A cystocele (SIS-to-seel) occurs when the supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. A cystocele is also called a prolapsed bladder.
In mild cases of cystocele, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:
- A feeling of fullness or pressure in your pelvis and vagina — especially when standing for long periods of time
- Increased discomfort when you strain, cough, bear down or lift
- A bulge of tissue that, in severe cases, protrudes through your vaginal opening and may feel like sitting on an egg — often going away when you lie down
- A feeling that you haven’t completely emptied your bladder after urinating
- Repeated bladder infections
- Pain or urinary leakage during sexual intercourse
- Treatments and drugs
Treatment depends on how severe your cystocele is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (prolapsed uterus). Mild cases — those with few or no obvious symptoms — typically don’t require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles.
If self-care measures aren’t effective, your doctor may recommend these options:
- Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
- Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — if you’ve already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.
When surgery is necessary:
If you have noticeable, uncomfortable symptoms, the cystocele may require surgery. How it’s done. Often, the surgery is performed vaginally and involves lifting your prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of your pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.
A posterior prolapse occurs when the thin wall of fibrous tissue (fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is also called a rectocele (REK-toe-seel) because typically, though not always, it’s the front wall of the rectum that bulges into the vagina.
A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:
- A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening
- Difficulty having a bowel movement with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement (“splinting”)
- Sensation of rectal pressure or fullness
- A feeling that the rectum has not completely emptied after a bowel movement
- Sexual concerns, such as feeling embarrassed or sensing looseness in the tone of your vaginal tissue
- Upright posture- The upright weight placed on a woman’s pelvic floor is the main reason women experience posterior prolapse.
- Increased pelvic floor pressure:- Chronic constipation or straining with bowel movements,Chronic cough or bronchitis,Repeated heavy lifting,Being overweight or obese
- Pregnancy and childbirth
- Surgery. If the posterior prolapse protrudes outside your vagina and is especially bothersome, you may opt for surgery. Surgery to repair posterior prolapse will repair the tissue bulge, but it won’t fix impaired bowel function.