Cystocele - Fallen Bladder
A cystocele occurs when the wall between the bladder and vagina weakens and lets the bladder drop into the vagina. This condition may cause discomfort and problems with emptying the bladder (urination).
In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs sneezes, laughs or does any action that puts pressure on the bladder. When the bladder drops from its normal position, it may cause two kinds of problems – unwanted urine leakage and incomplete emptying of the bladder.
There are 3 “grades” of cystocele:
- Grade 1 (mild) – the bladder droops only a short way into the vagina
- Grade 2 (moderate) – the bladder has sunk into the vagina far enough to reach the opening of the vagina.
- Grade 3 (severe) – the bladder bulges out through the opening of the vagina.
A cystocele may result from muscle straining while giving birth. Other kinds of straining – such as heavy lifting or repeated straining during bowel movements – may also cause the bladder to fall.
Some cystoceles may be diagnosed from a description of symptoms and from a physical examination. Other x-rays and tests may be needed to find or rule out problems in other parts of the urinary system.
Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, avoiding heavy lifting or straining that may worsen the symptoms may be the only thing recommended.
If symptoms are moderately bothersome, a pessary may be inserted into the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the most comfortable fit for each individual. Pessaries must be removed regularly to avoid infection or ulcers.
Large cystoceles may require surgery to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynecologist, a urologist or a urogynecologist. Clinical advances in surgical technique are improving outcomes and recovery in the treatment for cytocele.