What is bladder prolapse (cystocele)?

A cystocele is a type of pelvic organ prolapse. It 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. A cystocele can happen when the muscles and tissues that hold your bladder in place get weak or damaged.

It often doesn't cause serious health problems. But it can be uncomfortable or painful. It can be treated if it bothers you.

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 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.

Treatment for a cystocele depends on how bad your symptoms are. Sometimes treatment isn't needed. But if your symptoms bother you, you may want to think about treatment.

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.

Kegel exercises, which strengthen the pelvic floor muscles, may help relieve some symptoms.

Surgery may also be an option. But you may want to wait to have surgery if you plan to get pregnant in the future. Childbirth could cause your prolapse to come back.

• 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.