What is it?

    A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination, also called voiding, the bladder empties through the urethra, located at the bottom of the bladder.

    The urethra is the tube that carries urine outside of the body. The vagina is the tube in a woman’s body that runs beside the urethra and connects the womb, or uterus, to the outside of the body.

    Causes

    A cystocele may result from muscle straining while giving birth. Other kinds of straining such as heavy lifting or repeated straining during bowel movements may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. When women go through menopause — that is, when they stop having menstrual periods their bodies stop making estrogen, so the muscles around the vagina and bladder may grow weak.

    A woman’s pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as

    • repetitive straining for bowel movements
    • constipation
    • chronic or violent coughing
    • heavy lifting
    • being overweight or obese

    A woman’s chances of developing a cystocele increase with age, possibly because of weakening muscles and supportive tissues from aging. Whether menopause increases a woman’s chances of developing a cystocele is unclear.

    Risk factors

    These factors may increase your risk of anterior prolapse:

    • Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse.
    • Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen — which helps keep the pelvic floor strong decreases.
    • Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
    • Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
    • Obesity. Women who are overweight or obese are at higher risk of anterior prolapse.

    Symptoms

    • a vaginal bulge
    • the feeling that something is falling out of the vagina
    • the sensation of pelvic heaviness or fullness
    • difficulty starting a urine stream
    • a feeling of incomplete urination
    • frequent or urgent urination

    Women who have a cystocele may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. These movements can include coughing, sneezing, laughing, or physical activity, such as walking.

    Urinary retention, the inability to empty the bladder completely may occur with more severe cystoceles if the cystocele creates a kink in the woman’s urethra and blocks urine flow. Women with mild cystoceles often do not have any symptoms.

    Diagnosis

    A doctor may be able to diagnose a grade 2 or grade 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible. A voiding cystourethrogram is a test that involves taking x rays of the bladder during urination. This x ray shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.

    Treatment

    Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary, a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.

    Large cystoceles may require surgery to move and keep the bladder in a more normal position. This operation may be performed by a gynecologist, a urologist, or a urogynecologist. The most common procedure for cystocele repair is for the surgeon to make an incision in the wall of the vagina and repair the area by tightening the layers of tissue that separate the organs, creating more support for the bladder. The patient may stay in the hospital for several days and take 4 to 6 weeks to recover fully.

    Reference
    • National Institute of Diabetes and Digestive and Kidney Diseases
    • Cleveland clinic
    • Mayoclinic
    • Medicinenet

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