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 one of the most common forms of pelvic organ prolapse. This article explains how cystocele develops, why it occurs, and some of the available treatments.

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”). It’s worth noting that mild cases can be asymptomatic.

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 follows suit. Hence the term “cystocele.”

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. Here’s what you can expect:

1. Your doctor will ask about your symptoms.
2. A pelvic exam will be conducted, both internally and externally.
3. You may be asked to bear down, push, or cough to recreate your symptoms.
4. 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:

1. Watchful Waiting: For mild cases or if symptoms aren’t bothersome.
2. Physical Therapy: To strengthen pelvic floor muscles.
3. Home Exercises: Such as Kegel exercises.
4. Pessary: A device worn in the vagina to hold tissues in place.
5. Surgery: For more severe cases or when other treatments haven’t helped.

A Closer Look at Surgery

Surgical options for cystocele have evolved over time. While historically, surgeons focused on repairing only the anterior (front) wall of the vagina, recent research shows this approach may be less effective on its own.

Why? Because a bulge in the anterior vaginal wall often accompanies 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

Remember, because cystocele is typically not harmful, treatments focus on relieving your symptoms and meeting your specific goals.

Next Steps

If you’re experiencing symptoms of cystocele, don’t hesitate to seek medical advice. A urogynecologist can provide a thorough evaluation and discuss treatment options tailored to your needs and goals.

Schedule an appointment today to discuss your symptoms, treatment goals, and potential options - both surgical and non-surgical. With proper care, many women find significant relief from cystocele symptoms and improved quality of life.

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Frequently Asked Questions

What is a cystocele?

A cystocele, also known as bladder prolapse or anterior vaginal prolapse, is a condition where the front wall of the vagina bulges down toward the vaginal opening, often accompanied by the bladder.

What are the common symptoms of cystocele?

Common symptoms include leakage of urine, a feeling that the bladder or vaginal area has 'dropped', a visible ball or bulge at the vaginal opening, pelvic pressure, lower back discomfort, and difficulty during intercourse.

What are the risk factors for developing a cystocele?

Risk factors include childbirth, advancing age, pelvic trauma, and chronically elevated abdominal pressure from activities like heavy lifting, smoking (leading to chronic cough), obesity, and straining during bowel movements.

How is a cystocele diagnosed?

A cystocele is diagnosed through a pelvic exam performed by a trained physician or medical provider. The exam may include internal and external evaluations, asking the patient to bear down or cough, and possibly using a speculum to evaluate different parts of the vaginal wall.

What are the treatment options for cystocele?

Treatment options include watchful waiting, physical therapy to strengthen pelvic floor muscles and decrease abdominal pressure, home exercises like Kegel exercises, using a pessary device, and surgery.

Is surgery always necessary for cystocele?

No, surgery is not always necessary. Because cystocele is generally not dangerous, treatment decisions are guided by the patient's goals and preferences. Non-surgical options are often tried first, especially for mild cases.

What should I expect during a consultation about cystocele?

During a consultation, your doctor will ask about your symptoms, perform a pelvic exam, discuss your treatment goals, explain the exam findings (often using drawings), and answer any questions you have about available treatments.