Cystocele (Fallen Bladder): Symptoms, Causes, Treatment

What are the symptoms of cystocele?

A cystocele, also known as a prolapsed bladder, occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. Common symptoms of a cystocele may include:

1. A feeling of fullness or pressure in the pelvis: This sensation may be more pronounced when standing for long periods or at the end of the day.
2. Discomfort or pain during intercourse: The prolapsed bladder can cause discomfort or pain during sexual intercourse, often described as a sensation of “something being in the way.”
3. Frequent or urgent urination: A cystocele can lead to incomplete emptying of the bladder, causing more frequent urges to urinate or a feeling of urgency.
4. Incontinence: Some women with a cystocele may experience stress incontinence, where urine leaks during activities that put pressure on the bladder, such as coughing, sneezing, or laughing.
5. Visible bulge in the vagina: In more severe cases, a woman may notice a bulge of tissue protruding into the vagina. This bulge may be more noticeable when standing or straining and may lessen when lying down.
6. Recurrent urinary tract infections (UTIs): Difficulty fully emptying the bladder due to the cystocele can increase the risk of UTIs.

It’s important to consult with a healthcare provider for an accurate diagnosis and appropriate management if you suspect you have a cystocele. Treatment options can range from pelvic floor exercises to surgery, depending on the severity of the prolapse and symptoms.

What are the causes of cystocele?

Cystocele, or bladder prolapse, occurs when the supportive tissues between a woman’s bladder and vaginal wall weaken or stretch, allowing the bladder to bulge into the vagina. Several factors can contribute to this weakening of the pelvic floor muscles and connective tissues, including:

1. Childbirth: The most common cause of cystocele is childbirth, especially vaginal delivery. The process of childbirth can stretch and weaken the muscles and tissues that support the bladder and other pelvic organs.
2. Aging: As women age, the tissues in the pelvic area can naturally weaken and lose elasticity, leading to a higher risk of pelvic organ prolapse, including cystocele.
3. Hormonal changes: Changes in hormone levels, particularly a decrease in estrogen during menopause, can weaken the pelvic floor muscles and tissues.
4. Chronic coughing or heavy lifting: Conditions that cause chronic coughing, such as asthma or smoking, can strain the pelvic floor muscles. Similarly, regularly lifting heavy objects can also weaken these muscles over time.
5. Obesity: Excess weight puts increased pressure on the pelvic floor muscles and tissues, potentially leading to weakening and prolapse.
6. Pelvic surgery: Previous pelvic surgery, such as a hysterectomy, can weaken the supportive tissues and increase the risk of bladder prolapse.
7. Genetic factors: Some women may have a genetic predisposition to weaker pelvic floor muscles, making them more susceptible to cystocele.
8. Chronic constipation: Straining during bowel movements can stress the pelvic floor muscles and contribute to their weakening.
9. Connective tissue disorders: Conditions that affect the strength and integrity of connective tissues, such as Ehlers-Danlos syndrome, can increase the risk of pelvic organ prolapse, including cystocele.
10. Heavy lifting or strenuous activities: Regularly engaging in activities that put excessive strain on the pelvic floor, such as heavy lifting or high-impact exercises, can weaken the muscles over time.

It’s important to note that not all women with these risk factors will develop a cystocele, and the severity of symptoms can vary widely among individuals. If you’re experiencing symptoms of a cystocele, it’s advisable to consult with a healthcare provider for an accurate diagnosis and appropriate management.

What is the treatment for cystocele?

The treatment for cystocele, or bladder prolapse, depends on the severity of the prolapse and the symptoms experienced. Treatment options can range from conservative measures to surgical intervention. Here are some common approaches:

1. Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles can help provide support to the bladder and improve symptoms. A physical therapist specialized in pelvic floor rehabilitation can teach proper exercise techniques.
2. Lifestyle changes: Maintaining a healthy weight, avoiding heavy lifting, treating and preventing constipation, and quitting smoking (if applicable) can help reduce strain on the pelvic floor muscles.
3. Pessary: A pessary is a device inserted into the vagina to support the bladder and other pelvic organs. It can help alleviate symptoms of cystocele and is a non-surgical option.
4. Estrogen therapy: For postmenopausal women, topical estrogen therapy can help improve the strength and elasticity of vaginal tissues, which may reduce symptoms of cystocele.
5. Medications: In some cases, medications may be prescribed to manage symptoms such as urinary incontinence.
6. Surgery: If conservative measures are ineffective or the prolapse is severe, surgery may be recommended. Surgical options include:

• Anterior repair (anterior colporrhaphy): This procedure involves tightening and reinforcing the supportive tissues between the bladder and vaginal wall.
• Mesh surgery: In some cases, a synthetic mesh may be used to provide additional support to the pelvic organs. However, the use of mesh has been associated with certain risks and complications, so it’s important to discuss these thoroughly with your healthcare provider.
• Hysterectomy: If the prolapse is associated with uterine prolapse, removing the uterus (hysterectomy) may be recommended.

The choice of treatment depends on individual factors such as the severity of the prolapse, overall health, and personal preferences. It’s important to discuss all options with a healthcare provider to determine the most appropriate treatment plan.