A cystocele is a hernia type disorder that happens to women when the wall between the bladder and the vagina weakens, causing the bladder to drop into the vagina. A cystocele is also called a prolapsed bladder or dropped bladder and can happen from excessive straining during childbirth, chronic constipation or chronic heavy lifting. This means that older women who have given birth to several children are more likely to develop a cystocele than younger women.
In mild cases women may not even notice a bulge inside the vagina. However, when the cystocele is larger several symptoms will cause a woman to consider seeking the advice of her gynecologist. Symptoms can include a feeling fullness or pressure in the pelvic area, especially when standing for long periods of time. Women will be more aware of symptoms when they strain, cough, lift or bear down.
In severe cases women will notice a bulge of tissue that protrudes through the vaginal opening. This tissue can feel either walnut or even grapefruit size and will often go away when lying down. Other women will feel as if they have not completely empty the bladder after urinating or will lose control of their urine when coughing, laughing or sneezing.
Women who suffer from a cystocele will often have problems with re-current bladder infections because of the abnormal anatomical position of the bladder hanging into the vagina. Also because of the position women will have pain or urinary leakage during sexual intercourse.
The pelvic floor supports the bladder, uterus, colon and small intestines. These are all organs that fill the pelvic cavity and are supported by muscles and ligaments. If these tissues stretch or weaken some of the internal organs can sink lower into the body, or prolapse. Some of the most common causes are pregnancy and childbirth because the muscles and ligaments that support the vagina and bladder can become stretched during labor and delivery.
Not everyone who delivers a child will develop a cystocele. With the proper use of preventative Kegel exercises women are often able to maintain good strength in their pelvic floor muscles. Women who have had only cesarean section deliveries will also not develop prolapses.
Other common causes include obesity, repeated heavy lifting, chronic constipation and chronic cough or bronchitis. All of these factors deliver the same stress and strain to the pelvic floor muscles, the weakening of which are responsible for a cystocele developments.
Cystoceles are described by three different grades. A grade 1, mild cystocele, is when the bladder droops only a short way into the vagina. In a grade two the bladder has sunk into the vagina far enough to reach the opening and in grade 3 the bladder will actually come through the opening of the vagina. Grade two or three cystoceles are diagnosed from a description of symptoms and a subsequent physical examination of the vagina.
Although the physician will be able to determine exactly what is going on from a physical examination, they may also order a cystourethrogram to determine the shape of the bladder and any problems that may be blocking the normal flow of urine. Other tests are x-rays may be needed to rule out co-morbid problems in about urinary tract.
Treatment recommendations and protocols will be made by your physician depending upon the severity of the cystocele and your overall health and activity level. A mild case with few or no obvious symptoms may require no treatment other than simple self-care measures such as pelvic floor exercises and avoiding constipation and heavy lifting.
If self-care is not effective, treatment options include a pessary which is a plastic or rubber ring inserted into the vagina to support the bladder. Most women will use this temporarily as an alternative to surgical reconstruction but depending upon the severity of the cystocele and the woman’s activity level, she may use a pessary for years.
As an adjunct to either pelvic floor muscles exercises or a pessary your physician may also recommend using estrogen if you have already completed menopause. This is because estrogen will help to keep the pelvic muscles strong.
Severe cases of cystocele which are uncomfortable can require surgery to reconstruct the area. At this point this surgery is considered elective and you should work with your surgeon to prior authorized your individual case with your insurance company.
In most cases the surgery consists of a vaginal repair and placing the latter back into the correct position. The surgeon will tighten the muscles and ligaments of the pelvic floor and can require the removal of some stretched tissue. There is some risk of recurrence, partly because the pelvic muscles and nerves will continue to weaken as an individual ages.
If the problem recurs you and your physician may consider another surgery, although it’s more difficult to get a good result the second time. If the cystocele is associated with a prolapsed uterus as well as bladder, your surgeon may recommend removing the uterus to help correct the problem.
Another issue which women must deal with when suffering from a cystocele is urinary incontinence. There are a number of procedures to elevate the junction between the urethra and bladder or the doctor may use collagen injections to treat the incontinence caused by a cystocele.
In any case, it is extremely important to seek the advice of your gynecologist when dealing with a cystocele in order to help you maintain relatively normal daily activities and sexual health.
National Kidney and Urologic Disease Information Clearinghouse: Cystocele
The Merck Manual: Cystoceles, Urethroceles, Enteroceles and Rectoceles
Urology Associates: Cystocele