Cystocele (Fallen Bladder)

What is a cystocele?

A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. It’s a type of pelvic organ prolapse.

Other names for a cystocele (SIS-tuh-seel) include:

• Prolapsed bladder.
• Herniated bladder.
• Dropped bladder.
• Fallen bladder.

What are the types of cystoceles?

There are three grades of cystocele:

• Grade 1 (mild). Your bladder drops only a short way into your vagina.
• Grade 2 (moderate). Your bladder drops to the opening or slightly outside of your vagina.
• Grade 3 (severe). Your bladder bulges a lot past the opening of your vagina.

How serious is a cystocele?

It depends on the severity of your cystocele.

A mild cystocele may only cause discomfort or cause you to leak pee accidentally (urinary incontinence). A severe cystocele prevents you from being able to pee. This can cause an infection or kidney damage.

How common is a cystocele?

Cystoceles are common. Medical experts estimate that about 50% of women and people assigned female at birth (AFAB) have some grade of cystocele.

What are the symptoms of a cystocele?

Cystocele symptoms may include:

• Feeling or seeing something bulging through your vaginal opening.
• A feeling of fullness, heaviness or pain in your pelvic area. This feeling may get worse when you’re standing, lifting heavy objects, coughing or as the day goes on.
• Going to the bathroom more than usual.
• Difficulty fully emptying your bladder when you pee.
• Frequent urinary tract infections (UTIs).
• Difficulty inserting period products, including tampons and menstrual cups.

What causes a cystocele?

Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include:

• Vaginal births, which may strain the muscles in your pelvic floor.
• A biological family history of cystoceles.
• Obesity (having a body mass index, or BMI, greater than 30).
• Hysterectomy.
• A drop in estrogen production, usually as a result of aging. Estrogen is a hormone that helps keep the muscles around your vagina strong. As you age and enter menopause, your body produces less estrogen.

Who do cystoceles affect?

A cystocele can affect anyone with a vagina of any age. However, you’re more likely to have a cystocele as you age and your pelvic floor muscles weaken. The following can also increase your risk of developing a cystocele:

• Giving birth vaginally.
• Having surgery on your pelvic floor muscles or uterus, such as a hysterectomy.
• Having obesity.
• Having a biological family history of cystoceles.

What are the complications of a cystocele?

A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage.

How are cystoceles diagnosed?

A healthcare provider who specializes in the female reproductive and urinary systems (urologist or gynecologist) can diagnose a cystocele. They’ll review your medical history, ask questions about your symptoms and conduct a physical examination.

The provider may also perform the following tests:

• Urodynamic testing. This test measures your bladder’s ability to hold and release pee.
• Cystoscopy. A healthcare provider passes a long, pencil-sized lighted tube with a camera on the end (cystoscope) through your urethra to your bladder. They’ll look for malformations, blockages, tumors or stones in your urinary tract.

How do I check myself for a cystocele?

Only a healthcare provider can diagnose a cystocele. However, many may feel the bulge coming out of their vagina, and they can push it back in with their hands. If you have cystocele symptoms, see a healthcare provider immediately.

How do you get rid of a cystocele?

It depends on how severe your cystocele is.

If you have a mild cystocele that doesn’t bother you, you may not need any treatment other than to avoid heavy lifting or straining that could worsen the cystocele.

Other mild cystocele treatment options include:

• Maintaining a healthy weight for you.
• Estrogen replacement therapy.
• Kegel exercises to strengthen the openings of your urethra, vagina and rectum.
• A pessary device to help hold your bladder in place.

Some moderate or severe cystoceles may require surgery if the above options don’t work.

What happens during and after surgery for a cystocele?

A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

Cystocele surgery is usually an outpatient procedure, meaning you can go home the same day you have the surgery. Most people have a complete recovery in a few months.

If you never plan on having sexual intercourse again, there are surgical options that sew the vagina shut and shorten it so there are no longer any bulges.

If more than your bladder is falling down — such as your uterus, the top of your vagina (providers call this the apex after a hysterectomy) or the rectum — then your provider may discuss other types of surgeries with you.

How soon after treatment will I feel better?

For a severe cystocele that requires surgery, you should feel better soon after the surgery. But complete recovery may take a few weeks.

Can a cystocele be prevented?

It depends. You can control certain cystocele risk factors, including:

• Maintaining a healthy weight for you. Talk to a healthcare provider about what a healthy weight means for you.
• Avoiding constipation. You can help prevent constipation by eating a high-fiber diet, drinking plenty of water each day and exercising regularly.
• Protecting your pelvic floor muscles during heavy physical activity. Don’t try to lift heavy objects by yourself. If you’re lifting a heavy object on your own or working out, use proper form: bend your hips and knees to squat and keep your back straight. Don’t twist your torso while you lift.

However, you can’t modify other risk factors, like your family history or age.

What is the outlook if I have a cystocele?

Cystoceles aren’t life-threatening, but they can negatively affect your quality of life. A cystocele can get worse without treatment. In the worst cases, you may not be able to pee, which can cause an infection or damage your kidneys.

What should I avoid if I have a cystocele?

If you have a cystocele, you should avoid heavy lifting or any activities that put pressure on your pelvic floor muscles.

It’s also a good idea to prevent or treat chronic coughing. Avoid or quit smoking, and get treatment for conditions that cause a chronic cough, such as bronchitis. A long-lasting cough can put a lot of pressure on your chest and abdomen, which causes your pelvic floor muscles to strain.

When should I see a healthcare provider?

Reach out to a healthcare provider if you have any symptoms of a cystocele, especially if they affect your quality of life.

When should I go to the ER?

Go to the emergency room if you have signs of a cystocele and can’t pee.

What questions should I ask a healthcare provider?

• How do you know I have a cystocele?
• If I don’t have a cystocele, what other condition do I have?
• What treatment do you recommend?
• Can I manage a cystocele without surgery?
• Can I get a cystocele again after treatment?
• What activities or movements should I avoid?
• Can I still have sex if I have a cystocele?
• Should I see a gynecologist or urologist?

What is the difference between a prolapsed bladder and a cystocele?

A prolapsed bladder and a cystocele are the same condition. Prolapsed bladder is another name for cystocele.

A note from Cleveland Clinic

Cystoceles usually aren’t dangerous, but they can make you feel embarrassed or self-conscious. Don’t hesitate to contact a healthcare provider if you have cystocele symptoms that affect your quality of life. They’ll review your medical history and symptoms and suggest the best treatment options to repair your cystocele and improve your well-being.