Repair of Cystocele

A cystocele occurs when the connective tissue between a woman's pelvic organs becomes weakened, allowing the bladder to push through into the vaginal wall. Cystoceles are categorized into grades according to severity. Grade 1 is the least serious, with the bladder protruding only partially into the vagina. In grade 2, the bladder protrudes to the opening of the vagina. A grade 3 cystocele is one in which the bladder sags past the vaginal opening; this is the grade that most often requires surgery. Cystoceles occur for a variety of reasons, including chronic constipation, strain from heavy lifting and childbirth issues such as forceps delivery, multiple births or episiotomy. Doctors will usually try a conservative approach to grade 1 and 2 cystoceles, reserving surgery for grade 3.

Instructions

Nonsurgical Interventions

• 1

  Reduce the amount of heavy lifting you do to avoid putting additional strain on your pelvic muscles. Limiting strenuous lifting will allow the pelvic muscles to rest and prevent the cystocele from becoming worse.

• 2

  Perform Kegel exercises to strengthen the pelvic muscles, which will improve the muscles' ability to hold the bladder in place. Kegel exercises were developed to improve the tone of muscles in the genitourinary area. To perform Kegel exercises, which can be done sitting or standing, use the same motion you would use to cut off a stream of urine from your bladder. Voluntarily tighten the muscle, hold it for four seconds, then release. Repeat for 10 repetitions, which should be done at least 10 times per day.

• 3

  Talk to your doctor about the benefits of a pessary -- a device used to push the bladder back into place while also taking the pressure off the vaginal wall. Your doctor will explain options, such as which type of pessary will be used, as several varieties exist. It is common for several types or sizes to be tried before achieving a suitable fit.

• 4

  Investigate estrogen replacement therapy to help strengthen the pelvic walls and prevent additional weakening. Your doctor may suggest estrogen therapy in the form of patches, pills or topical cream, particularly if you are postmenopausal. Be sure to discuss your complete medical history before opting for estrogen therapy.

Surgical Intervention

• 5

  Talk to your doctor about the implications of a grade 3 cystocele -- the type most often requiring surgical repair. He will explain that you will receive either local or general anesthesia. You will have a urethral catheter inserted to reduce the pressure in your bladder. The surgeon will then make an incision through which he will repair the cystocele, either by folding tissue and muscle over itself and stitching it together for reinforcement, or by using a mesh material to reinforce the weakened area. The surgeon will also remove excess vaginal lining and weakened tissue before closing the incision.

• 6

  Drink fluids to the greatest extent you are able on the first day after surgery to encourage urine production. The doctor will remove the packing placed in your vagina during surgery and the nurses will assist you in standing and walking to help prevent blood clots from forming in your legs.

• 7

  Follow your surgeon's aftercare instructions upon your discharge from the hospital.