What is Cystocele (Prolapsed Bladder)?

A cystocele is the stretching or weakening of both the ligaments that hold the bladder up and the muscle between a woman’s vagina and bladder. This allows the vagina to partially sink into the bladder. This condition is also called a prolapsed, dropped, herniated, or fallen bladder.

Grades of Cystocele

There are three grades of cystocele based on the severity of the condition.

The three grades of a prolapsed bladder:

• Grade 1 – The mildest grade where the bladder dips slightly into the vagina.
• Grade 2 – The moderately severe grade where the bladder sinks to the opening of the vagina.
• Grade 3 – The most severe grade where the bladder protrudes through the vaginal opening.

Symptoms

The most common symptom of cystocele is feeling a lump, bulge, or protuberance in your vagina. Typically, you will be able to see and feel this bulge. Because pain and incontinence are other common cystocele symptoms, sometimes these signs are called cystocele incontinence and cystocele pain. It is also possible to experience cystocele without any symptoms.

Additional signs and symptoms of prolapsed bladder include:

• Pressure in the vaginal region
• Tissue protruding out of the vagina
• Pain in the vagina, lower back, abdomen or pelvic region
• Frequent urination or the urge to urinate
• Urinary incontinence or losing more urine than desired
• Difficultly using tampons
• Regular urinary tract infections
• No feeling of relief immediately after urination
• Pelvic pressure that worsens with standing, lifting or coughing
• Sexual intercourse might be painful

Causes

The primary cause of prolapsed bladder is childbirth.

Other potential cystocele causes are:

• Obesity
• Heavy lifting
• Previous pelvic surgery
• Constipation
• Aging
• Menopause
• chronic coughing (or other lung problems)
• Excessive straining during bowel movements

Risk Factors

There are several cystocele risk factors. Women at higher risk include those who have multiple pregnancies, deliver vaginally, or who experience labor that is long and difficult.

Other common risk factors for prolapsed bladder are:

• Aging
• Family history
• Previous pelvic surgery

Diagnosis

Cystocele diagnosis involves your doctor performing a physical and pelvic exam. Your doctor will also review your symptoms, and your family and medical history. Your exam may occur with you in a variety of positions: standing, sitting, straining or laying down. This can allow your doctor to measure the severity of your condition. Cystocele diagnosis is sometimes also called bladder prolapse diagnosis.

Additional diagnostic tests for prolapsed bladder include:

• Cystourethrogram: This test is also referred to as a voiding cystogram. A Cystourethrogram is an X-ray of the bladder taken while a patient is urinating. The patient’s bladder is usually filled with contrast dye to show the form of the bladder and reveal any obstructions.
• Magnetic Resonance Imaging (MRI): An MRI can help determine the scope of the condition.
• Cystoscopy: This is a test that allows your doctor to inspect the lining of your bladder and the urethra, the tubular conduit that releases urine out of your body.
• Urodynamics: This test demonstrates how well your bladder is working and if there are any leaks or obstructions.
• Ultrasound: An ultrasound scan uses sound waves to capture images of your bladder.

Additional tests may be needed to explore if there are any other problems in your urinary system.

Treatment

Treatment for cystocele depends on the severity or grade of the prolapsed bladder. Your doctor will customize bladder prolapse treatment to your particular medical history, family history, age, risk factors and condition.

Cystocele treatment may include:

• Lifestyle changes: Your doctor may recommend that you avoid or eliminate certain activities that could make your condition worse. Activities you might want to avoid are lifting heavy objects or excessive straining during bowel movements.
• Kegel exercises: These are daily pelvic muscle exercises.
• Pessary: This is a medical device positioned in the vagina to stabilize the bladder.
• Bladder Prolapse Surgery: Surgery can reposition the bladder. Your doctor may insert a sling to hold your bladder in place.
• Hormone replacement therapy: Your doctor may recommend hormone replacement therapy to strengthen the muscles throughout the vagina and bladder.

If you are considering surgery or hormone replacement therapy, we invite you to talk to your healthcare provider at Baptist Health about the risks and benefits.

Complications

There may be complications with cystocele. The prolapsed bladder complications range from mild to severe, and may impact your physical health, comfort, and relationships with romantic or sexual partners.

Common cystocele complications are:

• Regular urinary tract infections
• Discomfort or pain during sexual intercourse
• You may experience incontinence
• Urine may leak from your vagina
• Cystocele may reoccur over time
• A cystocele sling may wear away with time and need to be removed
• Injury to your bladder

If you or a loved one experiences any signs and symptoms of cystocele, please contact a health care professional at Baptist Health today.