Cystocele (Fallen Bladder)
Cystocele (Fallen Bladder)
A cystocele occurs when ligaments that hold the bladder up and the muscle between a woman’s vagina and bladder stretches or weakens. A cystocele ― also known as a prolapsed, herniated, dropped or fallen bladder (where your urine or “water” is stored) ― occurs when ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder stretches or weakens, allowing the bladder to sag into the vagina.
Cystocele Stages
What causes Cystocele ?
Cystocele occurs when the wall between a womans bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder. A bladder that has dropped from its normal position may cause two kinds of problems.. unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.
A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With a more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.
Causes of Cystocele
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.
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Pregnancy and vaginal childbirth
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Being overweight or obese
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Repeated heavy lifting
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Straining with bowel movements
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A chronic cough or bronchitis
Symptoms of Cystocele
In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:
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A feeling of fullness or pressure in your pelvis and vagina
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Increased discomfort when you strain, cough, bear down or lift
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A feeling that you haven't completely emptied your bladder after urinating
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Repeated bladder infections
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Pain or urinary leakage during sexual intercourse
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In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg
Risk Factor of Cystocele
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Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse.
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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.
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Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
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Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
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Obesity. Women who are overweight or obese are at higher risk of anterior prolapse.
Treatment of Cystocele
Treatment depends on whether you have symptoms, how severe your anterior prolapse is and whether you have any related conditions, such as urinary incontinence or more than one type of pelvic organ prolapse.
Mild cases — those with few or no obvious symptoms — typically don't require treatment. Your doctor may recommend a wait-and-see approach, with occasional visits to monitor your prolapse.
If you do have symptoms of anterior prolapse, first line treatment options include:
Pelvic floor muscle exercises. These exercises — often called Kegel exercises or Kegels — help strengthen your pelvic floor muscles, so they can better support your bladder and other pelvic organs. Your doctor or a physical therapist can give you instructions for how to do these exercises and can help you determine whether you're doing them correctly.
Kegel exercises may be most successful at relieving symptoms when the exercises are taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time. These exercises can help improve your symptoms, but may not decrease the size of the prolapse.
A supportive device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. A pessary does not fix or cure the actual prolapse, but the extra support the device provides can help relieve symptoms. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
If you still have noticeable, uncomfortable symptoms despite the treatment options above, your doctor may recommend surgical treatment.
How it's done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place using stitches and removing any excess vaginal tissue. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.
If you have a prolapsed uterus. For anterior prolapse associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues.
If you have incontinence. If your anterior prolapse is accompanied by stress incontinence — leaking urine during strenuous activity — your doctor may also recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms.
If you're pregnant or thinking about becoming pregnant, your doctor may recommend that you delay surgery until after you're done having children. Pelvic floor exercises or a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of recurrence — which may mean another surgery at some point.