What is bladder prolapse (cystocele)?

Cystocele (bladder prolapse) occurs when the bladder moves from its normal position and presses against the front wall of the vagina. This is also called anterior vaginal wall prolapse.

Cystocele can happen when the muscles and tissues that hold the bladder in place are weak or damaged. This can be caused by pregnancy and childbirth, being overweight, or frequent constipation. Or the muscles and tissues may get weaker as you age.

A cystocele usually does not cause serious health problems. But it can be painful or uncomfortable. You may find relief by making lifestyle changes and doing exercises to make the pelvic muscles stronger. Or your doctor may suggest a pessary to help with symptoms. Surgery may also be an option.

Sometimes a cystocele doesn't cause symptoms. But when symptoms appear, they may include:

• Feeling pressure and discomfort from your bladder pressing against the vaginal wall. This is the most common symptom.
• Leaking urine (incontinence), especially during coughing, laughing, or jumping.
• Having problems emptying your bladder. This may lead to a bladder infection (cystitis).
• Feeling like something is falling out of your vagina.
• Having pain during intercourse.

Symptoms are worse when you stand, jump, or lift. They usually are relieved if you lie down.

A cystocele that doesn't cause symptoms may not need treatment. But if you have symptoms that bother you, you may want to think about treatment. Which treatment is best for you depends on how bad your symptoms are. And it depends on if you have other health problems. Other important factors are your age and sexual activity.

To treat a cystocele, your doctor may fit you with a pessary. This is a device that is placed into the vagina. It is removable—you can take it out and put it back in. It supports the area where the bladder presses down.

Exercises to strengthen the pelvic floor muscles may help relieve some symptoms of a cystocele. These are called Kegel exercises.

Surgery may be an option if your symptoms don't get better with other treatments. You may also choose surgery if you prefer it over other options. But if you are thinking about getting pregnant in the future, you may want to wait to have surgery. If you have surgery and then give birth through the vagina, the strain on your pelvic muscles may cause your bladder to prolapse again.

A cystocele can be hard to diagnose. If it doesn't cause symptoms, it may be found during a routine exam. You may be aware that there's a problem. But you might not be quite sure where it is or what is causing it. If your doctor thinks you may have a cystocele, your doctor will ask you questions about your past and current health. This includes questions about your history of childbirth. Your doctor will also do a physical exam. This includes doing a pelvic exam. And it sometimes includes a rectal exam.

Your doctor may order tests, especially if the cystocele is causing urinary problems. The tests may include urodynamic tests or imaging tests, such as an ultrasound or MRI.

• Do not lift heavy objects or do anything that puts pressure on your pelvic muscles.
• Try pelvic floor (Kegel) exercises. These tighten and strengthen pelvic muscles. (If doing these exercises causes pain, stop doing them and talk with your doctor.)
  • Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
  • Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
  • Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
  • Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
• Lie down and put a pillow under your knees. This eases pressure on your vagina. You also can lie on your side and bring your knees up to your chest.
• Ask your doctor about a vaginal pessary. You can place this in your vagina. It supports the bladder. Your doctor can teach you how and when to remove, clean, and reinsert it.
• If your doctor prescribes vaginal estrogen cream, use it exactly as prescribed.

Some things increase the chance that you will have a cystocele. These things include:

• Childbirth. The more times you give birth, the higher your chance of having a cystocele. That's because during childbirth, the muscles, ligaments, and tissues that keep your bladder and other pelvic organs in place can get stretched. If they don't recover, they can't support your bladder.
• Age. It's more likely to happen as you get older.
• Being very overweight.
• Connective tissue disorders, such as Ehlers-Danlos syndrome.
• Menopause. Lower levels of the hormone estrogen in the body during and after menopause mean you have less collagen. Collagen is a protein. It helps the tissues in the pelvis stretch and return to their normal positions.
• Frequent constipation.

In rare cases, a cystocele may be present at birth (congenital).

A cystocele occurs when the muscles and tissues that hold the bladder in place get weak or damaged. This allows the bladder to move and press against the front wall of the vagina. A cystocele is most often linked to pregnancy and childbirth. Other causes can include aging, menopause, being overweight, or frequent constipation.