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Clinical Presentation of Enterocele

From the Department of Gynecology and Obstetrics and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio.

Address reprint requests to: Queena Chou, MD St. Joseph’s Health Care London St. Joseph’s Hospital Department of Obstetrics and Gynecology University of Western Ontario 268 Grosvenor Street, Room E361 London, Ontario, Canada N6A 4L6 E-mail: queena.chou{at}sjhc.london.on.ca

Objective: To characterize preoperative signs and symptoms in women with and without enteroceles.

Methods: Three hundred ten women completed preoperative questionnaires and had prolapses graded according to the International Continence Society system. Signs and symptoms in 77 women (25%) with enteroceles confirmed at surgery were compared with those in 233 women without enteroceles. Comparisons were tested for statistical significance with ² tests, Fisher exact tests, Wilcoxon rank-sum tests, and analysis of covariance.

Results: Women with enteroceles were statistically significantly older (median 67 versus 59 years, P < .001) and more likely to be postmenopausal (88% versus 76%, P = .04). More women with enteroceles had histories of hysterectomies (76% versus 39%, P = .001) and vaginal prolapse repairs (24% versus 11%, P = .008). Women with enteroceles had more advanced prolapses at points Ap, Bp, and C (all P < .001) but not point D. There were no significant differences in symptoms related to bowel function (infrequent bowel movements, straining, manual evacuation, and fecal incontinence) in women with and without enteroceles. Women with enteroceles were more bothered by symptoms caused by vaginal prolapse than women without enteroceles, but not after we controlled for stage of prolapse.

Conclusion: Women with enteroceles have more advanced apical and posterior vaginal prolapses than women without enteroceles, but do not differ from them in bowel function.

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