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A cystocele is also called a bladder or anterior prolapse, and it occurs only in women.

A cystocele is similar to a hernia involving the bladder and vagina. In the female genitourinary system, the bladder is located just anterior to the vagina and holds urine until it is released through the urethra. All of these structures are well contained and held in place by tissues, ligaments, and pelvic floor muscles.

A cystocele occurs when the bladder loses its tight shape and protrudes into the vagina.

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Causes

The primary cause for a cystocele is a weakening of the pelvic muscles which can occur as a result of multiple vaginal deliveries or obesity. Other causes include repeatedly lifting heavy objects, a history of constipation with straining during bowel movements, and respiratory conditions causing intense bouts of coughing. A previous hysterectomy, menopause, or family history of cystoceles are other risk factors.

Symptoms

Symptoms of bladder prolapse range from mild to severe and, without intervention, get worse with time. Some of the earliest symptoms are very mild and might go unnoticed. These include a fullness in the vagina and feeling like the bladder has not emptied completely after urination. As the condition progresses, women can experience stress urinary incontinence or leaking during intercourse as well as frequent bladder infections. In the most severe cases, the bladder falls and pushes a large bulge of tissue into the vagina which can feel like sitting on a ball.

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Diagnosis

When patients first complain about these symptoms, a physician will perform a pelvic exam with the patient both lying down and standing. Patients also usually complete a questionnaire so that the physician can gauge the degree to which the symptoms are limiting lifestyle. Urine is also tested for bacteria and other signs of infection. Finally, sometimes urologists will perform bladder tests to determine how efficiently the bladder drains as well as how much residual remains after urination.

Treatment

After making a diagnosis, the physician will discuss cystocele treatment options with the patient. In mild cases, a period of observation might be recommended. During this time, the patient might undergo physical therapy to learn techniques for strengthening the pelvic floor, and other risk factors might be mitigated through losing weight and taking supplements to avoid constipation. If the cystocele does not worsen, the patient needs no further treatment.

Treatment Options

For more severe cases, there are two main options. The first is a noninvasive approach which involves fitting the patient for a pessary. This is essentially a ring that fits into the vagina to provide extra support and hold the bladder in place. Estrogen supplementation may also be added. The other option is more invasive and consists of a surgical repair of the cystocele. This is done vaginally, using sutures to support the muscles and tissue that hold the bladder in place. This procedure can also be combined with related operations like a hysterectomy or repair of uterine prolapse. While surgery does quite often yield good results, early detection is preferential as it allows for less invasive treatment options.

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Judy Choi, M.D.
Female Urology
Assistant Professor of Clinical Urology
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Gamal Ghoniem, M.D., FACS
Female Urology
Professor of Clinical Urology and Vice Chairman

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