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Prolapse | Bladder (Cystocele)

From the Pelvic Floor Articles List

Bladder prolapse - what is a cystocele?I think my bladder is prolapsing. What testing do I need and what are my treatment options?


When the muscles and tissues supporting the bladder weaken or stretch, the bladder may fall from its normal position. This can cause it to press against the vaginal wall and even protrude into the vagina. A prolapsed bladder is known as a cystocele. There are several risks factors for a prolapsed bladder along with a variety of treatment options.

The supporting structures for the bladder can be compromised in many ways. These can include being pregnant and/or giving birth, being overweight, lifting heavy objects, straining, having a chronic cough, having inadequate estrogen, and/or having a genetic history of prolapse. If there is an underlying reason for your prolapsed bladder (such as low estrogen or constipation), it needs to be addressed along with the prolapse.

There are four grades of bladder prolapse:
  • Grade 1/Mild: The bladder only falls slightly, so there may be no symptoms.
  • Grade 2/Moderate: The bladder falls into the opening of the vagina, so symptoms are likely.
  • Grade 3/Severe: The bladder protrudes through the vagina causing symptoms to increase. Women tend to experience pain and discomfort.
  • Grade 4/Complete: The bladder falls outside the vagina worsening symptoms. At this stage women often experience other pelvic organ prolapses as well.

Women with bladder prolapse may experience pelvic pain or discomfort, lower back pain, and pain with intercourse. Urination issues can include incomplete voiding, difficulty urinating, and multiple bladder infections. Additionally, women with a cystocele may endure some embarrassing symptoms such as leaking urine when sneezing, coughing, or laughing. Finally, women may find they have a bulge in the vagina. Those with a mild cystocele may not have any noticeable symptoms, while those with a complete prolapse may experience multiple symptoms.

Your doctor may perform a variety of tests to help determine if you have a cystocele. For a moderate or complete prolapse, a pelvic exam conducted both lying down and standing may be enough for diagnosis. For less severe cases, other testing may be needed:
  • Voiding Cystourethrogram: A series of X-rays taken during voiding.
  • Urodynamics: This test measures the volume and pressure relationships in the bladder. This test is sometimes referred to as an EKG of the bladder.
  • Cystoscopy: A scope is used to look inside the bladder.

Cystocele treatment options can depend on the grade of prolapse and symptoms. There are both surgical and non-surgical choices, but either way, you should avoid heavy lifting and straining to promote a successful treatment outcome.

Non-surgical:
  • For early prolapse, a pessary may be effective. It is placed inside the vagina to hold the bladder in place.
  • Vaginal estrogen may also be prescribed with a pessary, or another form of estrogen may be prescribed separately.
  • Exercises and physical therapy may be helpful to strengthen the pelvic floor. Your doctor may suggest Kegel exercises and may recommend using biofeedback to determine if other exercises would be beneficial.
  • Electrical stimulation may strengthen and activate the pelvic floor muscles.

Surgical options:
  • Mesh or tissue grafting may be used to strengthen the vaginal wall.
  • Stitches may be placed to re-anchor the bladder.
  • A bladder sling could be used to pull the bladder back into place.
  • If the uterus has also prolapsed, a hysterectomy along with repairs to the pelvic floor may be necessary.

While a gynecologist or urologist may be able to help, the HysterSisters recommend finding a knowledgeable urogynecologist. These types of physicians specialize in both the gynecological and urological systems and thus may be able to offer the most appropriate treatment. As always, not all options are right for each woman, so weigh your own pros and cons carefully. Additionally, the HysterSisters advocate a second opinion before making any major decisions or scheduling a surgery.


This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

06-10-2013 - 11:52 AM


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