Pelvic organ prolapse occurs when weakened muscles and tissues no longer adequately support pelvic organs, causing them to bulge into the vagina. Among the common forms of this condition are cystocele and rectocele, which can significantly affect a woman’s comfort and quality of life.
Understanding Cystocele and Rectocele
A cystocele, commonly known as a prolapsed bladder, occurs when the supportive tissues and muscles between the bladder and the vagina weaken. This weakening allows the bladder to sag or bulge into the vaginal canal. The extent of a cystocele can vary, often graded from mild, where the bladder drops only slightly, to severe, where it may protrude significantly outside the vaginal opening.
Similarly, a rectocele, also called a posterior vaginal wall prolapse, involves the rectum bulging into the vagina. This happens when the tissue separating the rectum and the vagina, known as the rectovaginal septum, becomes thin or weak. Severity can range from a small bulge that causes no symptoms to a larger one that becomes noticeable and problematic.
Shared Causes and Risk Factors
Both cystocele and rectocele arise from a weakening of the pelvic floor muscles and connective tissues that provide support to the pelvic organs. A primary factor contributing to this weakening is childbirth, particularly vaginal deliveries, which can strain or injure the pelvic floor. Multiple births, prolonged labor, or the use of instruments during delivery can increase the risk.
Aging also plays a role, as natural processes and decreased estrogen levels after menopause can lead to weakened tissues. Conditions that cause chronic straining or increased pressure in the abdominal area are significant risk factors. These include chronic constipation, persistent coughing, and regular heavy lifting. Obesity and a genetic predisposition to connective tissue disorders can further contribute to the development of these conditions.
Identifying the Symptoms
Cystocele and rectocele symptoms can be distinct, though some general pelvic discomfort may overlap. With a cystocele, individuals often experience urinary issues. These include urinary incontinence, a sensation of pressure or fullness in the pelvis, frequent urination, or difficulty completely emptying the bladder. A bulge of tissue at the vaginal opening might also be noticed, which may feel worse when standing or straining.
Conversely, rectocele primarily presents with bowel-related symptoms. These include difficulty with bowel movements, a feeling of incomplete emptying after defecation, or needing to manually support the perineum or posterior vaginal wall to facilitate a bowel movement. Rectal pressure or a sensation of something “stuck” in the rectum are also common. Shared symptoms include pelvic pressure, discomfort during sexual intercourse, or a sensation of something falling out of the vagina.
Diagnosis and Treatment Paths
Diagnosis of cystocele and rectocele typically begins with a thorough medical history and a pelvic examination. During the exam, a healthcare provider can often identify the bulging of organs into the vagina, especially when the individual is asked to bear down or cough. While a physical exam is usually sufficient, imaging tests like ultrasound or MRI might be used to assess the extent.
Treatment approaches vary based on the severity of the prolapse and the individual’s symptoms, often starting with conservative management. Pelvic floor muscle exercises, commonly known as Kegel exercises, strengthen the supporting muscles and help alleviate symptoms. Vaginal pessaries, which are removable silicone devices, provide support to the prolapsed organs and reduce symptoms. Lifestyle adjustments, such as managing constipation and weight, are also important conservative steps.
When conservative methods are insufficient or symptoms are severe, surgical repair may be considered. For a cystocele, anterior colporrhaphy repairs the weakened wall between the bladder and vagina, restoring the bladder to its normal position. For a rectocele, posterior colporrhaphy strengthens the tissue between the rectum and vagina. These procedures alleviate discomfort and improve organ function.
Managing and Preventing Prolapse
Managing and preventing pelvic organ prolapse involves strategies focused on reducing strain on the pelvic floor. Maintaining a healthy weight helps to decrease pressure on the pelvic muscles and tissues. Preventing constipation through a diet rich in fiber and adequate hydration is also important, as straining during bowel movements can exacerbate prolapse.
Avoiding heavy lifting and practicing proper lifting techniques can protect the pelvic floor from undue stress. Continuing to perform pelvic floor exercises regularly can maintain muscle strength and support the pelvic organs. These lifestyle adjustments contribute to overall pelvic health and can help manage symptoms or reduce the likelihood of prolapse progression.