A cystocele (SIS-to-seel) occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. A cystocele is also called a prolapsed bladder.
Straining the muscles that support your pelvic organs may lead to a cystocele. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Cystoceles also tend to cause problems after menopause, when estrogen levels decrease.
For a mild or moderate cystocele, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.
In mild cases of cystocele, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:
- A feeling of fullness or pressure in your pelvis and vagina — especially when standing for long periods of time
- Increased discomfort when you strain, cough, bear down or lift
- A bulge of tissue that, in severe cases, protrudes through your vaginal opening and may feel like sitting on an egg — often going away when you lie down
- A feeling that you haven't completely emptied your bladder after urinating
- Repeated bladder infections
- Pain or urinary leakage during sexual intercourse
Doctors may refer to a cystocele as an anterior prolapse, as the front (anterior) vaginal wall stretches and the bladder bulges down into the vagina.
When to see a doctor
A severely prolapsed bladder can be uncomfortable — in some instances, even painful. It can make emptying your bladder difficult and may lead to bladder infections. Make an appointment with your doctor if you experience bothersome signs and symptoms of cystocele, such as those listed above.
These factors may increase your risk of cystocele:
- Childbirth. Women who have vaginally delivered one or more children have a higher risk of cystocele.
- Aging. Your risk of cystocele increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep pelvic muscles strong — decreases.
- Having a hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
- Genetics. Some women are born with weaker connective tissues, making them more susceptible to a cystocele.
Diagnosis of a cystocele may involve:
- A pelvic exam. You may be examined while lying down and while standing up. During the exam, your doctor looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. You'll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you'll be asked to contract them, as if you're trying to stop the stream of urine.
- Filling out a questionnaire. You may fill out a form that helps your doctor assess the degree of your prolapse and how much it affects your quality of life. Information gathered also helps guide treatment decisions.
- Bladder and urine tests. If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection, if it seems that you're retaining more urine in your bladder than is normal after urinating.
Treatment depends on how severe your cystocele is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (prolapsed uterus). Mild cases — those with few or no obvious symptoms — typically don't require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles.
If self-care measures aren't effective, your doctor may recommend these options:
- Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
- Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.
When surgery is necessary
If you have noticeable, uncomfortable symptoms, the cystocele may require surgery.
- How it's done. Often, the surgery is performed vaginally and involves lifting your prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of your pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.
- If you have a prolapsed uterus. For a cystocele associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues.
If you're thinking about becoming pregnant, delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of cystocele recurrence — which may mean another surgery at some point.
Dealing with incontinence
If your cystocele is accompanied by stress incontinence, your doctor may recommend one of a number of procedures to support the urethra (urethral suspension).