Cystocele - Symptom, Causes, Treatment of Cystocele

What is Cystocele

A cystocele can occur by itself, or it may happen along with other abnormalities such as a rectocele (when the rectum protrudes into the vagina). A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.

The size of the cystocele ranges from a small bulge that can be felt through the upper front wall of the vagina to a swelling that protrudes through the vaginal outlet. If the bladder sags below the urethra, it seldom empties completely.

The following factors may increase your risk of experiencing a cystocele:

• Childbirth. Women who have vaginally delivered multiple children have a higher risk of having prolapse.
• Aging. Your risk of experiencing prolapse increases as you age because you naturally lose muscle and nerve function as you grow older, causing muscles to become stretched or weakened. This is especially true after menopause, when estrogen — which helps keep pelvic muscles strong — decreases.
• Having a hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor.
• Genetics. Some women are born with weaker connective tissues in their pelvic areas, making them naturally more susceptible to a cystocele.

Causes of Cystocele

A cystocele can form after the muscles and connective tissues of the pelvic floor and vaginal wall have been weakened or abnormally stretched, either as a result of pregnancy and delivery and/or conditions that increase pressure with in the abdomen, such as persistent cughing, constipation and. obesity. The pelvic supports weaken with age and reduced oestrogen producion, so that many women with cystocele orectocele find that symptoms will begin, or are aggravated, after the menopause. Some of the events that may cause or contribute to the development of a cystocele include:

• Vaginal childbirth
• Repeated heavy lifting
• Habitually straining to pass bowel motions
• The drop in oestrogen levels that occurs at menopause.

Symptom of Cystocele

Minor degrees of cystocele may cause no symptoms. The symptoms of more serious prolapses include difficulty in starting and stopping urination, urinary frequency, feeling that the bladder needs mptying again soon after you have been to the toilet, and problems with bladder control particularly stress incontinence. Recurrent urinary infections can complicate cystocele if the bladder never empties properly. The symptoms of cystocele depend on individual factors such as the severity of the condition, but can include:

• Stress incontinence, which means that urine leaks when coughing, sneezing or laughing.
• Inability to completely empty the bladder after going to the toilet.
• Recurring urinary tract infections (UTIs).
• Urination problems, such as straining to get urine flow started or an unusually slow flow of urine that tends to stop and start.
• A sensation of fullness or pressure inside the vagina.
• A bulging mass felt on the front wall of the vagina.
• In severe cases, the vagina and the bladder protrude out of the vaginal entrance.

Treatment of Cystocele

Mild and moderate degrees of cystocele are often greatly helped by exercises and physiotherapy to strengthen the pelvic floor, and a strong ring pessary worn in the vagina may lift the bladder enough to prevent symptoms. Treatment for cystocele depends on the severity of the condition, but can include:

• Mild cases - when there are no symptoms, treatment may be unnecessary. Regular monitoring is needed to make sure the cystocele doesn't worsen. The doctor may advise a few lifestyle changes to prevent the condition getting worse, including doing pelvic floor exercises to strengthen the pelvic floor muscles.
• Moderate cases - a pessary is a small ring-like device that's inserted high in the vagina. This helps to keep the bladder in place. Health risks of long-term pessary use include infection and ulceration.
• Severe cases - surgery is usually necessary to repair a severe cystocele.

Prevention Tips

• Don't lift heavy objects.
• Increase the amount of fibre in your diet to prevent constipation and straining.
• Drink between six and eight glasses of water each day. Not drinking enough water makes stools hard, dry and difficult to pass.
• Exercise daily to help keep you regular.
• Use stool softeners, which may help in the short term.
• Avoid straining on the toilet.
• Perform pelvic floor exercises daily to strengthen the muscles supporting the pelvic organs. You may need instruction from your doctor or other health care professional, such as a pelvic floor rehabilitation physiotherapist.
• If you are postmenopausal, your doctor may recommend hormone therapy, usually in the form of local oestrogen preparations such as a cream or a vaginal tablet, to help tone the muscles supporting the vagina and bladder.
• Seek medical advice for any condition that causes coughing and sneezing, such as asthma, chest infections and hay fever.

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