Bladder Prolapse (Cystocele)

Bladder Prolapse

Cystocele is a medical condition which results in the prolapse (protrusion) of the bladder into the vagina.

This can occur when the upper portion of the anterior vaginal wall droops down and protrudes out of the vaginal canal in some cases. Apart from this, the urethra may also collapse along with the lower 1/3rd of the anterior vaginal wall, which is then known as urethrocele. This condition results in stress incontinence.

What are the grades of Cystoceles?

Cystocele is classified into progressing grades according to the severity of the drooping vaginal wall, such as:

  • Grade 1 – mild – when the bladder droops only a short way into the vagina
  • Grade 2 – more severe – when the bladder has sunk into the vagina far enough to reach the opening of the vagina
  • Grade 3 – most advanced – when the bladder bulges out through the opening of the vagina

What are the symptoms of Cystoceles?

Symptoms of bladder prolapse/Cystoceles include:

  • Stress incontinence (inadvertent leakage of urine with physical activity)
  • Urinary frequency
  • Difficult urination
  • Vaginal bulge
  • Vaginal pressure/pain
  • Painful sexual intercourse and
  • Lower back pain.

Urinary incontinence is the most common symptom of a Cystocele.

How are Cystoceles treated?

Initially, the doctor may advise non-surgical treatment for treating Cystocele, such as:

Pessaries – These are prostheses inserted in the vagina to maintain reduction of the prolapsed structures. Pessaries are of varying shapes and sizes, and some are inflatable. These need monthly cleaning for better maintenance and safety from complications.

Kegel exercises – These involve isometric contractions of the pubococcygeus muscle. Contraction of the correct muscle is best initiated by asking patients to simulate attempting to hold in urine. Exercises can be facilitated by use of weighted vaginal cones, which help patients focus on contracting the correct muscle, by biofeedback devices, or by electrical stimulation, which causes the muscle to contract.

Surgical repair – Surgical procedure is useful for supporting structures (anterior and posterior colporrhaphy) and can help relieve symptoms that are severe or do not resolve with nonsurgical treatment. There are several surgical methods used for treatment of Cystoceles and the doctor will help to decide the best-suited in individual cases.