Cystocele

What is a cystocele?

Ligaments, muscles, and connective tissue normally hold your bladder and other organs in their proper places in your pelvis. When these tissues get weak, organs in the pelvic area of your body may drop down into the vagina. When the bladder drops into the vagina, it is called a cystocele. The bladder may even come down so far that it causes a bulge at the opening of the vagina.

This problem may also be called a prolapsed bladder.

How does it occur?

The most common cause is weakening of the tissues of the pelvis and vagina after childbirth. This can happen because the muscles and skin of the birth canal (vagina) are stretched and sometimes torn during childbirth. They heal over time but may not be as strong as they were before.

Older women may have this problem because the loss of female hormones after menopause causes the vaginal tissue to get weaker.

A cystocele may also be caused by:

• a chronic cough
• chronic constipation or straining to pass bowel movements
• a lot of heavy lifting
• obesity
• injury to the vagina.

What are the symptoms?

You may not have any symptoms. If you do have symptoms, they may include:

• leaking of urine when you cough, sneeze, laugh, lift heavy objects or during sex
• frequent and painful urination (symptoms of bladder infection)
• backache
• feeling of pressure in the vagina
• pain during sex
• in severe cases, being unable to control urine at all.

You may feel tissue sticking out of the opening of the vagina.

The rectum may also press into the vagina. This problem is called a rectocele. It can cause trouble with bowel movement. For example, you may have bowel movements less often or you may have leaking of bowel movements.

How is it diagnosed?

Your healthcare provider will ask about your symptoms. You will have a pelvic exam. Your provider may ask you to bear down and push as you would to have a bowel movement. This will help your provider see how far the bladder bulges into the vagina. Your provider may also ask you to squeeze the muscles of your pelvis (as you would to stop urinating) to check the strength of your pelvic floor muscles. You may be examined in different positions: lying down, standing up, and squatting. You may also have a rectal exam.

You may also have blood and urine tests and tests of the nerves and muscles of the pelvis and around the bladder to see what treatment is best for you.

How is it treated?

Treatment may be surgical or nonsurgical depending on your symptoms and how severe the cystocele is. Possible treatments include:

• Kegel exercises: These are exercises you can do to strengthen the muscles in and around your vagina. They are done by squeezing the pelvic floor muscles on a regular schedule.
• Pessary: A vaginal pessary (a silicone or plastic ring or disc) is placed in the vagina to push the bladder up and back in place. Your healthcare provider can fit you with an appropriate one. It is important to follow your provider’s instructions regarding care of a pessary. This includes removing and cleaning it every night or every week and having regular checkups with your provider.
• Surgery: You may need surgery to repair weakened tissue. In some cases, a hysterectomy (removal of the uterus) may be recommended because the ligaments of the uterus are stretched and the uterus is falling down on top of the bladder.

How long will the effects last?

Doing Kegel exercises every day or using a pessary may be all that you need to do to relieve symptoms caused by the cystocele. Kegel exercises are usually recommended before surgery is considered. Talk to your healthcare provider about whether she or he thinks nonsurgical treatments will be helpful for you.

Surgery is usually very effective and can be a lasting cure as long as you maintain a healthy lifestyle and weight. However, later on the tissues could stretch and weaken again.

How can I take care of myself or prevent a cystocele?

You can take care of yourself by:

• treating and preventing constipation
• avoiding heavy lifting
• lifting correctly (with your legs and not with your waist or back)
• treating a chronic cough
• not smoking
• keeping a healthy weight
• doing Kegel exercises, especially after you have a baby

If you have problems with leaking of urine, try to empty your bladder regularly before you have the urge to go. This will reduce the chance that urine will leak. You may also want to wear a pad to absorb wetness in the event of leakage.

If you are using a pessary for treatment of the cystocele, tell your healthcare provider if:

• You have pain, bleeding, vaginal discharge, or odor.
• The pessary falls out.
• You have new or increased leaking of urine.

If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before delivery.