About cystocele (fallen bladder)

What is cystocele (fallen bladder)?

A cystocele occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina.

  • Symptoms of a cystocele include urine leakage and incomplete emptying of the bladder.
  • Causes of cystocele include muscle straining during childbirth, straining from heavy lifting, repeated straining during bowel movements, and menopause.
  • Treatment ranges from no treatment for a mild cystocele to surgery for a serious cystocele. A pessary (a device placed in the vagina to hold the bladder in place) may be recommended.

What is a cystocele?

A cystocele occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.

A bladder that has dropped from its normal position may cause two kinds of problems -- unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.

A cystocele is mild -- grade 1 -- when the bladder droops only a short way into the vagina. With a more severe - grade 2 - cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced -- grade 3 -- cystocele occurs when the bladder bulges out through the opening of the vagina.

 



What are the symptoms for cystocele (fallen bladder)?

The first symptom that women with a prolapsed bladder usually notice is the presence of tissue in the vagina that many women describe as something that feels like a ball.

Other symptoms of a prolapsed bladder include the following:

  • Discomfort or pain in the pelvis
  • Tissue protruding from the vagina (The tissue may be tender and may bleed.)
  • Difficulty urinating
  • A feeling that the bladder is not empty immediately after urinating (incomplete voiding)
  • Stress incontinence (Urine leakage during sneezing, coughing, or exertion)
  • More frequent bladder infections
  • Painful intercourse (dyspareunia)
  • Low back pain

Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.



What are the causes for cystocele (fallen bladder)?

Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).

Causes of stress to the pelvic floor include:

  • Pregnancy and vaginal childbirth
  • Being overweight or obese
  • Repeated heavy lifting
  • Straining with bowel movements
  • A chronic cough or bronchitis



What are the treatments for cystocele (fallen bladder)?

Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary -- a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers. Large cystoceles may require surgery to move and keep the bladder in a more normal position. This operation may be performed by a gynecologist, a urologist, or a urogynecologist. The most common procedure for cystocele repair is for the surgeon to make an incision in the wall of the vagina and repair the area by tightening the layers of tissue that separate the organs, creating more support for the bladder. The patient may stay in the hospital for several days and take 4 to 6 weeks to recover fully.



What are the risk factors for cystocele (fallen bladder)?

These factors may increase your risk of anterior prolapse:

  • Pregnancy and childbirth. Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse.
  • Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep the pelvic floor strong — decreases.
  • Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case.
  • Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
  • Obesity. Women who are overweight or obese are at higher risk of anterior prolapse.



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