Cystocele (aka Prolapsed Bladder)
Do you experience any of the following symptoms?
- Leakage of urine
- A feeling that your bladder or vaginal area has fallen out or "dropped"
- You see a ball or bulge at the vaginal opening
If so, then you may have a cystocele, also known as bladder prolapse or anterior vaginal prolapse. Cystocele is one of the most common forms of pelvic organ prolapse. This article explained how cystocele develops, why it occurs, and some of the available treatments.
Is That My Pelvic Floor?
Patients with cystocele often see their doctors with a feeling of pelvic pressure or lower back discomfort. Sometimes, they notice a bulge or ball at the opening of the vagina. Sometimes they also have lower abdominal or low back pain and have trouble with intercourse (often described as “something getting in the way”). Mild cases are often asymptomatic.
Cystocele is the term used to describe what is happening when the front wall of the vagina bulges down toward the opening of the vagina. When this happens, the bladder, which rests on the front wall of the vagina often follows. Hence the term “cystocele.”
cysto- means bladder and -cele means hernia -- and that's exactly what this is...a hernia.
Risk factors for cystocele include anything that can weaken the attachments of the anterior vaginal wall. The mose common risk factors may include:
- Childbirth
- Advancing age
- Pelvic trauma
- Chronically elevated abdominal pressure from:
- Heavy lifting or straining
- Smoking (and chronic cough)
- Obesity
- Straining to have bowel movements
Diagnosis of Pelvic Organ Prolapse (POP)
The diagnosis of cystocele is made with the help of a pelvic exam by a trained physician or other medical provider.
After asking a series of questions to determine your symptoms, urogynecologists like Dr. Stewart will examine the pelvis, internally and externally. During this exam, your doctor may ask you to bear down, push, or cough to re-create some of your symptoms. These actions increase the pressure inside the abdomen and encourage the bulge that you may feel after a long day of standing to present itself in the controlled environment of the doctor’s exam room.
Dr. Stewart will often use all or part of a speculum during the exam. This allows him to hold certain walls of the vagina in place while evaluating the movement of others. This helps him to localize the pelvic organ prolapse and develop a customized treatment plan to suit your particular variety of pelvic organ prolapse — cystocele or otherwise.
After the examination Dr. Stewart will again revisit your symptoms and your goals for treatment.
Common patient goals include:
- Improved sexual function
- Ability to exercise or enjoy specific activities
- Sitting comfortably
- Decreased urinary symptoms (like urinary incontinence)
- Improved function of pelvic organs (bladder & bowels)
Given this information and the findings of your examination of the pelvis, doctor Stewart will sit with you and explain the exam findings, often drawing pictures, and allowing you to ask questions about all of the various treatments available.
Treatments for Cystocele
Because bladder prolapse is not dangerous. The treatments for them are largely guided by patient goals and desires. Doctor Stewart will outline the various treatments for your prolapsed bladder and any pelvic floor problems you may also have. These treatments include watching/waiting, physical therapy, home exercises (like kegel exercises), pessary (a device worn in the vagina to hold the tissues in place), or surgical procedures.
Surgery for Cystocele
Surgeries for cystocele can include repairing only the anterior (front) wall of the vagina and “lifting the bladder.” Historically, this was the first surgical repair women with bladder prolapse would undergo. In recent years, however, it has been shown to be a less effective method. This is because a bulge in the anterior wall of the vagina is often accompanied by movement of the top (“apex”) of the vagina as well. This means that the top of the vagina, where the cervix is/was is also moving toward the vaginal opening.
If this part of the vagina is not moved to its normal position at the same time, the chances that symptoms will return after surgery are greatly increased. Because of this, during the exam, Dr. Stewart will evaluate for apical prolapse (and prolapse in other vaginal locations) as well in order to be able to suggest a solution that is customized to meet your needs.
Surgery for pelvic organ prolapse sometimes includes hysterectomy, pelvic floor reconstruction using your own tissue, and graft/mesh reinforcement.
Because, in most cases, cystocele is not harmful or dangerous in most cases, treatments are targeted towards relief of patients symptoms and the specific goals of the patient given her anatomy.
Treatments may include:
- Expectant management
- Training of pelvic floor muscles
- Pessaries
- Surgery
Schedule an appointment today with the Midwest Center for Pelvic Health to discuss your symptoms, goals for treatment, and potential surgical and non-surgical treatment options with Dr. Stewart and his team.