Enterocele Prolapse: Symptoms, Causes and Treatment Options
What Is an Enterocele Prolapse?
An enterocele can sound alarming — but you're not alone, and there is plenty that can be done. Here's everything you need to know, explained simply.
An enterocele prolapse happens when part of the small bowel (your small intestine) drops down and presses against the upper wall of the vagina, creating a bulge. In some cases it can slip further — settling between the rectum and the vagina — causing discomfort and making bowel movements more difficult.[1]
It happens because the pelvic floor muscles — the group of muscles and ligaments that hold your pelvic organs in place — have become weakened or stretched. When they can no longer do their job fully, organs can shift out of position. That's what's happening here.[1]
An enterocele prolapse is treatable. Many people manage it well without surgery. The most important thing is not to ignore it — the sooner you get support, the better your outcomes.
What does it feel like?
In the early stages, you might not notice anything at all. As the prolapse develops, symptoms tend to become more noticeable — particularly during or after a bowel movement. Here are the signs to look out for:
If you want to check for yourself, lie in a warm bath and gently place your thumb in your vagina and your ring finger in your rectum. If you feel a cylindrical loop of tissue between the two — that's a sign of an enterocele.
If you only feel smooth layers of tissue, you likely don't have one. Either way, if you're concerned, speak to your GP — they can assess the severity and advise you on next steps.
What causes an enterocele prolapse?
Several things can weaken the pelvic floor enough to allow a prolapse to develop. Most are very common life events — not things to feel embarrassed about.
- ChildbirthAround 50% of women who give birth vaginally experience some degree of prolapse. [3] A large baby, a long labour, forceps delivery, or multiple births all increase the risk.
- Avoid strainingRegularly straining on the toilet puts repeated pressure on the pelvic floor over time, gradually weakening it. A squatting toilet stool can help enormously.
- Previous surgeryA hysterectomy or previous prolapse repair can affect the surrounding tissues and increase the likelihood of a future prolapse.
- Persistent coughingA long-term cough — from smoking, asthma, or bronchitis — puts consistent pressure on the pelvic floor.
- High-impact exerciseRunning, jump training (plyometrics) and heavy lifting can strain the pelvic floor if the muscles aren't strong enough to cope.
- Body weightBeing overweight adds extra pressure to the pelvic area, increasing the risk of prolapse.
- AgeMuscle mass naturally reduces as we get older, which can affect how well the pelvic floor supports your organs.
- Family historyA genetic tendency towards weakened connective tissue or muscles can make prolapse more likely.
How can you reduce your risk?
If you think you might be at risk, these steps can make a real difference:
- Do your KegelsRegular pelvic floor exercises are the single most effective thing you can do. The stronger your pelvic floor, the better it can hold everything in place. Physiotherapist Amanda Savage has created a 12-week prolapse programme with the Kegel8 Ultra 20 — designed to work even if your muscles are too weak to feel right now.
- Eat wellA high-fibre diet (fruit, vegetables, wholegrains) and plenty of water will help keep your bowels regular and reduce the need to strain.
- Use a toilet stoolRaising your knees by using a squatting stool puts your body into the ideal position for a full, effortless bowel movement — no straining required.
- Manage your weightNICE recommends keeping your BMI below 30 to reduce pressure on the pelvis.[2]
- Get that cough seen toA cough lasting more than a week is worth a GP visit — persistent coughing adds up.
- Lift safelyKeep loads close to your body, bend your knees not your back, and — importantly — breathe out as you lift.
What are the treatment options?
The good news: many people manage an enterocele prolapse very effectively without surgery. Treatment always starts with the least invasive options first.
Pelvic floor exercises (Kegels)
For mild to moderate prolapses, this is often all that's needed.[5] Using an electronic pelvic toner like the Kegel8 Ultra 20 makes the exercises more targeted and effective — and Amanda Savage's 12-week prolapse programme takes the guesswork out of where to start.
Lifestyle changes
Maintaining a healthy weight, avoiding constipation, and changing how you lift and exercise can all help reduce pressure on the pelvic floor and slow progression. Read our guide to lifestyle changes for pelvic health.
Vaginal pessary
A small, usually silicone, device inserted into the vagina to support the prolapsed area. Different shapes and sizes suit different people — your GP or physio can help you find the right fit. It's the preferred option for those wanting to have children in the future, or who aren't suitable for surgery.
Support garments
Specialist garments like SRC Support Shorts and Leggings offer compression and anatomical support across the pelvis and perineal area — useful alongside other treatments.
If non-surgical options aren't providing enough relief, your doctor may discuss surgery. This involves repositioning the small bowel and reinforcing the supporting muscles with stitches — and sometimes a biological or synthetic mesh. It's usually a 30–60 minute procedure performed via the vagina or abdomen.
Note: Synthetic mesh is currently only recommended within a research context in the UK. Your surgeon will discuss what's right for you.[4]
Recovering from surgery
If you do have surgery, here's a realistic picture of what to expect:
A catheter and vaginal packing (soaked in oestrogen cream) are removed at your follow-up appointment. You may notice some temporary changes in urine flow due to swelling — this is normal.
Showers rather than baths (stitches are still in place). Some bleeding and a creamy white discharge is normal — use pads, not tampons. You may be advised not to drive, and some insurers won't cover you for the first two weeks.
Most people return to daily life and can resume sex. Continue to avoid heavy lifting and strenuous exercise.
You can gradually return to exercise. Pelvic floor exercises should become a long-term daily habit — they protect your recovery and help prevent recurrence.
Around 20% of people who have mesh-assisted surgery experience bright red vaginal bleeding afterwards. This can indicate the mesh is migrating. Treat this as an emergency and seek urgent medical attention.
It's also worth knowing that surgery can't repair the pelvic floor muscles themselves — only pelvic floor exercises can do that. Whatever treatment path you take, Kegels are always part of the long-term picture.
Our team in East Yorkshire has been helping people take control of their pelvic health for over 30 years. Whether you're managing a prolapse, recovering from surgery, or just want to stay strong — we're here for you.
Sources & further reading
- NHS (2022). Pelvic organ prolapse. www.nhs.uk/conditions/pelvic-organ-prolapse
- NICE (2019). Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. www.nice.org.uk/guidance/ng123
- Hendrix SL et al. (2002). Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. American Journal of Obstetrics and Gynecology, 186(6), 1160–1166.
- NHS England (2023). Mesh removal service. www.england.nhs.uk/mesh
- Cochrane Review (2023). Pelvic floor muscle training for pelvic organ prolapse in women. Cochrane Database of Systematic Reviews
- Bø K (2012). Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World Journal of Urology, 30(4), 437–443.
- Royal College of Obstetricians and Gynaecologists (RCOG). Pelvic organ prolapse — patient information leaflet. www.rcog.org.uk
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