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What is a cystocele?

A cystocele is a condition where part of your bladder falls into your vagina because of weakened or stretched pelvic muscles. In some cases your bladder may begin to slip through your vaginal opening.

What increases my risk of a cystocele?

A cystocele is commonly caused by weak pelvic muscles and ligaments that hold and support the bladder. Your risk of cystocele may be increased because of the following:

  • Pregnancy or childbirth: This causes increased pressure and may stretch and weaken your pelvic muscles. You may have had trauma during childbirth from forceps or your baby's head.
  • Aging: Aging and decreased hormones can cause your pelvic muscles to become weaker.
  • Obesity: If you weigh more than your healthcare provider recommends, it may increase your risk of a cystocele.
  • Straining: Constipation, severe coughing, or lifting heavy objects may cause increased pressure inside your abdomen and cause a cystocele.
  • Surgery: Pelvic surgery such as a hysterectomy can increase your risk of a cystocele.
  • Collagen diseases: You may have a disease, such as Marfan's syndrome and Ehlers-Danlos syndrome, that makes your pelvic muscles weak.

What are the signs and symptoms of a cystocele?

  • A soft bulge or lump in your vagina
  • Low back pain that is relieved when you lie down
  • Pelvic pain or pressure, especially when you urinate or have sex
  • Pink or red urine
  • Pressure in your abdomen, or you feel that you cannot completely empty your bladder
  • Difficult, painful, or frequent urination, especially at night
  • Urine leaks out when you cough, sneeze, or laugh

How is a cystocele diagnosed?

Your healthcare provider will ask about your health history. This includes your lifestyle, past pregnancies, and any health conditions you have. You may need one or more of the following tests:

  • Pelvic exam: Your healthcare provider gently puts a speculum in your vagina to open it and asks you to strain or bear down. This may help find the location and size of your cystocele. Your healthcare provider may also ask you to tighten the muscles of your pelvis as if you are trying to stop urinating. This helps find how strong your pelvic muscles are.
  • Blood and urine test: You may need blood or urine tests to check for an infection.
  • Ultrasound: Sound waves are used to show pictures of the inside of your abdomen. A small wand with lotion on it is gently moved around your abdomen. The wand may also be placed in your vagina. Pictures of your bladder, vagina, rectum, or other pelvic organs are seen on a monitor.
  • X-ray: This test can take pictures of your kidneys, bladder, and ureters. You may be given dye to help the pictures show up better. Tell healthcare providers if you are allergic to iodine or shellfish. You may also be allergic to the dye. You may have x-rays taken while you urinate.
  • MRI: This scan uses powerful magnets and a computer to take pictures of your bladder, vagina, and pelvic area. You may be given dye to help the pictures show up better. Tell healthcare providers if you are allergic to iodine or shellfish. You may also be allergic to the dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell healthcare providers if you have any metal in or on your body.
  • 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 show whether your bladder fills and empties in a normal way.
  • Cystoscopy: A thin tube with a scope is inserted into your urethra and up into your bladder. Your healthcare providers will look at the inside of your bladder for stones, bleeding, tumors, or signs of infection.

How is a cystocele treated?

Depending on your symptoms, you may need any of the following:

  • Estrogen therapy: Estrogen may help strengthen the pelvic muscles and keep your cystocele from getting worse. This may be taken as a pill, applied as a cream, or inserted in your vagina.
  • 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: You may need surgery to lift your bladder back into place. During surgery, stitches or a mesh patch may be placed between your bladder and vagina to hold your bladder in place.

What are the risks of cystocele?

You may have discomfort or an infection from using a pessary. You may have bleeding or an infection from surgery. If your cystocele is not treated, you may continue to have pain or difficulty urinating. If the cystocele comes out of your vaginal opening, it becomes more difficult to treat and control your symptoms.

How can a cystocele be prevented?

  • Do Kegel exercises regularly: These exercises can help your pelvic floor muscles get stronger. Tighten the muscles of your pelvis (the muscles you use to stop urinating). Hold the muscles tight for 5 seconds, then relax for 5 seconds. Gradually work up to hold the muscles contracted for 10 seconds. Do at least 3 sets of 10 repetitions a day.
  • Avoid straining: Do not lift heavy objects, stand for long periods of time, or strain to have a bowel movement. Prevent constipation by drinking plenty of liquids and eating foods high in fiber. Ask how much liquid you should drink every day. High fiber foods include fresh fruits, vegetables, and whole grains.
  • Maintain a healthy weight: Ask your healthcare provider if you are at a healthy weight and what is the best exercise program for you. Try to exercise at least 30 minutes every day. Exercise can also help prevent constipation.

When should I contact my healthcare provider?

  • You have a fever.
  • You have chills or feel weak and achy.
  • You have lower abdominal pain or back pain that does not go away.
  • You cannot urinate.
  • You have questions or concerns about your condition or care.

When should I seek immediate care?

  • You have abnormal bleeding from your vagina.
  • You have a mass coming out of your vagina that you cannot push back in.
  • You have severe lower abdominal pain.
  • You have a bad-smelling discharge coming from your vagina.

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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. 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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