A cystocele occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. A cystocele may also be called a prolapsed bladder.
Straining the muscles that support your pelvic organs may lead to a cystocele. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing and heavy lifting. Cystoceles also tend to cause problems after menopause, when estrogen levels decrease.
For a mild or moderate cystocele, nonsurgical treatment is often effective. In more severe cases of cystocele, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.
In mild cases, it's possible to not even notice any symptoms. When cystocele signs and symptoms do present themselves, they may include:
Physicians may refer to a cystocele as an anterior prolapse, as the front (anterior) vaginal wall has collapsed and the bladder is bulging downward into the vagina.
When to see a doctor
Your pelvic floor consists of muscles, ligaments and connective tissue that support your bladder, uterus and rectum — the organs that fill your pelvic cavity. If the connections between your pelvic floor muscles and ligaments are weak to begin with, you may be at greater risk of bladder prolapse. Intense pelvic pressure may stretch and weaken these structures, allowing organs such as the bladder sink lower in your body and become prolapsed.
Most common causes
A dropped or prolapsed bladder (cystocele) occurs when the bladder wall bulges into the vaginal space. It results when supporting muscles and tissues for the bladder give way. ...
The following factors may increase your risk of experiencing a cystocele:
Preparing for your appointment
If you have signs or symptoms common to cystocele, make an appointment with your primary care provider. In some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
For cystocele, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
To diagnose a cystocele, your doctor will conduct a pelvic exam. During the pelvic exam, your doctor:
Treatments and drugs
Cystocele treatment depends on the severity of the condition. Mild cases — those with few or no obvious symptoms — may require no treatment or simple self-care measures such as Kegel exercises to strengthen your pelvic floor muscles. A physical therapist who specializes in pelvic floor disorders may be helpful in teaching these exercises. If self-care measures aren't effective, treatment may include:
When surgery is necessary
In most cases, surgery consists of a vaginal repair. In this procedure, a surgeon elevates the prolapse back into place, removing redundant tissue and tightening the muscles and ligaments of your pelvic floor. While the benefits of this type of surgery can last for many years, there's some risk of recurrence. This is partly because of downward forces of gravity resulting in stretching of tissues again.
If the cystocele recurs, you may need surgery again. In some cases, especially where the tissues needed to support the vagina are unusually thin, using a special type of tissue graft may help thicken the vaginal tissues and increase support. If the cystocele is associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) to help correct the problem and prevent recurrence.
When possible, avoid surgical treatment until you're done having children. A pessary may help to relieve symptoms in the meantime. If the prolapse is so uncomfortable that you need a vaginal repair, you can still have children — though a cesarean delivery is sometimes recommended.
Dealing with incontinence
Lifestyle and home remedies
Kegel exercises, designed to strengthen your pelvic floor muscles, can help both prevent and treat stress incontinence. To perform Kegel exercises, follow these steps:
Kegel exercises may be most successful when they're taught by a therapist using biofeedback. Biofeedback uses information from a variety of pain-free monitoring devices to help teach you to control certain involuntary body responses, such as muscle tension. In this case, biofeedback can help ensure you're contracting the proper muscles, and that the intensity and duration of the muscle contractions are optimal.
You can help prevent prolapse with the following measures:
Last Updated: 2010-01-12
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