Cystocele

What is a cystocele?

A cystocele (SIS-to-sel) is a condition where a part of the bladder bulges out or protrudes into the vagina. The bladder is the organ at the lower part of the abdomen (stomach) where urine is stored. In women, the bladder lies just in front of the vagina. A tough, fiber-like tissue, called the vaginal wall, separates the bladder from the vagina.

What causes a cystocele?

A cystocele is commonly caused by weakness of the muscles and ligaments (bands of tissue) that hold and support the bladder. This may be due to the following:

• Pregnancy or childbirth: The pressure in your abdomen increases during pregnancy, especially if you are carrying a large baby. This may stretch and weaken muscles. Multiple pregnancies may also stretch and weaken the muscles around your vagina. Birth trauma or tears of the vagina during delivery may cause weak muscles. This trauma may caused by direct pressure from the child's head or because forceps were used.
  
  
• Aging: Aging can cause muscles to become weak. After menopause, a woman's body makes much less estrogen, which helps keep pelvic muscles strong.
  
  
• Collagen diseases: Diseases, such as Marfan's syndrome and Ehlers-Danlos syndrome, affect proteins that support muscle tissues in the body. This makes the muscles around your vagina weak and makes you more likely to develop a cystocele.
  
  
• Obesity: Weighing more than what is suggested by your caregiver may increase your risk of having a cystocele.
  
  
• Straining: The pressure inside your abdomen increases when you strain. This usually happens with constipation (dry, hard stools), severe coughing, or when lifting heavy objects.
  
  
• Surgery: Previous pelvic surgeries, such as a hysterectomy (removal of the womb), may weaken the muscles surrounding your vagina.

What are the signs and symptoms of a cystocele?

A cystocele may not have any signs or symptoms. If signs or symptoms are present, these may include one or more of the following:

• A soft bulge or lump in your vagina, which may or may not protrude through the vaginal opening.
  
  
• Low back pain that is relieved when you lie down.
  
  
• Pain or pressure in your vagina, especially when passing urine or having sex.
  
  
• Pink or red-colored urine.
  
  
• Pressure in your abdomen, or feeling that the bladder has not completely emptied after passing urine.
  
  
• Problems with voiding (passing urine), such as difficult, painful, or frequent voiding, especially at night.
  
  
• Urine leaks out when coughing, sneezing, or laughing.

How is a cystocele diagnosed?

Your caregiver will take a health history from you. This includes your lifestyle, past pregnancies, and any diseases you may have had. You may need one or more of the following tests:

• Bimanual examination: During this exam, feel free to ask for a woman to be there with you during the exam. Your caregiver gently puts a speculum (warmed tool) in your vagina to open it and asks you to strain or bear down. This may cause the cystocele to bulge so he can check its size and location. Your caregiver may also tell you to tighten the muscles of your pelvis (hips). This may be done as if you are trying to stop urinating. This helps your caregiver learn how strong your pelvic muscles are.
  
  
• Imaging tests:
  
  
  • Cystourethrogram: A dye is injected and x-rays are taken while you pass urine. The dye makes an outline of your bladder and urethra (tube where urine passes). This shows the changes that occur in your urinary tract while urinating.
    
    
  • KUB x-ray: An x-ray machine takes pictures of your kidneys (K), ureters (U), and bladder (B). The ureters are tiny tubes that carry urine from your kidneys to your bladder. The bladder is where the urine is stored before leaving your body. Caregivers use these pictures to check for problems with your intestines , kidneys, or abdomen.
    
    
  • Magnetic resonance imaging: This test is also called an MRI. During an MRI, computerized pictures are taken of your abdomen or pelvis. Caregivers use these pictures to look for problems in your bladder, vagina, rectum, or other pelvic organs. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Pelvic floor fluoroscopy: Fluoroscopy is a special type of x-ray that shows the movement of your bladder, vagina, or bowels. Pictures of these body parts are taken and may be shown on a video screen. Caregivers may give different contrasts, such as a dye, so your body parts show up better.
    
    
  • Ultrasound: Sound waves are used to show pictures of the inside of your abdomen. A small handle with lotion on it is gently moved around your abdomen. The handle may also be placed in your vagina. Pictures of your bladder, vagina, rectum, or other organs are seen on a TV-like screen.
  
  
• Other tests:
  
  
  • Cotton swab test: A clean cotton-tipped swab, lubricated with a jelly, is inserted through the urethra into the bladder neck. The urethra is the tube that carries urine from your bladder to the outside of the body. Caregivers will check and measure the changes of the position of the swab from resting to straining.
    
    
  • Cystoscopy: A thin tube is inserted into your urethra and up into your bladder. Caregivers will look at the inside of your bladder for stones, bleeding, tumors, or signs of infection.
    
    
  • Urine test: A sample of your urine is collected and sent to a lab for tests.
    
    
  • Urodynamics: This test checks if the muscles of your bladder are working properly. It also measures how much urine your bladder can hold. This test can also tell whether your bladder fills and empties in a normal way.

How is a cystocele treated?

Treatment of a cystocele will depend on how bad it is and what symptoms you have. A cystocele that is not causing any symptoms may not be treated. Caregivers may tell you to eat a high fiber diet and drink plenty of liquids. You may also need one or more of the following:

• Estrogen therapy: If you are in menopause, caregivers may recommend estrogen hormones. This may be taken as a pill by mouth or applied as a cream in your vagina. Estrogen helps keep your pelvic muscles strong and may prevent your cystocele from getting worse.
  
  
• Pessary or tampon: A pessary is a plastic or rubber ring and a tampon is a plug of cotton or other absorbent material. These are placed inside the vagina to support the bulging tissues in your bladder and vagina.
  
  
• Surgery: For a severe cystocele, surgery may be needed to move the bladder back into place. The muscles and ligaments around your vagina may be sutured (tied up) to make them strong. A mesh patch may be placed to add support to the vaginal wall.

With treatment, such as medicine, a pessary, or surgery, your symptoms may be relieved and your quality of life may be improved.

How can a cystocele be prevented?

• Avoid too much pressure in your abdomen: Do not strain if you are constipated. Lifting heavy objects or standing for long periods of time can also increase pressure in your abdomen.
  
  
• Do Kegel exercises regularly: This exercise squeezes your pelvic floor muscles and helps them become stronger. Ask your caregiver for more information about Kegel exercises.
  
  
• Drink 8 to 10 (eight ounce) cups of water each day: Good liquids to drink are water, prune juice, and milk. Limit the amount of caffeine you drink, such as coffee, tea, soda, and sports drinks.
  
  
• Eat more fiber: High fiber foods, such as fresh fruits, vegetables, and whole grains help prevent constipation and soften stools. This helps stools pass more quickly through your colon. . Be sure to slowly add fiber into your diet to avoid bloating, stomach pain, and gas.
  
  
• Maintain a healthy weight: Talk to your caregiver about your ideal weight and to help you plan the best exercise program for you. Try to exercise at least 30 minutes everyday.
  
  
• Treat your long-standing cough: If you have a chronic cough, have it treated. If you smoke, try to quit as many smokers develop a chronic cough later on. Ask your caregiver for more information about how to quit smoking if you are having trouble quitting.

Where can I find more information?

Having a cystocele may be hard for you and your family. Call or write the following organizations for more information:

• American Foundation for Urologic Disease
  1128 North Charles Street
  Baltimore , MD 21201
  Phone: 1- 410 - 468-1800
  Phone: 1- 800 - 242-2383
  Web Address: http://www.afud.org
  

• National Kidney and Urologic Diseases Information Clearinghouse
  3 Information Way
  Bethesda , MD 20892-3580
  Phone: 1- 800 - 891-5390
  Web Address: http://kidney.niddk.nih.gov/
  

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington , DC 20090
  Phone: 1- 202 - 638-5577
  Web Address: http://www.acog.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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