What Is A Cystocele?

A cystocele is an area of weakness in the anterior vaginal wall that allows the bladder to protrude into the vagina. It is a common condition with a variety of causes, including chronic constipation, heavy lifting and decreased estrogen in post-menopausal women. Most cystoceles are a result of childbirth, especially in women who have had multiple children.

Effects

• Cystoceles usually cause stress incontinence--urine leakage when coughing or sneezing--and, depending on their severity, may cause other symptoms as well. A bulge may be noticeable and in more severe cases may actually protrude from the vagina. A cystocele may also cause you to feel like you haven't emptied your bladder after urinating. Some people experience backaches and pain during sex; others may have repeated urinary tract infections.

Identification

• A cystocele can usually be diagnosed during a routine pelvic examination. Usually the bulge is noticeable when the doctor performs the bimanual exam. You may be asked to bear down so that the extent of the bulge caused by the cystocele can be judged. Other tests are sometimes performed to determine how much urine remains in the bladder following urination.

Types

• Cytoceles are assessed using a grading system to determine the severity of the condition. The mildest form is a grade 1 cystocele, when the bladder only protrudes slightly into the vagina. Grade 2 cystoceles protrude far enough that the prolapsed bladder reaches the vaginal opening. If the bladder protrudes outside of the vagina, the cystocele is a grade 3. Some doctors add a fourth grade to this system, depending on how much of the bladder protrudes from the vagina.

Prevention/Solution

• Treatment for a cystocele is chosen based on what grade the cystocele is and what symptoms it causes. Mild cystoceles, especially those that cause limited symptoms, are usually treated with pelvic exercises to increase the muscle tone in the area. Moderate cystoceles may require the use of a pessary--a device inserted into the vagina to push the bladder into its normal position. Grade 3 or 4 cystoceles and those that cause severe symptoms are treated surgically. Several methods are used to surgically repair cystoceles. Most operations for this condition involve creating a sling to support the bladder; the sling is securely attached to the pelvic bones or muscles and holds the bladder in its normal position.

Time Frame

• Cystoceles occur most frequently in women following childbirth. Advanced age is also a risk factor for developing a cystocele, and those who develop one due to giving birth may find it increases in severity after menopause. Estrogen helps to maintain the tissues of the vagina, and when estrogen levels decrease post-menopause, the vaginal muscles are often weakened. Although surgical correction of a cystocele can be performed at any age, it is usually postponed until after the woman has completed childbearing. Giving birth after a cystocele has been repaired may cause the condition to recur.