Cystocele

A cystocele occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.

What causes a cystocele?

A cystocele may result from muscle straining while giving birth. Other kinds of straining - such as heavy lifting or repeated straining during bowel movements - may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. When women go through menopause - that is, when they stop having menstrual periods - their bodies stop making estrogen, so the muscles around the vagina and bladder may grow weak.

How is a cystocele diagnosed?

A doctor may be able to diagnose a grade 2 or grade 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible. Other tests may be needed to find or rule out problems in other parts of the urinary system.

Treatments

Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.

Large cystoceles may require surgery to move and keep the bladder in a more normal position. This operation may be performed by a gynecologist, a urologist, or a urogynecologist. The most common procedure for cystocele repair is for the surgeon to make an incision in the wall of the vagina and repair the area to tighten the layers of tissue that separate the organs, creating more support for the bladder. It may take 4 to 6 weeks to recover fully.

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