Pelvic organ prolapse (POP) is a condition where pelvic organs shift from their normal position. It is a common occurrence, affecting a significant portion of the population. Among the various types of POP, cystocele and rectocele are specific forms involving the bladder and rectum, respectively. These conditions arise when the supporting structures of these organs weaken, allowing them to bulge into the vaginal area. Both cystocele and rectocele are treatable and often manageable conditions.
Understanding Cystocele and Rectocele
A cystocele, often called a “prolapsed bladder,” occurs when the bladder descends and bulges into the front wall of the vagina. This condition arises from the stretching or weakening of the supportive ligaments and muscles, including the pubocervical fascia, that normally secure the bladder and vaginal wall, leading to its protrusion into the vaginal canal.
Similarly, a rectocele, also known as a “posterior vaginal wall prolapse,” involves the rectum pushing forward and creating a bulge into the back wall of the vagina. This occurs when the rectovaginal septum, the supportive tissue between the rectum and the vagina, becomes thinned or compromised. The weakened septum allows the rectum to herniate into the vaginal space, which can impede normal rectal function.
Cystocele and rectocele specifically affect women due to the unique structure of the female pelvic anatomy and the shared wall between these organs and the vagina. The extent of the bulge can range from mild, barely noticeable shifts, to more severe cases where the organ may extend to or even beyond the vaginal opening.
Common Causes and Risk Factors
The development of cystocele and rectocele primarily results from a weakening of the pelvic floor muscles and connective tissues. Vaginal childbirth is a significant contributing factor, especially with multiple deliveries, prolonged labor, or larger babies. The physical strain during birth can damage these supportive structures.
Chronic straining also places stress on the pelvic floor. This includes persistent efforts due to long-term constipation or conditions causing a chronic cough. Frequent heavy lifting similarly exerts downward pressure, compromising pelvic floor support.
Aging naturally leads to a loss of muscle strength and tissue elasticity over time. The decline in estrogen levels after menopause further weakens pelvic floor connective tissues, as this hormone is involved in maintaining their health. Being overweight or obese also increases pressure on the pelvic floor, raising the likelihood of prolapse. Genetic predispositions or certain connective tissue disorders can also increase an individual’s susceptibility.
Recognizing the Symptoms
Symptoms of cystocele and rectocele vary in severity, with some individuals experiencing no noticeable signs in mild cases. When symptoms do occur, they often manifest as a feeling of pelvic pressure or heaviness, or a sensation that something is “falling out” of the vagina. A soft bulge of tissue may also be felt or seen protruding into or through the vaginal opening.
For a cystocele, symptoms are related to bladder function. These can include difficulty fully emptying the bladder, a frequent or urgent need to urinate, or urinary incontinence (involuntary leakage of urine). Some individuals may also experience frequent urinary tract infections due to incomplete bladder emptying.
Rectocele symptoms often involve bowel movements. Individuals might experience difficulty passing stool, a feeling of incomplete emptying, or the need to manually support the vaginal wall to facilitate defecation, sometimes referred to as “splinting.” Other rectal symptoms can include a feeling of fullness or pressure in the rectum. Pain during sexual intercourse can also occur with both conditions.
Diagnosis and Management Strategies
Diagnosing a cystocele or rectocele begins with a medical history review and a physical examination. During a pelvic exam, a healthcare provider can often identify the presence and extent of the prolapse. The individual may be asked to bear down, as if straining, to make the prolapse more visible and assess its severity. In some instances, imaging tests like an MRI or a special X-ray called a defecography may be used to further evaluate the extent of the bulge and its impact on organ function, particularly for rectocele.
Management strategies for cystocele and rectocele range from conservative, non-surgical approaches to surgical interventions, depending on symptom severity and impact on quality of life. For mild cases, lifestyle modifications are recommended. These include dietary adjustments to prevent constipation, like increasing fiber and fluid intake, and avoiding heavy lifting.
Pelvic floor exercises, also known as Kegel exercises, are a common conservative treatment to strengthen pelvic support muscles. A vaginal pessary, a removable device inserted into the vagina, can also provide support to the bulging organs and alleviate symptoms. These conservative measures focus on symptom relief and improving the individual’s comfort.
When conservative methods are insufficient or the prolapse is severe, surgical repair may be considered. Various surgical procedures exist to restore organs to their proper position and reinforce weakened tissues. The goal of these treatments is to alleviate symptoms, restore normal organ function, and enhance quality of life.