Cystocele: Meaning, Symptoms and Causes

Introduction

By definition, a cystocele is a medical condition in which a woman’s urinary bladder bulges into her vagina. It is also known as a prolapsed bladder, fallen bladder or an anterior vaginal prolapse.

About a Cystocele

It occurs when the ligaments that hold your bladder in position, and the tissues between the vagina and bladder weaken or stretch, allowing the bladder to bulge into the vagina. The chances of getting a cystocele increase with age since the muscles and tissues tend to weaken. 

What are the Different types of Cystoceles? 

Healthcare professionals classify a cystocele using a grading system.

1. Grade 1 is the mildest form of cystocele wherein the bladder drops only a short way into the vagina.
2. Grade 2 is the moderate form in which the bladder drops to the opening of the vagina.
3. Grade 3 is the severe form of cystocele wherein the bladder bulges through the opening of the vagina.

If it’s a more advanced cystocele, your bladder and vaginal wall might drop down so far enough that they may potentially bulge out through the opening of the vagina.

What are the Signs and Symptoms you experience in a cystocele? 

The more severe a cystocele is, the likeliness of experiencing a symptom increases. Some common symptoms experienced by women include:

• Feeling that something is falling out of vagina
• Seeing a vaginal bulge
• Difficulty in starting the flow of urine
• Frequent or urgent urination  
• A feeling of incomplete urination
• The sensation of pelvic heaviness or fullness, especially when you strain, cough, bend down or lift.
• Pain in the pelvic area and lower back.
• Frequent urinary tract infections.
• Painful sexual intercourse
• Urine leakage or urinary incontinence
• Problems inserting tampons or applicators.

The signs and symptoms can be observed, especially when you are standing for long periods of time and may go unnoticed when you lie down.

When should you See a Doctor? 

If you experience or see any of the above signs and symptoms, it is advisable to visit a doctor right away. 

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What are the Causes of a Cystocele?

Cystoceles are caused due to the weakening or damaging of muscles and connective tissues that support your bladder and the vaginal walls. Now, multiple factors may contribute to this. They include:

• Pregnancy and childbirth: The latter involves a lot of strain on the muscles, specifically vaginal childbirths.
• Intense physical activity, including repeated heavy lifting.
• Being obese or overweight.
• Repeated muscle straining during bowel movements or constipation.
• A history of pelvic reconstructive surgeries.
• Family history of cystocele or inherited genes.
• Certain connective tissue disorders like Ehlers-Danlos syndrome.
• Frequent coughing.
• A drop in the estrogen levels due to increasing age.
• Hypoestrogenism or estrogen deficiency.
• Cancer treatment of pelvic organs.

What are the Risk Factors associated with a Cystocele?

The following factors make you more susceptible to a cystocele:

• Pregnancy and childbirth: If you have had an instrument-assisted delivery, multiple pregnancies or if your infants had a high birth weight, you are at a higher risk of a cystocele.
• Hysterectomy: Having your uterus removed might contribute to the weakening of your pelvic floor.
• Age: Estrogen keeps muscles around your vagina strong, but women produce less estrogen as they enter menopause. Hence, the pelvic floor strength weakens with age. 
• Obesity: Being obese or overweight makes you more susceptible to a cystocele.
• Genetic: You might be born with weaker connective tissues from birth, and that puts you at a higher risk. 

How can a Cystocele be treated? 

Choice of treatment is also related to age, desire to have children, desire to continue having sexual intercourse and other disease conditions that a woman already has. Treatment consists of Surgical or Non-surgical management. 

Non-surgical treatment:

• Pessary: It’s a removable device inserted into the vagina to support the anterior vaginal wall, keep the bladder in place and block protrusion. These come in different shapes and sizes. These must be removed and cleaned regularly to prevent or avoid vaginal irritation.
• Pelvic floor exercises: These are individualized and structured exercises in order to strengthen the pelvic floor muscles. These are also known as kegel exercises.

Surgical treatment.

• The surgery will depend on the cause of the defect and whether it occurs in the top, middle or lower part of the anterior vaginal wall.
• One of the reconstructive surgeries to repair a cystocele is known as the anterior colporrhaphy during which the surgeon puts the bladder back in its position and tightens the muscles and tissues that hold the bladder in place using stitches.  
• Obliterative surgery is another option in which all or part of the vagina is narrowed off or shortened in order to provide more support for the bladder.

What are the Complications of a Cystocele?

Complications include urinary retention, recurring urinary tract infections and incontinence. Urinary retention is a condition in which you are unable to empty all the urine from the bladder. Incontinence is the involuntary leakage of urine.

A cystocele also interferes with the sexual activity as the anterior vaginal wall may actually protrude through the vaginal opening.

How can you Prevent a Cystocele?

Usually, a cystocele cannot be prevented. However, the steps that can be taken to prevent it from worsening are:

• Regular pelvic floor muscle exercises
• Controlling your weight.  
• Making changes to the diet and lifestyle such as eating more fruits and vegetables and maintaining healthy bowel habits.
• Another way is to either avoid heavy lifting or if it cannot be avoided, lift correctly.
• Prevent and treat constipation so as to avoid strain on the pelvic floor muscles.
• Controlling chronic cough.
• Smoking cessation

Conclusion

Cystoceles usually cause discomfort. It is important that you follow a good diet, exercise regularly and more importantly, consult a doctor if you experience any such discomfort or experience the above-mentioned symptoms.

Frequently Asked Questions (FAQs)?

Is a Cystocele serious or life-threatening?

A cystocele is generally not life-threatening, and many treatment options are available according to the symptoms experienced.

Does my cystocele worsen if ignored?

It is very likely that the cystocele will worsen over time if left untreated. In some cases, it can reach a stage that can cause urinary retention and can go on to damage the kidney.

What is a pessary?

A pessary is a small device that is inserted into the vagina and is used to keep the bladder in place. It comes in different shapes and sizes and can be fitted according to the types and degrees of the cystocele. It is safe to use and does not cause any pain, as well. It is a non-surgical option for treatment.

What is urinary incontinence?

It is a condition in which there is involuntary leakage of urine, that is, a person might urinate even if he/she does not want to.

References:

https://www.askapollo.com/diseases/cystocele
https://www.apollohospitals.com/patient-care/health-and-lifestyle/understanding-investigations/vdrl-test/
https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/urinary-incontinence-a-common-problem-in-the-elderly/