What is Cystocele?

Cystocele is the most common type of pelvic organ prolapse
that occurs after vaginal childbirth. During a vaginal delivery,
the pelvic floor muscles can be compromised as they stretch to
make room for the baby to make its grand entrance into the world.
The pelvic floor muscles are designed to hold up the organs of
the pelvis. A severe enough breach in the system can cause a
prolapse.


When these muscles are compromised, the organs are able to drift
or “sag” down the path of least resistance until they bulge into
the vaginal canal. It is important to know that there are many
types of pelvic organ prolapse besides cystocele that
will not be discussed in this article, but are listed below for
educational purposes:


Urethrocele or prolapse of the urethra

Uterine prolapse

Vaginal vault prolapse

Enterocele or prolapse of the small bowel 

Rectocele prolapse of the rectum



What causes a Cystocele? 


Cystocele (cysto- meaning bladder, -cele meaning pouching or
herniating) is the downward displacement of the bladder that
descends until the bladder bulges into the vaginal wall. This is
sometimes referred to as “fallen bladder” or “prolapse of the
bladder.” Though it is possible that cystocele occurs because of
reasons outside of childbirth, such as genetic disposition,
increased age or obesity, it is most commonly seen in women who
have experienced a vaginal delivery.


How is a cystocele diagnosed? 


Methods of diagnosis depend on how much the prolapsed bladder has
advanced from its usual position. 


The pelvic exam is used for the obvious prolapsed bladder. The
provider may only need to do a visual exam of both the vaginal
opening and the pelvis to spot the bladder in late staged
prolapse (I’ll break down the stages for you momentarily).
Typically this presents as a pronounced bulge in the vaginal
canal or through the opening of the vagina. I strongly recommend
doing this exam from a standing position. 


A voiding cystourethrogram may be used in less obvious cystoceles
since the prolapsed bladder is not always visible In the vaginal
opening in earlier stages of descent. Essentially, an X-ray is
taken of the bladder while you urinate to capture the shape and
placement of the bladder and vagina during the effort. Your
provider will guide you through the preparation for this
procedure, but there are typically no special precautions needed.


What are the symptoms of Cystocele? 


Symptoms of a cystocele vary from mild, moderate or severe
depending on just how far that bladder has sagged from its usual
position. 


Typically the first tell tale sign is a feeling of bulging in
your vagina, heaviness, fullness, feeling of bubbles in your
vagina and a change in your urine frequency/incontinence after a
vaginal delivery that doesn’t improve over time. 


If it is more advanced you may be able to see the bulge formed by
the bladder prolapse in the canal or vaginal opening. Heavy
lifting, bearing down or straining during bowel movements
may increase the feeling of pressure in the pelvic floor. Some
women report feeling as if they are sitting on a ball.