Cystocele, or bladder prolapse, occurs when the pelvic floor muscles and tissues supporting the bladder become stretched or weakened, causing the bladder to descend or bulge into the vagina. In severe cases, the prolapsed bladder may be visible at the vaginal opening.
Symptoms of Cystocele (Bladder Prolapse)
Women with bladder prolapse might experience symptoms such as:
- Sensation or visibility of a vaginal bulge
- Urinary incontinence
- Incomplete bladder emptying
- Frequent urination or strong urge to urinate
- Slow urine stream
- Pelvic, vaginal, lower abdominal, lower back, or groin pain
- Painful intercourse
- Heaviness or pressure in the vaginal area
- Protruding vaginal tissue that is tender or bleeding
Some women may not have any symptoms. Although cystocele cannot be completely prevented, steps such as maintaining a healthy weight, avoiding heavy lifting, treating constipation, and managing chronic cough can help prevent the condition from worsening.
Risk Factors for Cystocele
Bladder prolapse is caused by stress on the muscles and tissues that support the bladder. Contributing factors include:
- Multiple pregnancies
- Vaginal childbirth
- Prior pelvic surgery
- Prolonged or difficult labor
- Constipatio
- Obesity
- Aging
- Chronic coughing
- Heavy lifting
- Frequent straining during bowel movements
- Menopause
Women with a family history of pelvic organ prolapse are at increased risk of developing a cystocele. If left untreated, bladder prolapse may either remain the same or worsen, potentially causing urinary retention, which can lead to kidney damage or infection.
Diagnosing Bladder Prolapse
Diagnosis involves a pelvic exam to assess the severity and identify which parts of the vagina are affected. The physician will also review the patient’s medical history, family history, and current health issues, including bowel habits and medication use. Additional tests and imaging studies to evaluate the pelvic floor may include MRI, X-rays, ultrasound, urodynamics, post-void residual urine measurement, voiding cystourethrogram, and cystoscopy. Bladder prolapse is graded or staged, with Grade 1 being the mildest.
Treatment Options for Bladder Prolapse
Treatment may not be necessary if the patient has no bothersome symptoms and if urine flow is not obstructed. Non-surgical treatments include behavior therapy such as Kegel exercises to strengthen pelvic floor muscles, pelvic floor physical therapy, and using a pessary to support the vagina.
In some cases, surgery might be needed to repair the prolapse and relieve symptoms. Surgical options include:
- Minimally invasive laparoscopic surgery with multiple small abdominal incisions
- Robot-assisted laparoscopy using robotic instruments controlled by the surgeon
- Vaginal surgery with only a vaginal incision
Surgery may involve repairing native tissue and augmenting it with surgical materials like a biological graft or mesh. Before surgery, patients will be informed about the risks, benefits, and alternatives to the procedure.
If you are experiencing symptoms of bladder prolapse, also known as cystocele, the UCI Pelvic Health Center is here to help. Our expert team of specialists provides comprehensive diagnosis and effective treatment options to alleviate your discomfort.