What is a cystocele?
Pelvis with a cystocele (fallen bladder)
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.
Symptoms and Causes
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.
- Intense physical activity, including lifting heavy objects.
- 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).
What are the symptoms of a cystocele?
- Feeling or seeing something bulging through the vaginal opening
- Difficulty emptying the bladder (urinating)
- Having to run to the bathroom frequently to pass water, or just a feeling as if you have to go a lot.
- 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.
Diagnosis and Tests
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:
- 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.
Management and Treatment
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:
- 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.
What happens during and after surgery for a cystocele?
A moderate or severe cystocele may require reconstructive surgery to move the bladder into a normal position. There are a number of ways to perform this surgery, including an anterior repair. In an anterior repair, an incision (cut) is made in the wall of the vagina and the tissue that separates the bladder from the vagina is tightened. Another option, for more severe prolapse, is to place a synthetic material with a robotic or laparoscopic approach through the abdomen. This method may give more support to the tissue and help prevent the condition from happening again.
The patient usually goes home the day of the surgery. Complete recovery typically 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 percent effective.
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, the cystocele returned or another pelvic floor problem developed. 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.
Outlook / Prognosis
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.