A cystocele (pronounced SISS-toe-seal) is essentially a prolapsed bladder (fallen bladder). A woman’s bladder lies in front of the vagina, and it is supported by strong muscular and connective tissue. When that tissue becomes weak and loses some of its elasticity, the bladder can begin to bulge into the vaginal wall. This is also known as anterior prolapse. The word anterior refers to the front wall of the vagina.
The tissue can weaken for a variety of reasons, including childbirth or pelvic trauma. One may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. A cystocele may result from the repeated strain of heavy lifting, severe coughing, or chronic constipation.
Another common cause of cystocele is menopause. The hormone estrogen typically keeps a woman’s pelvic floor muscles and connective tissues healthy and supple. During menopause, the body decreases its production of estrogen, which can lead to degeneration of these muscles.
You may not notice any symptoms if your cystocele is mild. However, some symptoms that are commonly reported are:
- The sensation of pressure in your pelvis
- Pain or discomfort when lifting heavy objects, coughing, or straining your pelvic muscles
- The feeling of incomplete emptying of the bladder
- Leaking urine during sex or strenuous activities
- Pain during sexual intercourse
- Persistent bladder infections, common with urinary retention
- A palpable or visible bulge protruding outside your vaginal opening (severe prolapse)
Risk Factors for Cystocele
Although a prolapsed bladder can happen to anyone, they are much more likely in certain populations.
- Vaginal delivery. Women who have delivered one or more children naturally are at a higher risk of cystocele.
- Menopause is another factor that increases a woman’s risk for cystocele, due to the reduction in estrogen that keeps the vaginal tissue strong.
- The condition appears to have a hereditary component.
- Being obese or overweight may increase your risk.
- Women who have had their uterus surgically removed may have damaged or weakened pelvic floor muscles.
If you’re experiencing any unusual symptoms, make an appointment with your gynecologist. Your doctor will want to perform a pelvic exam to look for any bulging in your vagina and review your medical history. You may be asked to contract different groups of muscles, such as those you would use to hold your urine or to have a bowel movement.
Your doctor will ask you questions about your symptoms and how your prolapsed bladder is affecting your daily life. You may need to undergo a test to evaluate how well your bladder is functioning, and a sample of urine may be collected to check for any infections, such as urinary tract infections.
Some cases won’t require any medical intervention, especially if the cystocele isn’t causing any uncomfortable symptoms. In these cases, you may be sent home with a self-care plan that involves exercises to strengthen your pelvic floor muscles. This alone can sometimes improve the condition.
Pelvic floor exercises such as Kegel exercises are designed to strengthen the muscles that support your bladder, uterus, and bowels. These muscle exercises are easy to do and can be done at home, in the office, or even in the car. Contract the muscles you would use to stop the flow of urine, hold for 2-5 seconds, then relax your muscles. Repeat 10 times. You can do as many sets of Kegel exercises each day as you like.
If your condition doesn’t improve or if your symptoms are affecting your quality of life, your gynecologist may recommend one of these treatment options:
This is a conservative treatment option. A pessary is a device you can insert into your vagina to give your pelvic organs more support. There are a few varieties, including rubber, plastic, and balloon-shaped pessaries. Your doctor can insert the vaginal pessary and show you how to remove it, clean it, and re-insert it as needed. Sometimes, a vaginal pessary can be used temporarily before a surgical fix.
For women who have reached menopause, your doctor may recommend estrogen therapy, a nonsurgical treatment, to help rejuvenate your pelvic floor muscles. Estrogen therapy can be delivered into the vagina with cream or ring, or they can be taken orally via estrogen pills.
Cystocele Repair Surgery
Surgery is typically recommended in severe cases, and only if the woman is finished having children. The procedure is performed through the vagina and involves lifting the bladder and tightening the pelvic floor muscles and connective tissues. If the vaginal tissues are atrophied, the surgeon can strengthen them with a special type of tissue graft.
If you believe you are experiencing symptoms of, or suffering from Cystocele (Prolapsed Bladder), or have questions about it, please see your doctor.
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