Cystocele
Under normal conditions in women, the bladder is held in place by a "hammock" of supportive pelvic floor muscles and tissue. When these tissues are stretched and/or become weak, the bladder can drop and bulge through this layer and into the vagina. This results in bladder prolapse, also called cystocele. In severe cases, the prolapsed bladder can appear at the opening of the vagina. Sometimes it can even protrude (drop) through the vaginal opening. Bladder prolapse is common in women. The symptoms of bladder prolapse can be bothersome but it can be treated.
Symptoms
The most common symptom is the feeling of a vaginal bulge. A bulge in the vagina is something you can see or feel.
Other signs and symptoms that may be related to prolapse are:
- frequent voiding or the urge to pass urine
- urinary incontinence (unwanted loss of urine)
- not feeling relief right after voiding
- frequent urinary tract infections
- pain in the vagina, pelvis, lower abdomen, groin or lower back
- heaviness or pressure in the vaginal area
- sex that is painful
- tissue sticking out of the vagina that may be tender and/or bleeding
Some cases of prolapse may not cause any symptoms.
Conservative Management
Conservative measures involve
1. No treatment. Some women have bladder prolapse and do not have bothersome symptoms. You do not need to treat your prolapse if it is:
- not causing you problems
- not blocking your urine flow
2. Behavior therapy this can include:
- kegel exercises (which help strengthen pelvic floor muscles)
- pelvic floor physical therapy
- a pessary (a vaginal support device)
3. Drug therapy this includes:
- estrogen replacement therapy
Surgery
The goal of surgery is to repair your body and improve symptoms. Surgery can be performed through the vagina or the abdomen. There are several ways the surgery can be done, they include:
- Laparoscopic - the doctor places surgical instruments through the abdominal wall
- Robot-assisted surgery - robotic instruments are placed through the abdominal wall. They are attached to robotic arms, and are controlled by the surgeon.
Surgery also involves options of:
- native tissue repair (using one's own tissue and sutures)
- augmentation with surgical material
- biological graft such as mesh (rarely used)
Before having surgery you should have an in-depth talk with your surgeon. You should learn about the risks, benefits, and other choices for repairing cystocele with surgery. It is important that you give informed consent.
If prolapse is left untreated, over time it may stay the same or slowly get worse. In rare cases, severe prolapse can cause obstruction of the kidneys or urinary retention (inability to pass urine). This may lead to kidney damage or infection.
