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Cystocele (Fallen Bladder)

Cystocele, otherwise known as a fallen bladder, occurs when ligaments and muscle that supports the bladder stretches or weakens, allowing the bladder to sag into the vagina. Learn more from experts at Cleveland Clinic.

What is a Cystocele?

Diagram of a normal pelvis

normal pelvis

A cystocele―also known as a prolapsed, herniated, dropped, or fallen bladder (where your urine or “water” is stored)―occurs when ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder stretches or weakens, allowing the bladder to sag into the vagina.

There are three grades of cystocele:

  • Grade 1 (mild) – The bladder drops only a short way into the vagina.
  • Grade 2 (moderate) – The bladder drops to the opening of the vagina.
  • Grade 3 (severe) – The bladder bulges through the opening of the vagina.

What Are the Symptoms of a Cystocele?

  • having to run to the bathroom frequently to pass water, or just a feeling as if you have to go a lot
  • unwanted leakage of urine (incontinence). The fallen bladder may stretch the opening of the urethra (the tube through which urine passes). This can cause urine to leak out during coughing, sneezing, laughing, or moving in a way that puts pressure on the bladder.
  • incomplete emptying of the bladder
  • frequent urinary tract infections
  • feeling of fullness, heaviness, or pain in the pelvic area or lower back. This feeling may get worse when the person is standing, lifting, coughing, or as the day goes on.
  • the bladder bulging into or out of the vagina
  • painful sex
  • problems inserting tampons or applicators
Diagram of cystocele

cystocele

Symptoms of a cystocele include the following:

What Causes a Cystocele?

Risk factors for a cystocele include:

  • vaginal births, which may involve straining the muscles of the floor of the pelvis
  • family history
  • obesity
  • intense physical activity, including lifting heavy objects
  • hysterectomy
  • constipation and/or repeated muscle straining during bowel movements
  • frequent coughing
  • aging and a drop in the hormone estrogen. Estrogen helps keep muscles around the vagina strong, but women produce less estrogen as they enter menopause (the end of menstrual periods).

How is a Cystocele Diagnosed?

A Grade 2 or Grade 3 cystocele can be diagnosed from a description of symptoms and from an examination of the vagina.

The doctor may also perform certain tests, including the following:

  • Cystourethrogram - X-rays of the bladder during urination to show the shape of the bladder and reveal anything that might be blocking the normal flow of urine
  • Urodynamics – Measures the bladder’s ability to hold and release urine
  • Cystoscopy (cystourethroscopy) – A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stones.
  • Fluoroscopy – Real-time imaging (pictures) of bodily functions

How is a Cystocele Treated?

If it is not bothersome, a mild cystocele may not require any treatment other than avoiding heavy lifting or straining that could cause the problem to get worse.

Other potential treatment options include the following:

  • limiting fluids, especially drinks that contain caffeine, which are diuretics (increase the need to urinate)
  • bladder training in order to lengthen the amount of time between bathroom visits
  • emptying the bladder on a regular schedule
  • weight loss
  • estrogen replacement therapy
  • Kegel exercises to strengthen the openings of the urethra, vagina, and rectum. These exercises involve tightening the muscles that are used to stop the flow of urine, holding for 10 seconds, and then releasing.
  • If symptoms are modest , a device called a pessary may be placed in the vagina to hold the bladder in place. Pessaries are available in a number of shapes and sizes to ensure a proper fit. A pessary has to be removed and cleaned on a regular basis in order to avoid infection or ulcers.

A serious cystocele may require reconstructive surgery called an anterior repair to move the bladder into a normal position. In this type of surgery, an incision (cut) is made in the wall of the vagina and the tissue that separates the bladder from the vagina is tightened. The surgeon might also implant permanent mesh grafts made of synthetic or biologic materials to improve vaginal support.

The patient usually goes home the day after the surgery. Complete recovery usually takes four to six weeks.

For women who never plan on having sexual intercourse again, surgeries that sew the vagina shut and shorten it so it no longer bulges are nearly 100% effective. These techniques are best done in elderly patients with multiple medical problems that would make reconstructive surgery a high risk.

What is the prognosis (outlook) for someone with a cystocele?

Although not life-threatening, a cystocele can have a negative impact on a woman’s quality of life. If it is not treated at all, the condition can continue to get worse. In the worst cases, the woman may be unable to urinate, which can cause kidney damage or infection.

What can be expected after treatment for a cystocele?

In mild cases, non-surgical treatments may be all that is needed to successfully deal with a cystocele.

When surgery is performed for more serious cases, some women will eventually need another surgery because the first surgery failed, or the cystocele returned, or another pelvic floor problem developed. In addition, the use of permanent meshes may cause complications, including urinary tract infections, exposure of mesh into the vagina, and pelvic or genital pain. Women who are older, who smoke, are diabetic, or who have had a hysterectomy, may be at higher risk for complications.

How Can a Cystocele Be Prevented?

Certain risk factors, including heavy physical work, being overweight, and constipation, can be controlled, while risk factors such as family history cannot. As the population ages, the occurrence of cystocele is likely to increase.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/27/2014...#15468

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