Dr. MJ Bazos MD,
A cystocele occurs when the wall between a
woman's bladder and her vagina weakens and lets the bladder droop into the
vagina. This condition may cause discomfort and problems with emptying the
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
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
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.