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Cystocele (Fallen Bladder)

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 movement.

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 system.

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 straining.

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.



     
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OSCAR A. AGUIRRE, MD, FACOG

Dr. Aguirre
Dr. Aguirre is the Director of Aguirre Specialty Care, The Center for Female Pelvic Medicine. Dr. Aguirre is also a member of the Laser Vaginal Rejuvenation Institute of America.
The Laser Vaginal Rejuvenation Institute of America is founded and directed by Dr. David L. Matlock.

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