Cystocele

Cystocele

Alternate Names

  • dropped bladder
  • fallen bladder
  • Female pelvic organs

Definition

Cystocele is a condition in which part of the bladder drops down, or protrudes, into the wall of the vagina.

What is going on in the body?

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.

Risks

What are the causes and risks of the disease?

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 childbirth
  • obesity. 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 bladder
  • repeated 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

Prevention

What can be done to prevent the disease?

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.

Diagnosed

How is the disease diagnosed?

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 cervix
  • if 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 incontinence
  • voiding 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 bacteria
  • blood tests, including a complete blood count, or CBC, to check for infection
  • other X-rays, scans, or tests to rule out other causes of the symptoms

Long Term Effects

What are the long-term effects of the disease?

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.

Other Risks

What are the risks to others?

A cystocele is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

Treatment of a cystocele is aimed at reducing symptoms. These measures may help:
  • avoiding straining during bowel movements or heavy lifting
  • doing Kegel's exercises to strengthen the muscles supporting the bladder and vagina
  • using a pessary, which is a device fitted into the vagina to hold the bladder in place
  • taking 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

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the disease?

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.

Monitor

How is the disease monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Sources

http://www.niddk.nih.gov/health/urolog/summary/cystocel/index.htm. Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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