Definition: occurs when the wall between the bladder of a woman and her vagina weakens and allows the bladder to fall into the vagina.
Symptoms of a cystocele include leakage of urine and incomplete emptying of the bladder. The causes of cystocele include muscular effort during labor, heavy lifting, repeated efforts during bowel movements and menopause.
Treatment varies from no treatment for a mild cystocele to surgery for a severe cystocele. A pessary (a device placed in the vagina to hold the bladder in place) may be recommended.
A cystocele, also called prolapse or fall of the bladder, is the bulge or fall of the bladder in the vagina. The bladder, located in the pelvis between the bones of the pelvis, is a hollow, muscular, globe-shaped organ that expands when filled with urine.
During urination, the bladder empties through the urethra, located in the lower part of the bladder. The urethra is the tube that carries urine out of the body. The vagina is the tube in a woman’s body that runs next to the urethra and connects the uterus, or uterus, to the outside of the body.
What is a cystocele?
A cystocele occurs when the wall between a woman’s bladder and her vagina becomes weak and allows the bladder to fall into the vagina. This condition can cause discomfort and problems with emptying the bladder.
A bladder that has fallen from its normal position can cause two types of problems – the leakage of unwanted urine and the incomplete emptying of the bladder. In some women, a fallen bladder extends the opening to the urethra, causing leakage of urine when the woman coughs, sneezes, laughs or moves in any way that puts pressure on the bladder.
There are three degrees of cystocele:
- Grade 1 (mild) – The bladder falls only a short way into the vagina.
- Grade 2 (moderate) – The bladder falls into the opening of the vagina.
- Grade 3 (severe) – The bladder bulges through the opening of the vagina.
- A cystocele is mild – grade 1 when the bladder falls only a short way into the vagina.
- With a more severe grade 2 cystocele, the bladder sinks enough to reach the opening of the vagina.
- The most advanced – grade 3 – cystocele occurs when the bladder bulges through the opening of the vagina.
The cystocele may result from muscle stressing while giving birth. Other types of effort – such as heavy lifting or repeated efforts during bowel movements – can 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 the bladder can grow weak.
How is it diagnosed?
A doctor can diagnose a grade 2 or grade 3 cystocele from a description of the symptoms and physical examination of the vagina because the part of the bladder that is drooping will be visible.
Other tests may be necessary to find or rule out problems in other parts of the urinary system.
Treatment options vary from no treatment for a mild cystocele to surgery for a severe cystocele.
If the cystocele is not bothersome, the doctor can only recommend avoiding weightlifting or exertion that could cause the cystocele to get worse.
If the symptoms are moderately bothersome, the doctor may recommend a pessary – a device placed in the vagina to keep the bladder in place.
The pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries should be removed regularly to avoid infections or ulcers.
Severe cystocele may require surgery to keep the bladder in a more normal position. This operation can 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 can stay in the hospital for several days and take 4 to 6 weeks to fully recover.
The risks of repair of cystocele and urethrocele include:
- Urinary incontinence
- Urinary retention.
- Painful sexual relationships
- Bladder injuries
- Formation of an abnormal connection or opening between two organs (fistula).
Severe cystocele may require reconstructive surgery called anterior repair to move the bladder to a normal position. In this type of surgery, an incision (cut) is made in the wall of the vagina and the tissue that separates the bladder from the vagina is tightened.
The surgeon may also implant permanent mesh grafts made of synthetic or biological materials to improve vaginal support. The patient usually goes home the day after the surgery. Complete recovery usually takes four to six weeks.
For women who never plan to have sex again, the surgeries that sew the vagina and shorten it are almost 100% effective.
These techniques are best done in elderly patients with multiple medical problems that would make reconstructive surgery a high risk.
What is the prognosis for someone with a cystocele?
Although it does not threaten life, the cystocele can have a negative impact on a woman’s quality of life.
If it is not treated at all, the condition may continue to get worse. In the worst cases, the woman may be unable to urinate, which can cause kidney damage or infection.