A health condition in which the bladder moves from its usual position in the pelvic area and pushes on the vagina wall is called anterior vaginal prolapse (also called cystocele or a prolapsed bladder).
Specific muscles and connective tissues of the pelvic floor usually hold in place pelvic organs such as the bladder, uterus, and intestines. In people with this condition, these muscles become weak. Sometimes, the condition may occur over time due to pregnancy, chronic constipation, violent coughing, or heavy lifting.
Generally, this condition is treatable. To treat mild to moderate cystocele, doctors recommend nonsurgical options. In people with a severe form of the disease, surgery may be necessary to keep pelvic organs in their proper position.
Symptoms
People with mild cystocele usually do not experience symptoms. Check below some symptoms:
- A feeling of pressure or fullness in the pelvis and vagina
- A bulge of tissue in the vagina (sometimes)
- Elevated pelvic pressure when you cough, strain, or bear down
- Urinating problems (including inability to empty the bladder, frequent urination, leaking urine, also known as urinary incontinence, and others)
When the symptoms appear, they are usually noticeable and may disappear when you lie down.
This condition rarely causes pain. However, it is recommended to see a doctor even if it is not painful because cystocele may lead to bladder infections.
Causes
The pelvic area is made of muscles, ligaments, and connective tissues that help hold organs (such as the bladder and others) in place. These connections may weaken over time or due to trauma from childbirth, or long-term straining. As a result, the bladder moves lower and may bulge into the vagina (also known as anterior prolapse). Check below some causes of stress to the pelvic floor:
- Pregnancy and vaginal childbirth
- Prolonged heavy lifting
- Excessive body weight or obesity
- Straining with bowel movements
- Chronic cough
- Bronchitis
Risk Factors
Healthcare professionals have identified some factors that may increase your risk of developing cystocele. For example:
- Pregnancy and childbirth – Those who have a vaginal or instrument-assisted delivery, multiple pregnancies, or infants had high birth weight are at higher risk of developing this condition.
- Age – The risk of developing anterior vaginal prolapse significantly increases with aging, especially after menopause when Estrogen production is low.
- Hysterectomy – Females without a uterus are also at increased risk of cystocele. Additionally, the uterus is a part of the pelvic floor, and it helps maintain the organs and connective tissue in place.
- Genetics – Certain genes make some females be born with weakened connective tissue of the pelvic floor. As a result, the risk of cystocele increases.
- Obesity – Excessive body weight also elevates the risk of anterior prolapse.
Diagnosis
Diagnosis of the anterior vaginal prolapse usually involve the following examination and tests. Examples include:
- A pelvic examination – During this procedure, doctors will examine the vagina to check for a bulge that often indicates cystocele. Sometimes, pelvic examinations are performed while lying down and standing up. Physicians may also ask you to bear down and see how a bowel movement affects the prolapse and check the strength of the pelvic muscles.
- Bladder and urine tests – In severe cases, doctors may perform some tests to see how the bladder empties. Urine tests are often done to check for infections and to determine if the bladder retains more urine than usual.
Moreover, doctors may ask some questions about your medical and family history and symptoms. It may help get clues about your condition and make the best treatment plan for you.
Treatment
The treatment is often different among people with cystocele because it depends on several factors. For example, the severity of the condition, your age, existing health problems, and others.
Mild forms of cystocele usually do not cause symptoms and do not need treatment. Check below some treatments often recommended by doctors for people who have symptoms:
- Kegel exercises (also called Kegels) – These are specific exercises that help strengthen pelvic floor muscles. As a result, it helps support the bladder and other pelvic organs. Furthermore, these exercises may lessen the symptoms.
- Pessary (a supportive device) – This is a plastic or rubber ring that is inserted into the vagina. It helps to support the bladder and may relieve the symptoms. There are a lot of women who use pessaries as an alternative to surgery. Healthcare professionals often recommend a pessary when surgery is not an option.
Surgery
Those who experience uncomfortable symptoms despite treatment usually need surgery. In most cases, this procedure is done through the vagina and involves lifting of the prolapsed bladder back to its proper position. Vaginal tissue usually are reinforced with specific type of tissue graft.
If you experience an anterior prolapse, doctors may recommend hysterectomy. During this procedure, surgeons will remove the uterus and repair damage to the pelvic floor muscles. When a person experiences anterior prolapse with stress incontinence (urine leaking during strenuous activity), doctors often recommend multiple procedures that help support the urethra and lessen the symptoms.
If you are pregnant or planning to become pregnant, surgery is not an option to treat the condition. Usually, doctors recommend pelvic floor exercises and a pessary to relieve the symptoms. In addition, a prolapse may happen again despite successful treatment.
Lifestyle Changes
Check below some tips that may help prevent the worsening of an anterior prolapse:
- Try to get and maintain a healthy weight
- Manage chronic cough or bronchitis
- Quit smoking
- Avoid heavy lifting
- Treat and prevent constipation (usually dietary changes are effective)
Frequently Asked Questions
What happens if a cystocele goes untreated?
Without treatment, this condition may lead to obstruction of the kidneys or urinary retention (inability to pass urine). Other complications include kidney damage, infections, urinary incontinence, sexual dysfunction, and others.
What foods are bad for prolapse?
There are some foods that should be avoided by people with a prolapse. For example, spicy or acidic foods, caffeine, alcohol, and carbonated beverages.
What can be mistaken for a cystocele?
There are some conditions that can be mistaken for cystocele. Examples include anterior vaginal cysts, vaginal leiomyoma, rectocele, uterine prolapse, and others. This article does not contain a complete list of conditions that can be mistaken for anterior vaginal prolapse. If you have additional questions, ask your healthcare professional.
