Enterocoele and Sigmoidocoele
What are enterocoeles and rectocoeles?
An enterocoele (or enterocele) occurs when the small bowel pushes down from within the abdominal cavity onto the back wall of the vagina through the gap between the rectum and vagina [marked in red in the diagram] (the rectovaginal septum). When the sigmoid colon comes down, it is known as a sigmoidocoele (or sigmoidocele). Enterocoeles and sigmoidocoeles cause similar symptoms and usually respond to identical treatments and so we will consider them together.
What causes them?
The most common cause is a weakness in the rectovaginal septum from birth trauma, in particular multiple, difficult births. Whilst an enterocoele or sigmoidocoele may occur in isolation, it often occurs in association with other problems such as intussusception or prolapse.
What symptoms do they cause?
The common symptoms are of a lump coming down when the patient strains or tries to open their bowels. There is sometimes a “dragging” sensation in the pelvis or an ache. Some patients complain of backache. This may be due to the enterocoele or sigmoidocoele, though general back problems are a more common cause.
How are they diagnosed?
The surgeon seeing you will often be able to detect the presence of an enterocoele or sigmoidocoele by examining you. A proctogram is useful, however, in confirming the diagnosis and establishing whether the enterocoele/sigmoidocoele is an isolated problem or is present in association with other abnormalities such as prolapse.
How can they be treated?
Treatment for an enterocoele, in patients with significant symptoms, is usually by laparoscopic ventral rectopexy. This will also treat the rectocoele and intussusception that often co-exist.