Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
What is an enterocele?
An enterocele is a type of pelvic organ prolapse. The small intestine drops into the space between your vagina and rectum, creating a bulge in the upper back wall of the vagina. It is less common than a cystocele (bladder prolapse) or rectocele (a bulge from the rectum into the vagina), but it often shows up alongside them.
In fact, research suggests that what looks like a large rectocele on exam may actually be a combination of rectocele and vaginal vault descent, with the enterocele hiding behind it. Similarly, large cystoceles often have a vault prolapse component that needs to be addressed too.
How it develops
The space between your vagina and rectum is called the cul-de-sac (or pouch of Douglas). Normally, a small pocket of space here is fine. It is normal for this pocket to extend 4 to 5 centimeters along the back wall of the vagina without causing problems.
An enterocele forms when the tissue separating your vaginal wall from this space weakens enough that small bowel pushes into it. This happens most often after hysterectomy, when the support at the top of the vagina is disrupted. There are two main types:
- Traction enterocele: the cul-de-sac gets pulled down along with a prolapsing vaginal cuff or cervix, but intestine does not fill the space
- Pulsion enterocele: intestinal contents push into and stretch the space between the vagina and rectum, creating a noticeable bulge
Recognizing which type you have matters for surgical planning. Missing an enterocele during a prolapse repair is one of the reasons prolapse can come back.
Symptoms
- Deep pelvic pressure, especially when you are standing
- A pulling or dragging feeling
- Low backache that gets worse through the day
- Needing to push on the vaginal wall to have a bowel movement (splinting)
- Sometimes no symptoms at all, found during an exam for another type of prolapse
Not every enterocele causes symptoms. I see patients whose imaging shows a dramatic-looking hernia that does not bother them at all. We treat based on what you are feeling, not just what we see on an exam or image.
How it is diagnosed
I diagnose most enteroceles during a pelvic exam. I may ask you to bear down or examine you while standing, since enteroceles can be subtle in a lying-down position.
If I need more detail, defecography (a special type of imaging where you bear down during an X-ray or MRI) can show the enterocele and help me see whether other compartments are also prolapsing. This information helps with surgical planning if you choose that route.
Treatment options
Treatment depends on your symptoms, how much they bother you, and your goals. We will talk through the options together so you can make the choice that fits your life.
- Pessary: a removable device placed in the vagina that supports the vaginal vault and holds the prolapse back. It is a good option if you want to avoid surgery or are not ready for it.
- Pelvic floor physical therapy: working with a pelvic floor PT on strength, coordination, breathing, and core support can help manage symptoms. Our practice has in-office pelvic floor PTs who can work with you directly.
- Surgery: enteroceles are usually repaired as part of a larger prolapse surgery, since they rarely happen alone. The surgeon closes the defect and reinforces the area. The specific approach depends on which other compartments are involved and your overall goals.
Enteroceles are almost always part of a bigger picture of pelvic support changes. When we plan treatment, we look at all the compartments together rather than addressing one piece in isolation.
References
- Paquette IM, Rosman D, El Sayed R, et al. Consensus definitions and interpretation templates for fluoroscopic imaging of defecatory pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2021. doi:10.1097/SPV.0000000000000956
- Ridgeway BM, Weinstein MM, Tunitsky-Bitton E. American Urogynecologic Society best-practice statement on evaluation of obstructed defecation. Female Pelvic Med Reconstr Surg. 2018. doi:10.1097/SPV.0000000000000635
- Grimes CL, Lukacz ES. Posterior vaginal compartment prolapse and defecatory dysfunction: are they related? Int Urogynecol J. 2012. doi:10.1007/s00192-011-1629-3
- Sultan AH, Monga A, Lee J, et al. An IUGA/ICS joint report on the terminology for female anorectal dysfunction. Int Urogynecol J. 2017. doi:10.1007/s00192-016-3140-3
- Haylen BT, Vu D. Surgical anatomy of the vaginal vault. Neurourol Urodyn. 2022. doi:10.1002/nau.24963
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