Cystocele (Anterior Prolapse)
Cystocele — also known as anterior prolapse, a prolapsed bladder or a dropped bladder — occurs when the tissues and ligaments that support your bladder and vaginal wall begin to weaken or stretch so that the bladder is allowed to push or bulge into your vagina. Depending on the severity of your symptoms, you may not even notice.
If your cystocele is mild or moderate, your doctor most likely will encourage non-surgical treatments. If, however, your case is considered severe, surgery may become necessary to keep your pelvic organs in place. Otherwise, other organs could prolapse as well. Rectocele and cystocele often go hand in hand. Rectocele is the bulging or sagging of your rectum into your vagina.
Cystocele should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any underlying serious condition.
Signs and Symptoms of Cystocele
Even after you’re diagnosed with mild or moderate anterior prolapse, chances are that you likely won’t even notice anything out of the ordinary. If, on the other hand, you have severely prolapsed organs, you may experience such symptoms as:
- Leaking urine or pain during sex
- Repeated bladder infections
- Feeling a sense of pressure or bulging in your vagina
- Straining, coughing, bearing down or lifting becomes distinctly uncomfortable
- When urinating, a sensation that your bladder isn’t completely empty when you finish
- Leaking urine at odd times when you thought your bladder was empty
- Feeling or seeing that something’s bulging out of your vagina
- Feeling as if you’re sitting on something
- Feeling that something’s falling out of your vagina — some women actually have to push the bladder back up to urinate or have a bowel movement
- Having difficulties inserting tampons or applicators
- Experiencing symptoms that are most noticeable if you’ve been standing for a long time, but fade when you lie down
Symptoms should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any underlying serious condition.
Causes of Cystocele
When you strain the muscles in your pelvis, as during childbirth, it can eventually weaken them and lead to anterior prolapse. Childbirth is the most common cause of anterior prolapse in women, but here are some others:
- Being overweight
- Doing heavy lifting on a regular basis
- Straining during bowel movements
- Coughing chronically, as with a smoker or asthmatic
There’s some overlap between risk factors and causes, such as childbirth and obesity. But there are other factors that can put you at high risk for cystocele, such as:
- Childbirth, as mentioned, really puts a strain on your pelvic organs. Once you have delivered one or more children vaginally, your risk level goes up.
- Aging increases your risk, especially after menopause, as muscles and ligaments weaken. Furthermore, if you are post-menopausal, the loss of estrogen directly impacts the strength of your pelvic floor muscles.
- Hysterectomy may cause the surrounding organs and connective tissues to weaken without the support of the uterus.
- Genetically, some women are more susceptible to anterior prolapse because of naturally weaker connective tissues.
- Obesity, again, can cause a strain on connective tissues and put you at higher risk for a prolapsed organ.
Tests for Cystocele
First, you must undergo a pelvic exam. In this instance, your doctor may examine you in both a lying down position as well as standing. Your doctor is looking to see if the bulge presents during the exam. Additionally, your doctor more than likely will test the strength of your pelvic floor muscles. You may also be asked to monitor sensations during bowel movements or while bearing down.
And finally, bladder and urine tests may be necessary to rule out things like a bladder infection, for example. These tests may also include an ultrasound, to make sure no other organs have prolapsed, or a post-voidal residue test, to see if your bladder is retaining fluid.
Once a prolapse is confirmed, your doctor will grade the severity of your prolapse:
- Stage 0 — No problems exist; the bladder is perfectly supported. The number of women at stage 0 is very small.
- Stage 1 — A small bulge; this is the stage that most women fall into. They don’t experience any symptoms.
- Stage 2 — The bulge comes to within a centimeter of the vagina. Some women have symptoms at this stage.
- Stages 3 and 4 — At this point, the bulge comes out of the vagina, more than one centimeter from the opening. Most women at this stage are experiencing symptoms.
Treatment and Surgery
Once your diagnosis has been confirmed and the level of severity of the prolapse established, then a treatment plan can be put in place. If you have mild anterior prolapse and no symptoms, usually no treatment is necessary beyond self-care instructions. If you need assistance to cope with your symptoms, however, you may end up with a treatment plan or even cystocele surgery. Here are the treatment options:
- “Wait and see” is often encouraged if you have no symptoms or mild symptoms and are attempting to avoid more invasive treatment. If you follow self-care instructions, your prolapse can stay the same or actually get better. Check in with your doctor regularly if you take this path to make sure the prolapse has not worsened. Treatment plans can always be put into place later if the prolapse does get worse.
- Providing physical support, such as a pessary, can be the answer to providing surgery-free relief of symptoms. A pessary is inserted as a diaphragm or cervical cap, providing support so your vagina does not feel the pressure of the surrounding organs.
- Estrogen therapy is sometimes used in post-menopausal women to try to keep pelvic muscles strong.
- Practicing Kegel exercises whenever you can, which is possible because they are discreet exercises. Kegel exercises can help provide better support in the pelvic floor area, thereby giving you relief from any symptoms you might be experiencing.
The most common surgical repair is an anterior vaginal repair, also known as an anterior colporrhaphy. In this procedure, your doctor goes in through your vagina to repair and reinforce the vaginal wall. The repair is meant to bring connecting tissues closer together, thereby strengthening them and creating a bladder lift. This often provides relief if you suffer from urinary stress incontinence as well. This must take place in a hospital, with anesthesia, and may require an overnight stay. The recovery time on this surgery is usually four to six weeks.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.
Do you have questions about Cystocele (Anterior Prolapse)? Would like to schedule an appointment with the top New York City Gynecologist, Dr. Pedram Bral, please contact our office.
Dr. Pedram Bral, Gynecologist (Gynecologist NYC, Midtown)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4575