Genital Prolapse (Cystocele, Rectocele, Enterocele)

Cystocele, rectocele, and enterocele are vaginal hernias commonly seen in multiparous women. Cystocele is a hernia of the bladder wall into the vagina, causing a soft anterior fullness. Cystocele may be accompanied by urethrocele, which is not a hernia but a sagging of the urethra following its detachment from the pubic symphysis during childbirth. Rectocele is a herniation of the terminal rectum into the posterior vagina, causing a collapsible pouch-like fullness. Enterocele is a vaginal vault hernia containing small intestine, usually in the posterior vagina and resulting from a deepening of the pouch of Douglas. Enterocele may also accompany uterine prolapse or follow hysterectomy, when weakened vault supports or a deep unobliterated cul-de-sac containing intestine protrudes into the vagina. Two or all three types of hernia may occur in combination.

Supportive measures include a high-fiber diet. Weight reduction in obese patients and limitation of straining and lifting are helpful. Pessaries may reduce cystocele, rectocele, or enterocele temporarily and are helpful in women who do not wish surgery or are chronically ill.

The only cure for symptomatic cystocele, rectocele, or enterocele is corrective surgery. The prognosis following an uncomplicated procedure is good.