Enterocele (pelvic organ prolapse involving the small bowel) requires a tailored approach when the patient carries significant underlying medical conditions and does not wish to preserve vaginal function. This protocol is designed specifically for that subgroup.
This protocol applies to patients with significant medical comorbidities — such as cardiac disease, chronic obstructive pulmonary disease (COPD), or thromboembolic disease — who do not desire future vaginal intercourse or vaginal preservation. In this population, obliterative surgical procedures that narrow, shorten, or completely close the vagina are recognised as a first-line surgical option, and are associated with low rates of complications, intensive care unit admissions, and mortality.
For patients with asymptomatic prolapse, initial management centres on education and reassurance. Where symptoms are present, certain lifestyle measures may be introduced to address defecatory and bulge-related complaints. A vaginal pessary represents a recognised non-surgical alternative for appropriate candidates.
The full structured protocol — including the sequencing of interventions, patient-specific selection criteria, and all management steps for this high-comorbidity population — is available via the link below.Obliterative procedures––which narrow, shorten, or completely close the vagina––are effective for the treatment of POP and should be considered a first-line surgical treatment for women with significant medical comorbidities who do not desire future vaginal intercourse or vaginal preservation.
In addition, obliterative procedures for the treatment of POP are associated with low rates of complications, intensive care unit admissions, and mortality.
For women with asymptomatic prolapse, education and reassurance are appropriate.
Women considering treatment of POP should be offered a vaginal pessary as an alternative to surgery.
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