Chronic pelvic pain and rectal prolapse invite consideration of enterocele.

Data on the pathogenesis and symptoms of enterocele are limited. The objectives of this study were to determine the clinical phenotype of patients with enterocele, to highlight the main functional and/or anatomic associations and to improve the accuracy of the preoperative assessment of pelvic floor disorders.A total of 588 patients who were referred to a tertiary unit for an anorectal complaint underwent self-administered questionnaires, physical examination, anorectal manometry and defecography. Enterocele was defined using defecography as a radiological hernia of the small bowel into an enlarged rectovaginal space. One hundred and thirty-five patients with enterocele were age and gender-matched with 270 patients without enterocele. Factors associated with enterocele were assessed using univariate and multivariate analysis models.Patients with enterocele were less frequently obese than patients without enterocele (8/135 vs 36/270, p=0.02) and more frequently had a past history of pelvic surgeries (51/135 vs 75/270, p=0.04). They complained more frequently of pelvic pain on bearing down (29/135 vs 24/270, p=0.003), anal procidentia (37/135 vs 46/270, p=0.01) and more frequently had irritable bowel syndrome (IBS) (83/135 vs 131/270, p=0.01) and severe constipation according to the Kess score (104/135 vs 182/270, p=0.04). Anorectal function was comparable between the two groups. Patients with enterocele had more frequent rectoceles and overt rectal prolapses compared to patients without enterocele.Enterocele should be investigated in patients with chronic pelvic pain, overt rectal prolapse and/or a past history of pelvic surgery. WHAT DOES THIS PAPER ADD TO LITERATURE?: This paper highlights that patients with enterocele more frequently had rectal prolapse and complaints of pelvic pain. These features should draw attention to the possibility of enterocele, and conventional defecography should be considered.