A cystocele, commonly known as a prolapsed bladder, is a condition where the bladder descends and bulges into the vagina. This occurs when the supportive tissues between the bladder and the vagina weaken or stretch. It is a common form of pelvic organ prolapse, a broader term for when pelvic organs shift from their normal positions. The severity of a cystocele can vary significantly among individuals.
Understanding a Cystocele
The female pelvic floor comprises a complex network of muscles, ligaments, and connective tissues that act as a supportive hammock for pelvic organs, including the bladder, uterus, and rectum. The anterior vaginal wall, specifically the pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle, are important in supporting the bladder. When these structures lose their integrity or become damaged, the bladder can descend from its normal anatomical position.
This weakening allows the bladder to push against the front wall of the vagina, creating a noticeable bulge. Factors like childbirth, chronic straining, and aging can contribute to the deterioration of these supporting elements, leading to a cystocele.
Grading System Explained
Healthcare providers classify cystoceles using a grading system to assess the extent of the prolapse, which helps guide treatment decisions. While specific systems like the Pelvic Organ Prolapse Quantification System (POP-Q) exist for precise measurements, a simplified grading system is used for general understanding. This system ranges from Grade 1 to Grade 3 or 4, indicating increasing severity.
Grade 1 represents a mild cystocele, where the bladder has dropped only a short distance into the vagina. A Grade 2 cystocele is considered moderate, meaning the bladder has descended far enough to reach or approach the opening of the vagina.
A Grade 3 cystocele indicates a more advanced prolapse, where the bladder bulges significantly past the vaginal opening. Some systems also include a Grade 4, representing the most severe form, where the bladder completely protrudes outside the vagina.
Recognizing Symptoms and Getting Diagnosed
Symptoms of a cystocele can range from mild to bothersome. Common complaints include a feeling of fullness, pressure, or heaviness in the pelvic area or vagina, which may worsen with standing, lifting, or coughing. Many individuals report a sensation of something bulging out of their vagina, which they may even be able to see or feel.
Urinary issues are often associated with a cystocele, such as difficulty fully emptying the bladder, frequent urination, or involuntary urine leakage (urinary incontinence). Some women may also experience recurrent urinary tract infections or discomfort during sexual intercourse.
Diagnosis involves a thorough physical examination, including a pelvic exam. During the exam, the healthcare provider may ask the individual to strain or cough to observe the degree of bladder prolapse. Sometimes, imaging tests like ultrasound or a voiding cystourethrogram (an X-ray taken while urinating) may be used to assess the bladder’s position and function, and rule out other conditions.
Managing and Treating a Cystocele
Treatment approaches for a cystocele are individualized and depend on the grade of the prolapse, the severity of symptoms, and the patient’s overall health and preferences. For mild cystoceles with minimal symptoms, conservative management is often recommended. This includes lifestyle modifications such as maintaining a healthy weight, avoiding heavy lifting, and preventing constipation through a high-fiber diet and adequate fluid intake.
Pelvic floor exercises, often called Kegel exercises, are a conservative treatment. These exercises aim to strengthen the muscles that support the bladder and vagina, which can improve bladder control and provide better support. A healthcare provider or physical therapist can provide guidance on proper technique. For more symptomatic cases, a vaginal pessary may be an option.
A pessary is a removable device, made of silicone, that is inserted into the vagina to physically support the bladder and hold it in a more normal position. It does not cure the prolapse but can effectively relieve symptoms. For moderate to severe cystoceles, or when conservative measures are insufficient, surgical intervention may be considered. The most common surgical procedure is an anterior colporrhaphy, which involves moving the bladder back into its correct anatomical position and tightening the supportive tissues in the front vaginal wall with stitches. Recovery from surgery takes a few weeks to months, with many procedures performed on an outpatient basis.