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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.
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