A cystocele (pronounced sis-toe-seel) is also called an anterior prolapse, dropped or prolapsed bladder. It often occurs because the wall between the vagina and bladder has been torn or weakened during childbirth allowing the bladder to bulge or drop into the vaginal vault. Other less common causes can be severe obesity, straining regularly because of chronic constipation, violent coughing or even lifting heavy things incorrectly.
As with all types of prolapse, the effects can range from mild to severe and may need treatment or not, depending on whether or not it is affecting a woman’s quality of life or health.
A mild cystocele (grade 1) might not even be noticed by some women and may only be diagnosed when a nurse or doctor is doing a pelvic examination. In these cases strengthening exercises for the abdominal muscles and pelvic region may be recommended. Alongside avoiding getting constipated and heavy lifting Kegel and pelvic floor exercises can often be enough to prevent the prolapse from worsening. The most common symptoms are a feeling of heaviness in the abdominal region and pain or leaking during sex.
A severe cystocele (grade 2 or 3) is where the fallen bladder is noticeable to the woman, perhaps even protruding from the vagina and between the labia (folds of skin around the bladder). In such cases women may find it uncomfortable to sit or stand for long periods of time, they may have difficulty fully emptying their bladder and have recurring urinary tract infections.
Self management is often recommended for mild cases, with regular monitoring by your GP. Learning how to do the Kegel exercises correctly and undertaking exercise designed to strengthen your core abdominal muscles will be helpful in all cases of prolapse.
Vaginal pessaries may be recommended if the cystocele is advanced. These are designed to hold everything in place and are often used while waiting for surgery or if surgery can’t be performed for other reasons. Clear guidance will be given on how to look after them to prevent infections occurring.
Oestrogen only hormone replacement therapy may be prescribed to help your muscles retain their strength, which naturally declines after the menopause.
Surgery is common for severe cystocele cases and involves stitching the bladder back at the same time as tightening the ligaments that support abdominal organs of the pelvic region. It may be performed at the same time as a hysterectomy if there are other complications such as fibroids or uterine prolapse.
(Image: Courtesy of http://scientia.wikispaces.com/Pelvis+Viscera+-+Lecture+Notes)