| A cystocele (SIS-tuh-seal) occurs when the wall between a
woman's bladder and her vagina weakens and lets the bladder droop into the vagina. This
condition may cause discomfort and problems with emptying the bladder. In some women, a
fallen bladder stretches the opening into the urethra, causing urine leakage when the
woman coughs, sneezes, laughs, or does any action that puts pressure on the bladder. So a
bladder that has dropped from its normal position may cause two kinds of problems~unwanted
urine leakage and incomplete emptying of the bladder.
A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina.
A more severe (grade 2) cystocele means that the bladder has sunk into the vagina 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.
A cystocele may result from muscle straining while giving birth. Other kinds of
straining~such as heavy lifting or repeated straining during bowel movements~may also
cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina
strong. When women go through menopause (when they stop having periods), their bodies stop
making estrogen, so the muscles around the vagina and bladder may grow weak.
A doctor may be able to diagnose a grade 2 or grade 3 cystocele from a description of
symptoms and from physical examination of the vagina because the fallen part of the
bladder will be visible. A voiding cystourethrogram (sis-toe-yoo-REETH- roe-gram) is a
test that involves taking x-rays of the bladder during urination. This shows the doctor
the shape of the bladder and lets the doctor see any problems that might block the normal
flow of urine. Other x-rays and tests may be needed to find or rule out problems in other
parts of the urinary system.
Treatment options range from no treatment for a mild cystocele to surgery for a serious
cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy
lifting or straining that could cause the cystocele to worsen. If symptoms are moderately
bothersome, the doctor may recommend a pessary~a device placed in the vagina to hold the
bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to
find the most comfortable fit for the patient. Pessaries must be removed regularly to
avoid infection or ulcers.
Large cystoceles may require surgery to move the bladder back into a more normal
position and keep it there. This operation may be performed by a gynecologist, a
urologist, or a urogynecologist. The patient should be prepared to stay several days in
the hospital and expect to take 4 to 6 weeks for a full return to a normal life.
Estrogen replacement therapy (ERT) may be recommended for postmenopausal women. This
can help strengthen the muscles around the vagina and bladder. ERT may be used alone, with
a pessary, or before and after surgery. The patient should be informed about advantages
and possible risks of taking estrogen.
For more information, contact the following organizations:
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