A cystocele is a type of pelvic organ prolapse that occurs when the tissues and muscles that hold the bladder in place are stretched or weakened. This can cause the bladder to move from its normal position and press against the wall of the vagina, forming a bulge.
A bladder prolapse may develop if a woman's pelvic muscles become damaged by pregnancy, labor, childbirth, or a previous pelvic surgery or are weakened by aging. In rare cases, a cystocele can be present at birth (congenital).
A cystocele may be associated with leaking of urine (incontinence), especially during coughing, laughing, or jumping. Or it may cause difficulty emptying the bladder, which may progress to a bladder infection (cystitis).
Exercises to strengthen the pelvic floor muscles, called Kegel exercises, may help relieve some symptoms of a cystocele. A doctor may recommend use of a pessary, an instrument placed in the vagina to support the uterus. In severe cases, surgery may be needed.
What are the symptoms of a cystocele?
Many women who have a cystocele don't have symptoms. But when symptoms appear, they may include:
- Feeling pressure and discomfort from your bladder pressing against the vaginal wall. This is the most common symptom.
- Leaking urine (incontinence), especially during coughing, laughing, or jumping.
- Having problems emptying your bladder. This may lead to a bladder infection (cystitis).
- Feeling like something is falling out of your vagina.
- Having pain during intercourse.
- Symptoms are worse when you stand, jump, or lift. They usually are relieved if you lie down.
How is a cystocele diagnosed?
A cystocele can be hard to diagnose. If it doesn't cause symptoms, it's often found during a routine exam. You may be aware that there's a problem. But you might not be quite sure where it is or what is causing it. If your doctor thinks you may have a cystocele, he or she will ask you questions about your past and current health. This includes questions about your history of childbirth. Your doctor will also do a physical exam. This includes doing a pelvic exam. And it sometimes includes a rectal exam.
Your doctor may order tests, especially if the cystocele is causing urinary problems. The tests help your doctor find out more about the cystocele.
How is a cystocele treated?
Treatment for a cystocele depends on how bad your symptoms are. Many women don't need treatment.
If your symptoms are mild, you may be able to relieve many of them at home. But if your symptoms are bad or bother you, you may want to think about treatment.
To treat a cystocele, your doctor may fit you with a pessary. This is a device that is placed into the vagina. It is removable—you can take it out and put it back in. It supports the area where the bladder presses down.
Kegel exercises, which strengthen the pelvic floor muscles, may help relieve some symptoms.
Surgery is an option if your symptoms don't get better with other treatments or you don't want to try them. But you may want to wait to have surgery if you plan to have children. Childbirth could cause your prolapse to come back.
Why is repair of bladder prolapse (cystocele) or urethra prolapse (urethrocele) done?
Repair of the bladder and urethra is done to manage symptoms such as pressure on the vaginal wall from the movement of those organs, difficulty urinating, urinary incontinence, and painful intercourse. If you are experiencing involuntary release of urine (urinary incontinence), further testing may be needed to find out what procedure is needed.
Bladder and urethral prolapse often occur with the prolapse of other pelvic organs, so tell your doctor about any other symptoms you have. If your doctor finds a uterine prolapse, rectocele , or small bowel prolapse (enterocele) during your routine pelvic examination, that problem can also be repaired during surgery.