The hernia descends below the proximal (upper) third of the vagina in females,[2] or, according to another definition, below the pubococcygeal line (PCL).
"[4] As such, peritoneocele, enterocele, sigmoidocele, and omentocele could be considered as types of cul-de-sac hernia.
In terms of pelvic organ prolapse, a cul-de-sac hernia is located in the posterior compartment of the pelvis.
[2] It has been suggested that the terms enterocele and sigmoidocele are inaccurate, since hernias are usually named according to location and not according to contents.
[3][4] Cul-de-sac hernias may be classified as rectal, septal, or vaginal depending on the structure they herniate into.
Primary cul-de-sac hernias are associated with factors such as multiparity, old age, lack of elasticity, obesity, constipation, and increased abdominal pressure are present.
[10] Possible symptoms include: Cul-de-sac hernias are the most difficult to diagnose during physical examination, and to distinguish from anterior rectocele or enterocele.
[3] Combined vaginal and rectal digital palpation may be used (examiner's thumb in vagina, index finger in anal canal).
[1] Risk factors include prior hysterectomy and urethropexy because of the damage caused to the rectovaginal fascia.