information that you will receive from the doctor.