Cystocele

________________________________________________________________________

KEY POINTS

• A cystocele is a bulging of the bladder into the vagina. A cystocele is a type of pelvic support problem. It may also be called a prolapsed bladder.
• The treatment depends on your symptoms and how severe the cystocele is. You may feel better with lifestyle changes, exercises, a support device, or surgery.
• Ask your provider how to take care of yourself at home, if there are activities you should avoid, and when you can return to your normal activities.

________________________________________________________________________

What is a cystocele?

A cystocele is a bulging of the bladder into the vagina. A cystocele is a type of pelvic support problem. It may also be called a prolapsed bladder.

What is the cause?

Ligaments, muscles, and connective tissue normally hold your bladder and other organs in their proper places in your lower belly. If these tissues get weak, your bladder or other organs may push down into the vagina.

Childbirth is the most common cause of a cystocele, especially if you had a large baby or a long or difficult labor. The muscles and skin of the birth canal (vagina) are stretched and sometimes torn during childbirth. The tissues heal over time but may not be as strong as they were before.

Older women may have this problem because the loss of female hormones after menopause weakens the vaginal walls.

Over time, the following may increase your risk of having a cystocele:

• Inherited weak ligaments and muscles
• Chronic coughing
• Chronic constipation
• Frequent heavy lifting
• Frequent straining to pass bowel movements
• Obesity
• Injury to the vagina

What are the symptoms?

You may not have any symptoms. If you do have symptoms, they may include:

• Leaking of urine when you cough, sneeze, laugh, lift heavy objects, or have sex
• Frequent and painful urination (symptoms of bladder infection)
• Feeling like you can’t empty your bladder completely
• Backache
• Feeling of pressure in the vagina
• Pain during sex
• Feeling tissue sticking out of the opening of the vagina
• In severe cases, being unable to control urine at all

The rectum may also press into the vagina. This problem is called a rectocele. It can cause trouble with bowel movements. For example, you may have bowel movements less often or you may have leaking of bowel movements.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and do a pelvic exam. You may also have a rectal exam. Your provider may ask you to bear down and push as you would to have a bowel movement. This will help your provider see how far the bladder bulges into the vagina. Your provider may also ask you to squeeze the muscles of your pelvis (as you would to stop urinating) to see how strong they are. You may be examined in different positions: lying down, standing up, and squatting.

Tests may include:

• Blood tests
• Urine tests
• Tests of the nerves and muscles of the pelvis and around the bladder

These tests can help your provider know what treatment might be best for you.

How is it treated?

The treatment depends on your symptoms and how severe the cystocele is. Possible treatments include:

• Lifestyle changes: Sometimes the symptoms can be treated with changes in diet, weight loss, or avoiding strenuous activities.
• Kegel exercises: These are exercises you can do to strengthen the muscles in and around your vagina. When you do Kegel exercises, you squeeze and relax your pelvic muscles as though you were trying to stop a flow of urine. Hold each squeeze for up to 10 seconds, then let go. Try to do 50 squeezes per day.
• Pessary: A pessary is a silicone or plastic device prescribed by your healthcare provider. It’s inserted into the vagina to help support the uterus, bladder, and rectum. It can help if you leak urine when you cough, strain, or exercise.
• Surgery: You may need surgery to remove or repair weakened tissue. In some cases, removal of the uterus (hysterectomy) may be recommended because the ligaments of the uterus are stretched and the uterus is falling down on top of the bladder.

How can I take care of myself?

• If you have problems with leaking of urine, try to empty your bladder regularly before you have the urge to go. This will lower the chance that urine will leak. You may also want to wear a pad to absorb wetness when you have leaking.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Eat high-fiber foods to help you move your bowels without straining.
• Drink plenty of fluids.
• Strengthen your pelvic muscles by doing Kegel exercises. It is especially helpful to do these exercises before and after childbirth.
• Don’t wear tight underwear or clothing that puts pressure on your belly.
• Avoid frequent heavy lifting. When you do lift, bend your knees and hips and keep your back straight.
• If you have a chronic cough, talk to your healthcare provider about treating the cough.
• If you smoke, try to quit.

If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before your baby is born.

• Ask your provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup.