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What is a cystocele?

A cystocele is also known as a prolapsed, herniated, or dropped bladder, is a condition that occurs when the supportive ligaments that hold the bladder up and the muscle between a woman’s vagina and bladder stretches or weakens, allowing the bladder to sag into the vagina.

There are three stages of cystocele:

Mild stage- the bladder drops a little into the vagina

Moderate stage- the bladder drops to the opening of the vagina

Severe stage- the bladder bulges almost through the opening of the vagina.

What are the symptoms of a cystocele?

  • Difficulty starting the flow of urine (hesitancy).
  • A kind of feeling, something is bulging out of the vaginal opening.
  • Heaviness or pain in the pelvic area or lower back. It may get worse when you are standing, lifting, or coughing.
  • Incomplete urination
  • Urge to urinate
  • Fatigue
  • Painful sexual intercourse
  • Recurrent urinary tract infection
  • Lower back and pelvic pain

What causes a vesicovaginal fistula?

The reasons for vesicovaginal fistula are tissue damage that occurs due to trauma, medical procedures, or diseases such as

  • Childbirth
  • Abdominal surgery (cesarean section or hysterectomy)
  • Pelvic or cervical cancer
  • Radiation treatment
  • Bowel disease like diverticulitis
  • Infection (including, a tear you had during childbirth)
  • Traumatic injury
  • Sometimes repeat urinary tract infections can lead to fistulas, but it’s rare.

What causes a cystocele?

A cystocele occurs when the muscles, fascia, tendons, and connective tissues between a women’s bladder and vagina weaken. The type of cystocele that can develop can be due to one or more vaginal wall attachment failures such as the midline defect, the paravaginal defect, and the transverse defect.

Midline defect- this is a cystocele caused by the overstretching of the vaginal wall

Paravaginal defect- - this defect is the separation of the vaginal connective tissue at the arcus tendinous fascia pelvis.

Transverse defect- occurs when the pubocervical fascia becomes detached from the top of the vagina.

Muscle injuries are identified in women with cystocele. These injuries are more likely to occur due to childbirth. These muscular injuries result in less support to the anterior vaginal wall.

What are the risk factors for developing a cystocele?

Risk factors for developing a cystocele are:

  • An occupation that involves heavy lifting
  • Pregnancy and childbirth
  • Chronic lung disease
  • Smoking
  • Hypoestrogenism (low levels of Estrogen)
  • Pelvic floor trauma
  • Hysterectomy
  • Forceps delivery
  • Age
  • obesity

How is a cystocele diagnosed?

A Grade 2 or Grade 3 cystocele can be diagnosed from the symptoms and a vaginal examination.

The doctor may perform certain tests, that includes:

Urodynamics: This test measures the bladder’s capacity to hold and release urine.

Cystoscopy: a long thin tube with a tiny camera is sent through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stones.

How is a cystocele treated?

Treatment options vary from mild cystocele to severe cystocele.

For a mild cystocele, if it is not bothersome to the patient, then no treatment is required. The doctor may suggest you not to do, straining activities or lifting heavy things that can cause the problem to get worse.

Other potential treatment options are:

  • reducing weight
  • Estrogen replacement therapy
  • Kegel exercises to strengthen the pelvic floor muscles. These exercises help in tightening muscles that are used to stop the flow of urine.
  • if symptoms are modest, then the doctor may recommend a device called a pessary, that is placed in the vagina to hold the bladder in place.

How is cystocele surgery done?

Cystocele surgery is done for severe prolapse cases when physical therapies and medication fail to resolve the condition.

A cystocele surgery will help to restore the normal position of the bladder and reduce the pressure caused due to the bulging bladder on the vagina. Surgery is done by making an incision on the vagina or belly with 3 basic techniques that are:

  • Anterior colporrhaphy,
  • Paravaginal repair,
  • Anterior colporrhaphy with graft.

During the surgery:

General anesthesia is given, an incision is made in the vaginal wall. The tissue between the bladder wall and the vaginal wall is tightened with stitches to allow the strengthening of the muscles and ligaments. If the tissue lining is very thin, then extra tissue may be removed or tissue grafts are used.


Kokilaben Dhirubhai Ambani Hospital

Address: Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, Maharashtra 400053

Phone: +91-98 88 66 22 00

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