Cystocele

What is a cystocele?

A cystocele is a hernia (a bulging or protrusion) of the urinary bladder into the vagina. The bladder may even come down so far that it causes a bulge at the opening of the vagina.

How does it occur?

The most common cause of a cystocele is weakening of the tissues of the pelvis and vagina as a result of childbirth. The muscles and ligaments in the pelvis around the vagina which hold the vagina in place and support it become stretched and weakened during labor and delivery. The more babies you deliver, the more the support tissues are stretched and weakened. Not everyone who has a baby will develop a cystocele. Some women have very strong supporting muscles and ligaments in the pelvis and may never have a problem. Women who have a Cesarean section delivery usually do not develop a cystocele.

A cystocele may also be caused by:

• a chronic cough or bronchitis
• obesity
• a lot of heavy lifting
• an injury to the vagina
• normal aging because of decreased estrogen after menopause

What are the symptoms?

You may have a cystocele but not have any symptoms. If you do have symptoms, they may include:

• recurring bladder infections
• backache
• feeling of pressure in the vagina
• painful sexual intercourse
• feeling part of the vagina protruding from the vaginal opening
• loss of urine when you cough, sneeze, laugh, or lift or during sex
• in severe cases, being unable to control urine at all

Since a cystocele is often found along with a weakened wall of the rectum, known as a rectocele, you may also have bowel symptoms.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and will perform a pelvic exam. Your provider may ask you to bear down and push like you are having a bowel movement so he or she can see how far the bladder protrudes into the vagina. Your provider may also ask you to contract the muscles of your pelvis (like you are stopping the stream in the middle of urinating) to check the strength of your pelvic floor muscles. You may be examined in different positions: lying down, standing up, and squatting. A complete exam will also include a rectal exam.

Your provider may do blood and urine tests and tests of the nerves and muscles of the pelvis and around the bladder to see what treatment is best for you.

How is it treated?

Treatment may be surgical or nonsurgical depending on how severe the cystocele is and the symptoms you are having. Possible treatments include:

• Kegel exercises: These are exercises you can do to strengthen the muscles in and around your vagina. They are done by squeezing the pelvic floor muscles on a regular schedule.
• Pessary: A vaginal pessary (a plastic or rubber ring) is placed in the vagina to push the bladder up and back in place. In some cases, a large tampon or vaginal diaphragm might be used instead of a pessary. (The tampon must be changed at least daily, and the diaphragm needs to be removed and cleaned every 1 to 2 days.)
• Surgery: Several different types of surgical procedures may be done to correct the cystocele. The procedure used depends on the type and extent of damage to the pelvic muscles and ligaments. In some cases, a hysterectomy (removal of the uterus) may be recommended because the ligaments of the uterus are stretched and the uterus is falling down on top of the bladder.

How can I take care of myself and prevent cystocele?

You can take care of yourself by:

• treating and preventing constipation
• avoiding heavy lifting
• lifting correctly (with your legs and not with your waist or back)
• treating a chronic cough or bronchitis
• not smoking
• avoiding too much weight gain
• doing Kegel exercises, especially after you have a baby

If you have incontinence, try to empty your bladder regularly before you have the urge to go. This will reduce the chance for urine to leak. You may also want to wear a pad to absorb wetness in the event of leakage.

If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before delivery.