Cystocele is commonly known as anterior prolapse or bladder prolapse. This condition occurs exclusively in women. Cystocele is considered a common issue for women and can be caused by a number of contributing factors including childbirth, surgery, and the aging process.
Definition & Facts
Cystocele requires the care of a urologist though the patient may also seek the guidance of a gynecologist. The condition develops when the muscles of the pelvic floor that typically holds the bladder in position becomes weakened. When these muscles become weakened, the bladder moves down into the vagina and can even protrude out through the vaginal opening. There are three grades of cystocele: mild, moderate and severe.
Symptoms & Complaints
- A feeling of fullness in the abdomen or bladder.
- A continual feeling of urgency to void.
- A tenderness or pressure in the pelvic or vaginal area.
- Leaking or urinary incontinence, especially during sexual intercourse or while coughing/sneezing, lifting heavy things, bending, laughing, or working out.
- Difficulty getting started urinating.
- Lower back pain, vaginal pain, pelvic pain, groin pain or abdominal pain.
- Painful intercourse.
- Chronic urinary tract infections (UTIs).
- A feeling of "sitting on an egg" caused by the bladder protruding from the vagina.
The causes of cystocele are often as common as the issue itself. Any incident or activity that puts undue strain or pressure on the muscles and tissues in the pelvic floor can eventually lead to a bladder prolapse. These causes include:
- Chronic intense coughing or sneezing.
- Childbirth (especially vaginal childbirth).
- Continual straining when having bowel movements.
- Chronic constipation.
- Repeatedly lifting heavy things.
- Becoming obese or overweight.
- Prior history of surgery in the pelvic area (including hysterectomy).
- Onset of menopause (due to a drop in estrogen levels).
- The natural aging process.
Diagnosis & Tests
The presence of cystocele can be diagnosed in a number of different ways. The first step is to take a personal and family medical history and list of current symptoms if any. Next some tests are typically performed:
- Pelvic exam. This physical exam is usually done first. The person will be tested both while standing up and while lying on an exam table. The physician examines the entire pelvic area and tests for muscle strength.
- Void test. The void test evaluates how well and fully the person can completely empty their bladder. The test typically includes doing a post-void test to see how much urine remains in the bladder.
- UTI test. Often a complementary test is done to determine if a bladder infection is present.
- Cystoscopy. This test allows the physician to look into the bladder and urethra with the aid of a small tube and a lens. If tissue seems abnormal a sample may be taken as well.
- Urodynamic testing. This is a group of tests (including urethral pressure profile, pressure flow study, and others) to examine urine flow, voiding, pressure and other factors.
- Electromyogram (or EMG). Electrodes are placed near the vaginal opening to measure the strength and activity of the pelvic floor muscles.
- X-rays. Often X-rays are combined with the suite of urodynamics tests to capture pictures of pelvic muscle activity.
Treatment & Therapy
For very mild cases where symptoms are rare or absent, it may be possible to defer treatment. However, even for very mild cases, usually the woman is prescribed Kegel (pelvic floor strengthening) muscles exercises to improve the strength and function of the relevant muscle groups.
There are two treatment approaches: non-surgical and surgical. Typically, the non-surgical approach is pursued first for all but the most severe cases. Two of the most common options for women who do not want or cannot have surgery are:
- Vaginal pessary. The pessary is a rubber ring that is personally fitted to each patient. The ring fits inside the vagina and helps to support the pelvic floor muscles.
- Hormone therapy. Another alternative to surgery is to begin a course of estrogen replacement therapy (pill, cream, ring). This option can help strengthen the pelvic floor muscles and is often a first course of treatment for women in menopause.
For very severe cases of cystocele or for women who want to resolve the problem quickly, surgery is often the treatment of choice. The type and scope of surgery will depend on the nature of the damage to the pelvic floor area. Minor surgery is often done laparoscopically. Major repairs may require more invasive surgery to treat. The treatment goal of surgery is to repair the structure of the pelvic area, re-position the bladder, and ease symptoms. Sometimes a hysterectomy is recommended if the uterus has also become prolapsed.
Prevention & Prophylaxis