Understanding Cystocele: Causes, Symptoms, and Treatments

A cystocele occurs when the bladder sags into the vagina to some degree. It is caused by the stretching and weakening of the pelvic muscles and ligaments that usually support the bladder. Unlike a full prolapse, the bladder tissue is not usually exposed in a cystocele. It remains covered and protected by the vaginal skin.

Many things can cause the weakness and stretching that lead to a cystocele, including repetitive straining from constipation or bowel movements, heavy lifting, vaginal birth, chronic coughing, and being significantly overweight. Cystoceles also appear to have a familial link. The chances of a woman developing a cystocele increase with age, though it is unclear if they are directly related to menopause.

Cystoceles are graded according to their severity. A grade one cystocele is mild, and the bladder only slightly drops into the vagina. Grade two is moderate, and the bladder drops to the opening of the vagina. The most severe is grade three, which occurs when the bladder bulges through the vaginal opening.

Symptoms of a cystocele vary and may depend on the severity. They include a feeling of heaviness or fullness in the pelvis, lower back pain, frequent urinary tract infections, an urgent need to urinate, incomplete bladder emptying, painful intercourse, and a bulge inside the vagina. A cystocele can also cause pressure in the pelvis that gets worse with lifting, coughing, or standing. Some women describe a "pulling" sensation in the area of their vagina.

One of the tests for a cystocele is a postvoid residual. A doctor may perform this test when a woman feels she cannot empty her bladder; it uses an ultrasound to measure the amount of urine that remains after a woman urinates. This is a simple outpatient test that does not require anesthesia.

Another diagnostic test for a cystocele is a cystourethrogram. Contrast dye is injected into the bladder and urethra. While the woman is urinating, an x-ray shows the shape of the bladder. A radiologist interprets the results to determine if something is blocking urine flow. This test does not require anesthesia, but the patient may be sedated.

Treatment varies depending on severity. Mild cystoceles may only require the woman to avoid straining and heavy lifting, to prevent the problem from worsening. Other interventions for mild to moderate cystoceles include losing weight and doing Kegel exercises to strengthen the pelvic muscles. Depending on the cause, the doctor may recommend estrogen replacement therapy in some cases.

Sometimes, a vaginal pessary can treat a cystocele. The small silicone device is placed inside the vagina to hold the bladder in place and support the pelvic muscles and ligaments. Pessaries come in a range of shapes and sizes, so there are many options to choose from to ensure the patient is comfortable.

In some cases, a cystocele requires surgical repair. The most common approach is to repair the anterior vaginal wall. The surgeon folds over and sews tissue in place to provide support between the bladder and vagina. Recovery from this procedure usually takes between four and six weeks.

Surgery is usually only done in severe cases, and it does come with risks. Some women will eventually need a second surgery, either because another problem develops or the original procedure fails. People who are at higher risk for complications include women who are older or have diabetes, smokers, and those who have had a hysterectomy.