Cystocele
A cystocele, also known as a prolapsed or dropped bladder, occurs when the wall between the vagina and bladder weakens, causing the bladder to sag into the vagina. This condition can result from factors such as childbirth, chronic coughing, aging, or heavy lifting. Symptoms may include discomfort, difficulty urinating, painful intercourse, increased urinary infections, and stress incontinence, where urine leaks during activities like coughing or sneezing. Cystoceles are categorized by severity, ranging from mild (Grade 1) to complete protrusion outside the vagina (Grade 4).
While a cystocele does not resolve on its own and may deteriorate over time, treatment options are available. Conservative approaches include pelvic floor exercises, behavioral modifications, and estrogen replacement therapy. Non-surgical interventions may involve the use of a pessary, a device that provides support within the vagina. For more severe cases, surgical correction is common and typically involves strengthening the vaginal wall, often with the use of grafts or mesh. Urologists and urogynecologists are specialists who diagnose and treat this condition, using a combination of physical exams and imaging techniques.
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Cystocele
A cystocele is a weakening of the wall that separates the vagina and the bladder that can cause the bladder to sag into the vagina. It is also called a dropped or prolapsed bladder or anterior prolapse. It can be caused by childbirth, chronic cough, age, and heavy lifting. Treatment options include exercises to strengthen the pelvic muscles, surgery, and hormone replacement therapy.
Prolapsed bladder can cause several complications. Among those are discomfort, difficulty urinating, painful intercourse, and more frequent bladder infections. Stress incontinence, or leaking of urine when coughing, laughing, or sneezing, is also common. While for many people these problems affect quality of life, in severe cases the entire bladder may completely protrude outside the vagina. Bladder prolapse will not reverse itself, and often becomes more severe over time.
Overview
The organs of the pelvic region are supported by a set of muscles that work like a hammock. These muscles, which are called the pelvic floor, run between the pubic bone in the front and the tailbone at the back and from side to side. The pelvic floor muscles support the bladder and bowel, and in women the uterus. When the pelvic floor becomes weak or is under a great deal of pressure, anterior prolapse can occur.
The bladder is an organ that stores urine. It is supported in women by the front wall of the vagina. Estrogen helps to keep the pelvic floor muscles strong, but as women age and reach menopause, their bodies produce less estrogen. Stress from childbirth can also weaken the vaginal wall.
Urologists and urogynecologists typically diagnose and treat prolapsed bladder. Diagnosis involves a genital and pelvic exam. In some cases, a test using dye and X-ray films may help the doctor determine the shape of the bladder. Other procedures such as a cystoscopy, or insertion of a scope into the bladder, may also be performed.
Cystocele is classified by how far the bladder sags into the vagina. Grade 1, or mild cystocele, means only a small part of the bladder is drooping into the vagina. Moderate or Grade 2 means the bladder is drooping enough to reach the vaginal opening. Cystocele is severe, or Grade 3, if the bladder is protruding from the vaginal opening. Grade 4, or complete cystocele, means the bladder is protruding entirely outside the vagina.
Conservative therapies include behavioral therapy and exercise of the pelvic floor muscles. Behavioral therapy includes treating constipation, obesity, and other risk factors. Exercise involves contracting the pelvic floor muscles and holding them for up to ten seconds in sets of ten. The physician or physical therapist will prescribe the frequency and duration of the exercises. Estrogen replacement therapy is another option for many patients.
Another nonsurgical option is the use of a pessary. This prosthetic device, which is inserted into the vagina to support its internal structure, must be fitted by a medical professional. Side effects are usually treatable and include vaginal irritation and urinary tract infections.
Pelvic organ prolapse surgery, including cystocele correction, is a common procedure. It is usually performed through the vaginal wall and may involve the use of tissue grafts or synthetic materials, such as mesh, to strengthen the vaginal wall. In the United States, more than 200,000 of these surgeries are performed annually.
Bibliography
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“Anterior Prolapse (Cystocele).” Mayo Clinic, www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452. Accessed 4 Feb. 2021.
“Cystocele.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/cystocele. Accessed 4 Feb. 2021.
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“How to Find and Exercise Your Pelvic Floor Muscles (for Women and Men).” Queensland Health, 29 Nov. 2019, www.health.qld.gov.au/news-events/news/find-exercise-pelvic-floor-women-men. Accessed 4 Feb. 2021.
Lazarou, George. “Pelvic Organ Prolapse.” Medscape, 15 Oct. 2019, emedicine.medscape.com/article/276259-overview. Accessed 4 Feb. 2021.
“Prolapsed Bladder.” WebMD, www.webmd.com/women/guide/prolapsed-bladder##1. Accessed 4 Feb. 2021.
Young, Becky. “Pessary.” HealthLine, 26 Mar. 2018, www.healthline.com/health/pessary. Accessed 4 Feb. 2021.