What is a cystocele?
A cystocele occurs when a woman’s bladder sags into her
vagina because of the weakening of the wall between her bladder and her vagina.
In addition to causing some minor pain, this condition can also affect a
woman’s ability to fully empty her bladder as well as cause urine leakage.
Because the fallen bladder falls below the support of the
pelvic floor muscles, urine leaks out when a woman coughs, sneezes, laughs, or
moves in any way that puts pressure on her bladder.
When the bladder sags just slightly into the vagina the
cystocele is consider mild and is classified as a grade 1. If the bladder
extends far enough to reach the opening of the vagina, it is classified as a
grade 2, slightly more severe than a grade 1.
Even more severe is grade 3, which happens when the bladder protrudes
through the opening of the vagina.
What causes a cystocele?
A cystocele can occur when a
woman strains her muscles during childbirth or damage to the vaginal wall
occurs. A cystocele can also result from
the straining that occurs when a woman lifts something heavy, or during a bowel
During menopause a woman’s body stops making estrogen,
causing the muscles around her vagina and bladder to weaken. Estrogen replacement therapy can help a woman
keep the muscles/tissues surrounding her vagina strong.
How is a cystocele diagnosed?
There are a couple ways a doctor can diagnose a grade 2 or
grade 3 cystocele: by listening to the symptoms a patient is suffering from and
by physically examining the patient’s vagina. During the physical exam, the doctor will
actually be able to see the sagging bladder.
In addition, a test called a voiding cystourethrogram can
be used to determine the presence of a cystocele. During this test, an X-ray that shows the
shape of the bladder is taken while the woman is urinating. The X-ray allows the physician to identify any
problems that interfere with the normal urine flow. The doctor may then decide to order other
tests to determine if there are any other problems with the woman’s urinary
How is a cystocele treated?
There are a variety of ways to treat a cystocele ranging
from no treatment for a grade 1 cystocele to surgery for a severe, or grade 3,
cystocele. If a woman is not
particularly bothered by the cystocele, her physician may just tell her not to
do anything that could cause it to become worse like heavy lifting or
However, if the cystocele is causing some discomfort, the
doctor may suggest a pessary, a removable device inserted into the vagina to
support the bladder and keep it in place. In order to avoid infection or even ulcers,
the pessary must be removed on a regular basis.
A doctor may choose to recommend surgery on a severe
cystocele in order to move the bladder into a more normal position. A
gynecologist, urologist, or urogynecologist could perform the operation. During
the operation, the surgeon usually makes an incision in the vagina wall and
creates more support for the bladder by tightening the tissues that separate
the two organs.
This may be performed in an outpatient setting or with an
overnight hospital stay followed by a recovery period of four to six weeks.