Clinical Scenario

This protocol addresses enterocele occurring in the context of uterine prolapse in women who prefer to avoid hysterectomy — for example, to preserve fertility or maintain body image. Hysteropexy is a recognised alternative to hysterectomy in this setting, though the evidence base for uterus-sparing approaches is more limited than for hysterectomy-based repair.

Management Overview

Initial management includes education and reassurance for asymptomatic prolapse, alongside targeted lifestyle modifications and pelvic muscle exercises. A vaginal pessary is offered as a non-surgical alternative, with specific pessary types considered in sequence. The complete protocol details how these steps are structured and when further options apply.

Full sequencing, decision points, and complete regimen are available in the structured protocol below.

References

DOI: 10.1097/AOG.0000000000003519

Hysteropexy is a viable alternative to hysterectomy in women with uterine prolapse, although there is less available evidence on safety and efficacy compared with hysterectomy.
Women who desire surgical treatment of POP may choose to avoid hysterectomy for a variety of reasons, including preservation of fertility, maintenance of body image, and beliefs about adverse effects on sexual function.
For women with asymptomatic prolapse, education and reassurance are appropriate.
Pelvic muscle exercises, performed either independently or under professional supervision, may improve symptoms or slow the progression of POP.
Women considering treatment of POP should be offered a vaginal pessary as an alternative to surgery.
In one study protocol, a ring pessary was inserted first, followed by a Gellhorn pessary if the ring did not stay in place.

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Enterocele in Uterine Prolapse — When the Patient Prefers to Avoid Hysterectomy

References