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Cystocele is a condition that occurs when the muscles and tissues between the vagina and bladder stretch or weaken, allowing the bladder to protrude into the vagina.

It’s also known as a:

  • bladder prolapse
  • anterior prolapse
  • prolapsed bladder
  • dropped bladder
  • fallen bladder

Cystocele is caused by an increase in pressure in the pelvic region.

Most people with cystocele don’t have any symptoms. If symptoms do occur, they may include a frequent or urgent need to urinate, a vaginal bulge, and a feeling like is something falling out of the vagina.

Read on for more information about cystocele.

The bladder is an organ that holds urine before it’s released from the body. The vagina is a muscular canal that connects the uterus and cervix to the outside of the body. The wall of the vagina contains layers of tissue with many elastic fibers.

The pelvic floor muscles surrounding the vagina contain a hammock of muscles that usually helps support the vaginal wall and hold the bladder in place. With a cystocele, these muscles and ligaments stretch or weaken, causing the bladder to move out of place and push into the vagina. When an organ moves out of its normal position, it’s called a prolapse.

There are many reasons why your pelvic floor muscles can weaken. The most common reason is childbirth, especially if it’s a complicated or difficult delivery.

Other causes of cystocele include:

Cystocele is the most common type of pelvic organ prolapse.

Healthcare professionals may rank the severity of cystocele using a grading system known as the Baden–Walker Halfway Scoring System:

  • Grade 0. There is no cystocele; the bladder is in its proper position.
  • Grade 1. The mildest form of the condition, grade 1 cystocele occurs when the bladder drops halfway to the hymen (the thin tissue that’s located at the opening of your vagina).
  • Grade 2. Considered moderate, this stage happens when the bladder drops to the level of the hymen.
  • Grade 3. This stage is when the bladder drops halfway below the hymen.
  • Grade 4. The most severe or advanced form of cystocele, this stage is when most of the bladder has dropped below the hymen and out of the vagina.

Other healthcare professionals may choose to use a more modern staging system called the Pelvic Organ Prolapse Quantification (POP-Q) system. The stages of the POP-Q system include:

  • Stage 0. There is no proplase.
  • Stage I. The furthest point of the prolapse is more than 1 centimeter (cm) above the level of the hymen.
  • Stage II. The furthest point of the prolapse is between 1 cm above the hymen and 1 cm below the hymen.
  • Stage III. The prolapse is more than 1 cm beyond the plane of the hymen, but it isn’t completely bulging through the opening of the vagina.
  • Stage IV. The prolapse is completely bulging through the opening of the vagina.

Most people with cystocele don’t experience any symptoms. If you do have symptoms, they may include:

  • pressure or fullness in the pelvic region
  • difficulty in starting to urinate
  • a feeling like there’s something falling out of the vagina
  • frequent urinary tract infections (UTIs)
  • difficult bowel movements
  • a bulge near the opening of the vagina
  • leaking urine (urinary incontinence)
  • frequent urge to urinate

A doctor can diagnose cystocele with a pelvic exam. A doctor will also ask you about your medical history. During the pelvic exam, your doctor may take measurements to determine the extent of the prolapse.

A doctor may also want to run additional tests and imaging studies to check the pelvic floor and the bladder. These may include:

Most of the time, a cystocele doesn’t cause any symptoms. In this case, a doctor will likely monitor the cystocele to make sure it doesn’t get any worse.

Conventional treatment options

A doctor may recommend you strengthen your pelvic floor with pelvic muscle exercises, also known as Kegel exercises. You can do these exercises at home. Kegel exercises focus on tightening and holding the muscles that control urine flow.

If a cystocele causes bothersome symptoms, your doctor may recommend you insert a device known as a pessary.

A pessary is a prosthetic device that can be inserted into the vagina to provide structural support. You’ll need to see a doctor, usually a gynecologist, for an initial fitting. The doctor will also train you on how to insert and clean the pessary at home.

Once fitted, you can remove a pessary to wash it with soap and water as needed. You can then reinsert the pessary on your own. You’ll need to see a doctor for an examination every 3 to 6 months to check for any ulcers. Other side effects from a pessary include:

  • vaginal irritation
  • foul-smelling discharge
  • more frequent UTIs

Surgery

For severe cases, surgery may be needed to move the bladder back into place. This type of surgery is called anterior colporrhaphy.

During the surgery, a doctor will sew the muscles and tissue back into place or use a mesh-type material to strengthen the tissue. Risks include:

  • infection
  • inability to pass urine
  • painful sex
  • injury to the bladder

You may need to stay in the hospital for 1 or 2 days following the surgery. You should avoid lifting heavy objects, having sex, or doing heavy physical activity for 6 weeks after surgery.

The number one risk factor for cystocele is vaginal childbirth. This is especially true for people who have given birth more than once or had a long or difficult childbirth.

Other risk factors include conditions that repeatedly strain or increase pressure in the pelvic area, such as:

Cystocele is usually not serious or life threatening, but it can have a negative impact on your quality of life. Pessaries or surgery can help, but they may not relieve all of your symptoms.

Research suggests that pessary insertion may be a successful treatment option. One study found that three-quarters of patients still found pessary treatment effective at a 5-year follow-up.

Success rates for surgery are between 63 and 77 percent, depending on the method used. However, there’s a chance that the prolapse can return or the bladder can prolapse through a different part of the vaginal wall. Research has found that about 40 percent of people require a repeat surgery.

Cystocele is a common condition affecting people assigned female at birth, especially those who have had a vaginal childbirth. Most cases don’t cause symptoms. However, if you’re experiencing symptoms such as pressure or fullness in the pelvic region and a bulge near the opening of the vagina, discuss these symptoms with a doctor.

A doctor may recommend inserting a pessary device to help support the structures of your pelvic floor. Cystocele can often be managed without surgery, but more advanced cases may require surgery to put the bladder back in place.