Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
What is a cystocele (bladder prolapse)?
A cystocele is sometimes called a “dropped bladder” or “bladder prolapse.” It happens when the front wall of the vagina weakens and the bladder pushes down into the vaginal space. It is the most common type of pelvic organ prolapse, detected about twice as often as posterior prolapse (rectocele) and three times more often than apical prolapse.
How it develops
The front wall of your vagina acts like a hammock that supports your bladder. When that support weakens, the bladder can descend into the vagina. You might feel pressure, fullness, or notice a bulge at the vaginal opening.
Several things can weaken that support over time. Vaginal childbirth, aging, hormonal changes after menopause, and chronic straining (from constipation or heavy lifting) are common risk factors. Connective tissue changes also play a role, and some women are more prone to prolapse even without these factors.
About half of cystoceles involve descent of the upper vagina (the “apex”) along with the front wall. That means what looks like a bladder-only problem often has a deeper support issue higher up. I assess all of these levels during your exam so we can plan the right approach.
Symptoms
- A feeling of vaginal pressure or fullness, especially when standing or at the end of the day
- A visible or noticeable bulge at the vaginal opening
- Trouble fully emptying your bladder
- Urinary frequency or urgency
- Leaking urine with coughing, sneezing, or lifting (stress incontinence)
Not everyone with a cystocele has symptoms. Most women start to feel it when the bulge reaches the opening of the vagina.
Treatment options
Not every cystocele needs treatment. If it is not bothering you, we can simply keep an eye on it. In one large study, 78% of women with untreated prolapse had no change at 16 months, and some even improved on their own.
When symptoms do bother you, we talk through the options together and choose what fits your life and goals. There is no single “right” order to try things.
- Pelvic floor physical therapy – a trained pelvic floor PT works on strength, coordination, endurance, relaxation, and surrounding muscle groups (hips, core, breathing). This is not just Kegels. In the largest trial of PT for prolapse (447 women), the PT group had more symptom improvement than the control group at 12 months. Our practice has in-office pelvic floor PTs, which makes it easier to get started.
- Pessary – a removable device you place in the vagina to hold the bladder up. About 92% of women can be fitted with one. Both ring and Gellhorn types work well, and we help you find the right size and shape. Many women manage their own pessary at home.
- Surgical repair – anterior colporrhaphy (front vaginal wall repair) is the standard procedure for cystocele. Because so many cystoceles involve some loss of support at the top of the vagina, I often address apical support at the same time. We would discuss the details together based on your anatomy and what matters most to you.
- Vaginal estrogen – helps keep vaginal tissue healthy, especially after menopause. It can also make pessary use more comfortable.
References
- Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853. doi:10.1136/bmj.i3853
- ACOG/AUGS Practice Bulletin No. 214: Pelvic organ prolapse. Obstet Gynecol. 2019;134(5):e126-e142.
- 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. Lancet. 2014;383(9919):796-806. doi:10.1016/S0140-6736(13)61977-7
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal pessary use and management for pelvic organ prolapse. Urogynecology. 2023;29(3):203-218. doi:10.1097/SPV.0000000000001293
- Lamblin G, Delorme E, Cosson M, Rubod C. Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. Int Urogynecol J. 2016;27(9):1297-1305. doi:10.1007/s00192-015-2832-4
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. AUGS best practice statement: evaluation and counseling of patients with pelvic organ prolapse. Urogynecology. 2025;31(1):e1-e14. doi:10.1097/SPV.0000000000001641
- Andy UU, Meyn L, Brown HW, et al. Outcomes at 12, 24, and 36 months in women treated for pelvic organ prolapse with pessary or surgery. Urogynecology. 2025;31(2):e135-e145. doi:10.1097/SPV.0000000000001669
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