Cystocele: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Anterior vaginal prolapse can occur when the bladder shifts in the pelvis and presses against the vaginal wall. It is sometimes referred to as a cystocele or a prolapsed bladder.

Usually supported by the muscles and connective tissues of the pelvic floor, the bladder, uterus, and intestines are the pelvic organs held in place. The pelvic floor becomes weaker or experiences extreme pressure, which leads to anterior prolapse. This can occur gradually, in conjunction with hard lifting, prolonged constipation, vigorous coughing, or all at once with a vaginal birth.

One can treat anterior prolapse. In most cases, a mild or moderate prolapse can be successfully treated without surgery. In more severe situations, surgery can be required to protect the vagina and other pelvic organs in their proper positions.

Causes Of Cystocele

Your pelvic floor is made up of the muscles, ligaments, and connective tissues that support your bladder and other pelvic organs. The ligaments and organs in your pelvis may weaken over time due to continuous straining or injuries sustained during childbirth. The disease known as anterior prolapse occurs when your bladder falls into your vagina more often than usual.

A few factors that may put undue strain on the pelvic floor include:

• Pregnancy and delivery via the vagina
• Being overweight
• Performing repetitive heavy lifting
• Having trouble urinating
• Having bronchitis
• Having a chronic cough

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Symptoms Of Cystocele

If your anterior prolapse is mild, you may not experience any symptoms or warning signs. When symptoms do manifest, they may include any of the following:

• A feeling of pressure or fullness in the pelvis.
• There may occasionally be a tissue protrusion in your vagina that you can feel or see.
• Increased pelvic pressure when straining, coughing, lifting, and bearing down
• Urinary problems include difficulty starting a urine stream, the feeling that your bladder is still partially full after urinating, frequent urges to urinate, or leaks of urine (urinary incontinence). Signs and symptoms are often more noticeable after prolonged standing and may go away when you lie down.

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Risk Factors Of Cystocele

Some factors that may increase your risk of anterior prolapse are as follows:

• Pregnancy and delivery: Numerous pregnancies, vaginal deliveries, instrument-assisted deliveries, and high birth weight kids are associated with a higher incidence of anterior prolapse in women.
• Getting older: Proximal prolapse is more common in older adults. Your body generates less estrogen after menopause, which keeps your pelvic floor strong. This is especially true.
• Hysterectomy: You may not always experience a weakening of your pelvic floor following uterine excision.
• Inherited traits: Because of their inferior connective fibers at birth, some women are more likely to experience anterior prolapse.
• Having a weight gain: The likelihood of anterior prolapse is higher in obese or overweight women.

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Diagnosis Of Cystocele

Possible diagnoses for anterior prolapse include:

• An examination of the pelvis: For the examination, one may choose to stand or lie down. Your doctor examines you to check for pelvic organ prolapse, which is indicated by a bulge of tissue in your vagina. You may be asked to bear down as though having a bowel movement to measure the impact on the degree of prolapse. You will be asked to contract your pelvic floor muscles as though you are trying to stop a stream of urine to measure the strength of these muscles.
• Completing an online survey: You can complete a form that will assist your healthcare professional in determining your medical background, the extent of your prolapse, and the impact it has on your quality of life. Treatment decisions are also guided by this knowledge.
• Tests on the urine and bladder: You may be checked to see how fully and effectively your bladder empties if you have a major prolapse. If you seem to be holding more pee in your bladder after urinating than is typical, your doctor may also do a test on a urine sample to check for indications of a bladder infection.

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Treatment Of Cystocele

The course of treatment is determined by your level of symptoms, the severity of your anterior prolapse, and the existence of any concomitant disorders, such as several types of pelvic organ prolapse or urinary incontinence.

Usually, mild cases with few or no noticeable symptoms don't need medical attention. Your doctor might advise waiting it out and making sporadic trips to check on your prolapse.

If anterior prolapse symptoms are present in you, the following first-line treatments are available:

• Pelvic floor muscle exercises: These exercises, often known as Kegels or exercises, strengthen the muscles in your pelvic floor, enabling them to support your bladder and other pelvic organs more effectively. You can learn how to perform these exercises from your healthcare physician or a physical therapist, who can also assist you in determining whether you're doing them correctly.
• Kegel Exercises: The best Kegel exercises for symptom reduction might be those that are taught by PTs and reinforced with biofeedback. Biofeedback is the process of using monitoring instruments to ensure that you're contracting the proper muscles for the right length of time and intensity. These exercises could improve your mood even though the prolapse's size might not decrease.
• A pessary, or assistance device: A vaginal pessary is a rubber or plastic ring that is inserted inside your vagina to support your bladder. A pessary can assist in controlling symptoms, but it cannot cure or treat a prolapse. It can only provide additional support. Your doctor or other healthcare provider fits you for the device and shows you how to clean and replace it correctly.

In instances where surgery is too hazardous, many women turn to pessaries as a temporary remedy.

Surgery may be necessary to fix the prolapse if the previous treatment options fail to reduce your noticeable and annoying symptoms.

Often, the operation is performed vaginally, with the prolapsed bladder being raised back into place with stitches after any excess vaginal tissue is removed. In cases when your vaginal tissues seem abnormally thin, your physician might restore and strengthen your vaginal tissues using a special type of tissue graft.

Uterus prolapse. In cases where your anterior prolapse is associated with a prolapsed uterus, your doctor may recommend a hysterectomy in addition to treating the injured pelvic floor muscles, ligaments, and other tissues.

If you are incontinent. If you have stress incontinence along with your anterior prolapse, your doctor may recommend one of many therapies to support the urethra (urethral suspension) and relieve your symptoms.

If you are pregnant or considering becoming pregnant, you may need to wait until after you have finished having children before having surgery. Pelvic floor exercises or a pessary can help reduce your symptoms in the meantime. While the benefits of surgery can last for many years, prolapse may eventually reoccur and necessitate another surgery.

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