Cystocele, also called a bladder hernia, is a type of pelvic organ prolapse. It can have a variety of causes. While not life-threatening, without proper management and treatment, it can cause a range of uncomfortable side effects and conditions.

What is a cystocele?
A cystocele (pronounced SISS-toe-seal) is a prolapsed bladder or a bladder that has fallen out of its normal position. A woman’s bladder lies in the pelvic area in front of the vagina, and it is supported by strong muscular tissue and connective ligaments.
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.
Bladder prolapse can occur for a variety of reasons. One of the most common is vaginal childbirth. Although pregnancy, pelvic surgery such as a hysterectomy, or any pelvic trauma can cause the condition as well. Another common cause of cystocele is menopause.
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.
Other things that may lead to a cystocele include repeated strain of heavy lifting, severe chronic cough, or chronic constipation.
Symptoms of a cystocele
You may not notice any symptoms if your cystocele prolapse is mild.
However, some cystocele symptoms that are commonly reported are:
- The sensation of pressure or heaviness in your pelvis
- Pain or discomfort when lifting heavy objects, coughing, or straining your pelvic muscles
- The feeling of incomplete voiding of the bladder
- Urinary incontinence, such as urine leakage during sex or strenuous activities (stress incontinence)
- 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. The reduction in estrogen that keeps the vaginal tissue strong.
- Family history. The condition appears to have a hereditary component.
- Obesity. Being overweight may increase your risk.
- Pelvic surgery. Women who have had their uterus surgically removed or prior pelvic reconstructive surgeries may have damaged or weakened pelvic floor muscles.
Diagnosing cystocele
If you’re experiencing any unusual symptoms, make an appointment with Dr. Aliabadi. She 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 muscles, such as those you would use to hold your urine or have a bowel movement.
Dr. Aliabadi will ask about your symptoms and how your prolapsed bladder affects your daily life. You may need to undergo a test (cystourethrogram) 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.
Treating cystocele
Some cases won’t require any medical intervention, especially if the cystocele isn’t causing any uncomfortable symptoms or affecting quality of life. In these cases, medical cystocele treatments may not be necessary.
Instead, Dr. Aliabaid might recommend an at-home self-care plan that involves exercises to strengthen your pelvic floor muscles. This alone can sometimes improve the condition. Nonsurgical treatment options can include the following.
Kegel exercises
Pelvic floor exercises such as Kegel exercises are designed to strengthen the muscles supporting 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 Kegel exercises each day as you like.
Pessary
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.
Estrogen therapy
For women who have reached menopause, your doctor may recommend estrogen therapy, a hormone replacement treatment, to help rejuvenate your pelvic floor muscles. Estrogen therapy can be delivered into the vagina with cream or ring, or it can be taken orally via estrogen pills.
Cystocele repair surgery
Surgery is typically recommended in severe cases of wall prolapse and only if the woman is finished having children. Cystocele prolapse surgery is performed through the opening of 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.
Have questions about your health? Talk to Dr. Aliabadi
Dr. Aliabadi isn’t only an expert OB/GYN but is knowledgeable in all aspects of women’s health and well-being, including bladder prolapse. Dr. Aliabadi and her caring, supportive staff are available to support you through menopause, childbirth, infertility, or even just routine gynecological care.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Cystocele FAQs
What are the most common fallen bladder symptoms?
Not all cystocele cases produce symptoms, but if you have a symptomatic cystocele, you will likely notice pelvic pressure, a frequent need to urinate or urine leakage, and a vaginal bulge.
What to expect after cystocele prolapse repair?
The recovery period often lasts around 2-3 weeks, during which you may notice some soreness, pain, and spotting. You should avoid intense exercise, heavy lifting, and intercourse for 4-6 weeks post-cystocele surgery.
Can you have a cystocele with rectocele?
Yes, you can have both a cystocele and a rectocele, in which the back wall of the vagina bulges and pulls the rectum with it. The conditions can occur together as they have similar causes and risk factors.
Sources
Cystocele. https://www.ncbi.nlm.nih.gov/books/NBK564303/
Pelvic Organ Prolapse. https://www.ncbi.nlm.nih.gov/books/NBK563229/
Rectocele. https://www.ncbi.nlm.nih.gov/books/NBK546689/
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