Cystocele is a condition in which part of the bladder drops down, or protrudes, into the wall of the vagina.
The bladder is the holding place for urine. It lies just above the vagina in a female. Between the bladder and vagina is a wall made of tissues and muscles that support the bladder and the urethra. The urethra is a tube that carries urine from the bladder to the outside of the body.
When a woman has a cystocele, the wall supporting the bladder is weaker than usual. This weakening allows part of the bladder to protrude or drop down into the vagina. As the bladder droops into the vagina, the urethra becomes stretched, possibly allowing urine to leak out of the urethra.
The most common symptoms of cystocele are: difficulty emptying the bladder during urinationpelvic pressurestress incontinence, a condition that causes leakage of urine when pressure is put on the bladder by coughing, sneezing, or laughing
Other symptoms may include: pelvic painabdominal distressfrequent urinationfeeling an urgency to urinatefeeling of a bulging in the vagina
A cystocele results from a weakening or stretching of the tissues supporting the bladder. The causes of this weakening include: previous vaginal deliveries causing the muscles and tissues to be stretched during childbirthobesity. However, a woman inherits her fascial support of the pelvis, so occasionally a woman will have weakness of the vaginal tissues in spite of not being overweight or having a vaginal delivery heavy lifting that causes stress on the muscles surrounding the vagina and bladderrepeated straining during bowel movements, which can be caused by frequent constipation menopause. Estrogen helps keep the muscles around the bladder and vagina strong. During menopause, estrogen levels decrease.normal aging, which can cause the muscles to become weaker
A cystocele may not be preventable. Using caution when doing heavy lifting may decrease the risk.
Kegel exercises may strengthen the wall supporting the vagina and bladder.
A rubber or soft plastic device called a pessary may help keep a cystocele from becoming worse. This is a device that can be put into the vagina to hold the bladder in place.
Staying active and eating a healthy diet with fiber, fruits, and vegetables may decrease constipation that can aggravate a cystocele.
Diagnosis begins with a complete history and physical, including a pelvic exam.
Other tests may include: ultrasound, which uses sound waves to show the uterus, bladder, and cervixif incontinence is present, urodynamic testing can be done to determine the bladder and urethral pressures and decide if the incontinence is stress incontinence or urge incontinencevoiding cystourethrography (VCU), a test in which X-rays of the bladder are taken while the person urinates. This test allows the healthcare provider to see the shape of the bladder. It can also reveal any other reasons why the flow of urine is blocked.urinalysis and urine culture, in which the urine is analyzed and examined for bacteriablood tests, including a complete blood count, or CBC, to check for infectionother X-rays, scans, or tests to rule out other causes of the symptoms
Long-term effects of a cystocele depend on the severity of the condition. A cystocele may lead to frequent urinary tract infections. Embarrassment about leaking urine can cause stress. Other long-term effects depend on the success of treatment.
A cystocele is not contagious and poses no risk to others.
Treatment of a cystocele is aimed at reducing symptoms. These measures may help: avoiding straining during bowel movements or heavy liftingdoing Kegel's exercises to strengthen the muscles supporting the bladder and vaginausing a pessary, which is a device fitted into the vagina to hold the bladder in placetaking hormone therapy, or HT, for postmenopausal women
Surgery may be needed for severe or persistent symptoms, or for a progressive cystocele. The goal of the surgery is to move the bladder back into its normal position and hold it there. This may be done by reapproximating the supporting fascia or by interposing mesh into the area for support
Side effects that can occur with hormone replacement therapy include vaginal bleeding, breast tenderness, weight gain, abdominal bloating, and headaches. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.
Treatment outcomes vary with the methods used to manage the cystocele. For example, the treatment of mild symptoms might include long-term activity restrictions, such as the avoidance of straining and heavy lifting. A pessary must be removed regularly to avoid infection or irritation of the lining of the vagina. Recovery from surgery may take a few days to several weeks, depending on the procedure used.
Any new or worsening symptoms should be reported to the healthcare provider.
http://www.niddk.nih.gov/health/urolog/summary/cystocel/index.htm. Harrison's Principles of Internal Medicine, 1998, Fauci et al.
