Understanding Cystocele (Prolapsed Bladder)
Do you experience any of the following symptoms?
- Leakage of urine
- A feeling that your bladder or vaginal area has “dropped”
- A visible ball or bulge at the vaginal opening
If so, you may be dealing with a cystocele, also known as bladder prolapse or anterior vaginal prolapse. Cystocele is the most common form of pelvic organ prolapse. It’s found about twice as often as a rectocele and three times as often as prolapse of the uterus or the top of the vagina. Below is how a cystocele develops, why it happens, and how it’s treated.
Is That My Bladder?
Patients with cystocele often visit their doctors with complaints of pelvic pressure or lower back discomfort. Some notice a bulge or ball at the opening of the vagina. You might also experience lower abdominal or low back pain and have trouble with intercourse (often described as “something getting in the way”). Mild cases may cause no symptoms at all.
A cystocele can also cause urinary frequency and urgency. A large one that reaches past the vaginal opening can keep the bladder from emptying all the way.
Cystocele occurs when the front wall of the vagina bulges down toward the vaginal opening. The bladder, which rests on the front wall of the vagina, often comes along with it, which is where the name “cystocele” comes from.
What you see or feel is not your bladder…
…it’s the skin of the vagina. What’s behind that skin is likely the bladder.
Risk Factors
Several factors can weaken the attachments of the anterior vaginal wall, leading to cystocele. Common risk factors include:
- Childbirth
- Advancing age
- Pelvic trauma
- Chronically elevated abdominal pressure from:
- Heavy lifting or straining
- Smoking (and chronic cough)
- Obesity
- Straining during bowel movements
Diagnosis of Cystocele
Diagnosing cystocele involves a pelvic exam performed by a trained physician or medical provider. At the visit:
- Your doctor will ask about your symptoms.
- Your doctor will examine you, both externally and internally.
- You may be asked to bear down, push, or cough to recreate your symptoms.
- A speculum may be used to evaluate different parts of the vaginal wall.
After the examination, your doctor will discuss your symptoms and treatment goals with you.
Common patient goals include:
- Improved sexual function
- Ability to exercise or enjoy specific activities
- Sitting comfortably
- Decreased urinary symptoms (like urinary incontinence)
- Improved function of pelvic organs (bladder & bowels)
Your doctor will explain the exam findings, often using drawings, and answer any questions you have about available treatments.
Treatment Options
Because bladder prolapse is generally not dangerous, treatment decisions are guided by your goals and preferences. Treatment options may include:
- Watchful Waiting: For mild cases or if symptoms aren’t bothersome.
- Physical Therapy: To strengthen pelvic floor muscles.
- Home Exercises: Such as Kegel exercises.
- Pessary: A device worn in the vagina to hold tissues in place.
- Surgery: For more severe cases or when other treatments haven’t helped.
Most cystoceles don’t change much over time, which is why watching one is a reasonable plan if it isn’t bothering you. In one study, 78% of women with untreated prolapse had no change over 16 months.
Pelvic floor physical therapy has good evidence behind it. In the largest trial of pelvic floor muscle training for prolapse, 447 women, 70% of those who worked one-on-one with a physical therapist said their prolapse was better at 12 months, compared with 45% of women who got only advice. Up to 92% of women can be fitted with a pessary.
A Closer Look at Surgery
Surgeons used to focus on repairing only the anterior (front) wall of the vagina. More recent research shows this approach may be less effective on its own.
A bulge in the anterior vaginal wall often comes with movement of the top (“apex”) of the vagina. If this part isn’t addressed during surgery, symptoms are more likely to return.
Modern surgical approaches may include:
- Repairing the anterior vaginal wall
- Addressing apical prolapse
- In some cases, hysterectomy
- Pelvic floor reconstruction using your own tissue
- Graft or mesh reinforcement in certain situations
Since a cystocele is typically not harmful, treatment focuses on relieving your symptoms and meeting your goals.
Next Steps
If you have symptoms of a cystocele, a urogynecologist can examine you and go over treatment options that fit your goals.
Schedule an appointment to talk through your symptoms, your goals, and both surgical and non-surgical options. With treatment, many women get significant relief from their symptoms and a better quality of life.
References
- Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourology and Urodynamics. 2016. doi:10.1002/nau.22922
- Barber MD. Pelvic organ prolapse. BMJ. 2016. doi:10.1136/bmj.i3853
- Lamblin G, Delorme E, Cosson M, et al. Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. International Urogynecology Journal. 2016. doi:10.1007/s00192-015-2832-4
- Nager CW, Grimes CL, Nolen TL, et al. Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes after Vaginal Apical Procedures. Female Pelvic Medicine & Reconstructive Surgery. 2019. doi:10.1097/SPV.0000000000000526
- Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Pelvic Organ Prolapse (Practice Bulletin No. 214). Obstetrics & Gynecology. 2019.
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal Pessary Use and Management for Pelvic Organ Prolapse. Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
- Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet. 2014. doi:10.1016/S0140-6736(13)61977-7
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. American Urogynecologic Society Best Practice Statement: Evaluation and Counseling of Patients With Pelvic Organ Prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641