Pelvic organ prolapse refers to a pelvic organ (the uterus, bladder or rectum) dropping out of its usual anatomic position into the vaginal canal. Cystocele is specifically a dropping or bulging of the bladder into the vagina. A cystocele, also known as bladder prolapse, occurs when the pelvic floor muscles and the ligaments between the bladder and vagina weaken, allowing the bladder to sag into the vagina. A cystocele may be asymptomatic or may be very symptomatic. When asymptomatic, with no associated pain or complications, this may not require any additional treatment. When symptomatic, common symptoms include pelvic pressure or discomfort, difficulty emptying the bladder, chronic urinary tract infections, or painful intercourse. Women with prolapse may also feel a bulge in the vagina or as if they are “sitting on a ball.” Symptoms may be more noticeable at the end of the day or after standing for long periods of time.

Cystocele: Bladder Prolapse

Cystocele After Hysterectomy

Normal Pelvic Anatomy

Normal Anatomy After Hysterectomy

A cystocele may be asymptomatic in some women. In others, it may cause the following symptoms:

  • A soft bulge of tissue in the vagina that protrudes through the vaginal opening
  • Pelvic pressure or heaviness
  • Difficulty emptying the bladder
  • The need to press one’s fingers into the vagina to reduce the bulge (splint) or the need to reposition to empty the bladder

The three main factors that contribute to the development of a cystocele are:

  1. Hereditary. Cystoceles tend to run in families. There are genes that code for the supporting structures of the pelvic floor and variations in these genes can lead to weakening of the pelvic floor.
  2. Childbirth. Vaginal deliveries can stretch and weaken the supporting structures of the pelvic floor.
  3. Age. Supporting structures of the pelvic floor weaken with increased age.

A cystocele is diagnosed by pelvic exam. When a cystocele is present, other defects of the pelvic floor are often also found on exam, such as rectocele, uterine prolapse or enterocele.

Treatment for cystocele ranges from no treatment for a mild and asymptomatic cystocele to surgery or a pessary for a more advanced cystocele.

A pessary is typically used in women who are not candidates for surgery due to age or poor health.

Surgery is elective and done to relieve symptoms. Symptoms of prolapse do not decrease without treatment. Reconstructive surgeries are done to restore the anatomy of the vagina; these include vaginal prolapse repair or robotic sacrocolpopexy. The type of surgery recommended is based on each individual’s exam and desired outcome.

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