Cystocele – Dealing With Prolapsed Pelvic Floor and Bladder
A little understanding about the different anatomical structures in the region would help.
What Is Cystocele ?
Cystocele is a cystic (fluid containing) swelling formed by the prolapse of a part of urinary bladder wall into the anterior vaginal wall.
The three viscera, the urinary bladder, vaginal tube and part of rectum are arranged one after the other in the pelvic region. Spaces between them are tightly packed by muscles and connective tissues. During activities in which undue pressure has been exerted by muscles of the pelvis, all muscles and connective tissues between them stretch and subsequently thin out. Such activities include- childbirth, lifting heavy weights, chronic constipation and chronic severe cough (as in bronchitis).
These stretched muscles with connective tissue between them do not come back fully to the normal (original) state. The padding between bladder and anterior vaginal wall; as well as that between posterior vaginal wall and underlying rectal wall is thinned out. In such situations, a portion of the bladder wall may protrude into the anterior vaginal wall, presenting as a swelling called cystocele. So cystocele is essentially a prolapsed bladder.
Similarly, when a part of rectal wall protrudes out of the posterior vaginal wall into the vaginal canal, it is called a rectocele.
Stress Incontinence and Other Symptoms
Depending upon the severity of the condition, one may observe either no symptom at all, or any of the following symptoms-
- Stress incontinence is a common symptom in these cases. Whenever you cough, lift something heavy or have physical stress in any form, urine leaks out.
- A feeling of heaviness in the groin on standing for long hours.
- In severe cases, a tennis ball like swelling protrudes out of the vagina opening, especially on straining or standing for long hours. The swelling goes back inside when you lie down.
- Leakage of urine during sexual intercourse.
- Recurrent bladder infections.
- After urinating, you may feel as if you have not urinated completely.
Diagnosis is made on examination of the patient. The patient is asked to sit in squatting position. The doctor looks for any protruding mass or bulge from the vaginal opening. The patient may further be asked to exert to assess the extent and hence the severity of prolapse.
The strength of pelvic muscles is also assessed. This is done as follows- The doctor puts his finger inside the vaginal opening and asks the patient to squeeze it as if trying to stop a stream of urine. The strength with which the patient is able to squeeze his finger, he assess the condition of her pelvic musculature.
Management
This depends on the severity of bladder prolapse and the associated symptoms.
In mild cases, with few symptoms, we tried to make the patient strengthen her pelvic floor muscles. This is very effective if done regularly and usually the only corrective step required to solve the problem.
Pelvic floor exercises are also called Kegel exercises. They are done as follows:
Lie down comfortably on your bed. Now tighten (contract) your pelvic floor muscles as if stopping to urinate. Maintain this position for five seconds, then relax. Repeat this 10-15 times.
Do these exercises at least thrice a day for better results. Also, some self care would be necessary:
- Avoid lifting heavy weights.
- Avoid having constipation. Have plenty of roughage to prevent it.
- Avoid standing for long hours. If possible, take little breaks while carrying out your daily works.
If the above techniques don’t work, vaginal pessaries may be used. A pessary is a removable device put inside the vaginal canal. It provides support to the pelvic organs, acts as a stent. It is inserted either by hands or with the help of an applicator. Take all precautions of hygiene while inserting it. Also assure that it is placed deep into the vaginal canal.
Surgical Repair of Cystocele (Prolapse Surgery)
Also called colporrhaphy. This is done in the following cases:
- The symptoms are too many , interfering with normal day activities.
- Pelvic floor muscles are not strong and there is little hope of their improvement.
- The patient is getting recurrent infections.
- Patient in menopausal with very lax pelvic floor and severe symptoms.
Complete assessment of the patient is made before going for surgery. The purpose of surgery is to keep all pelvic organs in their respective positions
Procedure:
Surgery is done vaginally. The procedure is also called sling operation. It involves lifting and placing back the prolapsed part of the bladder into its original position. The extra tissue is resected out. Muscles and ligaments of the pelvic floor are also tightened.
If there is any prolapsed uterus, removing the uterus (hysterectomy) is also done along.
Hi, I had a hysterectomy in 98 and haven’t been able to be with my husband since. Every time we try to have sex it is so painful at the opening of my vagina, he can’t enter. We have tried lubricants of all sorts and nothing works. He is not a very sexual person and neither am I, so we just let it go. But I would like to find out what the cause is. I’m wondering if it may be scar tissue from the surgery. Could you please advise what to do or how to overcome?
This is likely to be due to scar tissue.
How old are you and why was the hysterectomy done?
I was 57 when it was done, now 73. I had pain in my abdomen and some bleeding. When they operated they found that there was a polyp that had burst and was stuck to my bowel so they had to scrape is away. Every since then I can’t have intercourse because of the pain. Would I have to have operated on to get rid of the scar tissue?
Operating for the scar tissue won’t be easily. It may lead to further complications.
You may get yourself examined to know how big is the scar. Is it healed or not? What is its condition?
Are you having proper bowel movements? Let us know of any irregularity, diarrhea or constipation.
I have always had trouble with passing stool. I have been like that since I was in my early 20’s. Now 73. No blood and my hemmies don’t bother me. I have never had a child. I am barren.
Are you constipated?
I just recently had a C-section and since then I have shaved or had sex. Today I woke up with a lumpy feeling under my vagina skin. It hurts if I put any pressure on it. I don’t know what it could be.
You need to go for an internal examination to get yourself diagnosed.
From what you have written, it appears to be a cystocele.
When the pelvic floor muscles become weak due to exertion during labor, a part of the urinary viscera may protrude from inside it. This mass presents as a lump coming out from the vaginal opening.
The lump sags out more after standing for long hours. It is painful, also may give you an urge to urinate again and again.
Hi, I recently was scheduled for surgery for a cystocele, and had a urodynamic test done. When I stand or bear down the cystocele is very present, but during the urodynamic my doctor asked what it felt like and while I was lying down he said where is it? That’s has me worried that I am imagining this golf ball size thing in there. It only seems to be there when I bare down when laying down or I have to be standing up. BUT in feels like it’s falling out when I exercise, when jump rope or jumping jacks I leak. Am I imagining this? Now I’m freaked out that he doesn’t really believe me. I’m 58 and had three children last two were big babies. Thank you in advanced
Suzanne
You are likely to be having it. Cystocele present themselves when you lift weight or stand for sometime. They usually go inside to disappear when you lie down.
For smaller cystocele, you may try doing Kegel’s exercises at home. A vaginal pessary may be used for support.
I am 62 and had a hysterectomy with a bladder suspension when I was 36 for a grade 3 cystocele. I was an RN in PICU and did a considerable amount of lifting patients. 5 years later I had a Marshall marchetti done for the same reason. I continued to work there for about 20years. I have had on and off problems since I quit work. Had my left ovary removed in 2009 and the right ovary removed 6 months later in 2010. I had my gallbladder removed 3 years ago and during all this I still had stress incontinence. Now my cystocele had become more of a problem again. I am scheduled for a cysto. tomorrow and don’t know anymore. I have gained 40 lbs since my gallbladder surgery which I know doesn’t help. What should I do other than lose weight?
Not much can be done, you know, other than surgical interventions aiming at tightening your suspensory ligaments.
Losing weight and strengthening your pelvic musculature help. You may try Kegels exercises on a daily basis. A month or two of regular Kegels may show a difference.
Besides the above, I also have an autonomic nervous system disorder and autoimmune disease
My doctor diagnosed me with mild cystocele and small vaginal tube…my bladder is not emptying properly so I am getting the urge frequently.what is the cause of small or narrow vaginal tube? Is it linked with cystocele or it’s different? Plz explain
Number of kids? Your age?
I have been diagnosed with a cystocele today and awaiting referral. In the meantime is it OK to still play competitive tennis, Pickleball and Pilates. I’m a very active 68yr old and will be devastated if I have to stop these activities! I had a hysterectomy in the late 90s.
Start doing Kegels Exercises at the earliest. This would help you develop a good pelvic musculature and help managing the condition.
You may continue playing your games. Just avoid lifting heavy weights.
I’m 36 and have two children. I gave birth 2 months ago and have noticed a firm, oval shaped bulge coming out of my vagiva. It does not hurt, even when I press on it and I don’t have an urgency to urinate when I press on it. What could it be?
Likely to be a prolapsed part of your vaginal wall.
Start with Kegels exercises on a daily basis. This would help.