Cystocele develops when the muscles and ligaments supporting the bladder weaken or stretch in women. People can have trouble urinating or putting in menstruation products, or they may feel or see tissue bulging through their vaginal opening. Sexual intercourse may also be painful.

Understanding the aetiology, symptoms, risk factors, diagnosis, and treatment of cystocele is useful in early diagnosis, treatment, and successful long-term management. Additionally, if you are a NEET PG medical student, learning about this condition is a must for enhancing your clinical knowledge as well as providing improved patient care. 

Read on to find out more!

What is a Cystocele?

The medical ailment known as cystocele develops when the muscles and ligaments supporting the bladder and the vaginal lining weaken or stretch. Loss of these supports causes the bladder to sag or bulge into the vaginal canal. It is a pelvic organ prolapse.

Other names for a cystocele (say SIS-tuh-seel) are:

• Tilted bladder
• Prolapsed bladder
• Herniated bladder
• Dropped bladder
• Fallen bladder

Furthermore, cystoceles are generally graded into 3 types by severity:

1. Grade 1 (Mild): There is very little descent of the bladder into the vagina.
2. Grade 2 (Moderate): The bladder descends to the vaginal opening or bulges somewhat out from it.
3. Grade 3 (Severe): The bladder bulges way out from the vaginal opening.

What are the Causes of Cystocele?

A cystocele develops when muscles and supportive tissues around the bladder and vaginal wall become weakened or lose their elasticity. A number of factors can make them weaken, including:

• Pregnancy and vaginal delivery
• Medical conditions that result in persistent pressure in the pelvic area, e.g., persistent cough, chronic constipation, or being obese
• Connective tissue disorders, like Ehlers-Danlos syndrome or Marfan syndrome
• Chronic heavy lifting
• History of prior pelvic surgery, e.g., hysterectomy
• Family history of cystocele
• Ageing has a natural tendency to increase the weakness of the muscles and tissues of the pelvic floor

What are the Risk Factors of a Cystocele?

Any woman can develop a cystocele at any age. The risk increases with older age due to the natural weakening of the pelvic floor muscles. Other risk factors include:

• Vaginal childbirth
• Previous pelvic floor or uterine operation, e.g., hysterectomy
• Overweight or obesity
• History of cystocele or pelvic prolapse in a biological relative

What are the Symptoms of a Cystocele?

Cystocele symptoms can include:

• A feeling of heaviness or fullness in the pelvis
• Feeling or noticing a bulge inside the vagina
• Pain or pressure in the lower abdomen or pelvis
• Lower back pain
• Increased frequency of urinary tract infections (UTIs)
• Urgency or frequent urination
• Involuntary loss of urine
• Incomplete bladder emptying
• Constipation or straining at stools
• Having to manually push pelvic organs back into place to urinate or have a bowel movement
• Pain or discomfort during sexual intercourse
• Difficulty with insertion of tampons or vaginal applicators
• Worsening pelvic pressure when standing, lifting, coughing, or as the day progresses
• Vaginal bleeding from exposed tissue

What is the Diagnosis of a Cystocele?

Diagnosis of an anterior prolapse (cystocele) can include the following:

• Pelvic Examination: A physician will do a physical examination of the pelvic region to determine if there is a bulge of tissue within the vagina. They may ask to bear down to assess how the prolapse changes with strain. You might also be asked to do a pelvic floor muscle contraction to evaluate the strength of these muscles.
• Medical History Review: This includes medical and surgical history and history of pregnancies.
• Bladder and Urine Function Tests: Certain individuals undergo tests to assess how well the bladder is emptying. A health care provider may also test a sample of the urine for signs of a bladder infection.

What is the Treatment of a Cystocele?

If a cystocele is mild and not causing discomfort, treatment might not be necessary. But if symptoms do develop or quality of life is impaired, the treatment will be based on how severe the condition is, the age, general health, and other individual circumstances. 

Available management options are described below:

• Pelvic Floor Muscle Exercises

Muscles supporting the bladder and vaginal wall are reinforced using Kegel exercises. They can help stabilise the bladder and serve to alleviate symptoms, like leakage of urine.

• Vaginal Pessary

A pessary is a small, soft, silicone object placed within the vagina to help support the vaginal wall so as not to prolapse the bladder. The proper fit among various sizes and shapes will be prescribed by a doctor. A pessary can be removed, cleaned, and reused when needed to prevent irritation.

• Surgical Treatment

In more serious cases or when other treatments fail, surgery may be suggested. Among the most common surgeries are:

• Anterior Vaginal Repair: It is the most common surgery for cystoceles. It is a repositioning of the bladder and pulling up of the area around it with stitches.
• Obliterative Surgery: In this surgery, the vagina is narrowed or closed entirely or partially in order to offer a greater amount of support for the bladder. This surgery is not appropriate for women who might want to have vaginal intercourse in the future.

FAQs About Cystocele

1. Can a cystocele harm the kidneys?

Yes, in a few instances. A cystocele can press upon the urethra or kink it, leading to urinary retention, where the bladder cannot empty entirely. In sporadic cases, the condition also leads to a kink in the ureters and can cause a backup of urine into the kidneys. This can lead to kidney damage if not treated.

2. Can a cystocele be cured without surgery?

Yes, a prolapsed bladder is treated effectively in some patients with conservative care. Non-operative treatments like pelvic floor exercises or a pessary alone are adequate if prolapse is not causing obstruction of bladder emptying or severe symptoms are not arising.

3. At what age does one most commonly develop a cystocele?

Cystocele typically develops in women aged between 50 and 60 years. Many reasons can cause it, such as stress of delivery, prolonged chronic constipation and straining, or chronic heavy lifting for years.

4. Can infections be caused by a cystocele?

Yes. Severe prolapse can also impair the capacity of the bladder to empty, causing urinary tract infections and, rarely, kidney damage.

5. What are the warning signs of a cystocele?

When symptoms develop, they may include:

• A feeling of heaviness, pressure, or fullness in the vagina and the pelvis
• Experience of a palpable or visible vaginal bulge of tissue
• Sense of increased pelvic pressure on lifting, coughing, straining, or bearing down
• Difficulty in urinating 

Conclusion

Cystoceles are not usually severe, but they can make you self-conscious. Don’t delay seeking a healthcare professional’s advice if you experience symptoms that impact your quality of life. Doctors will examine the medical history and symptoms, and recommend the best course of treatment to repair the cystocele and improve overall well-being.

For medical students studying for the NEET PG exam, understanding conditions such as cystocele is essential for clinical practice. That’s where DocTutorials steps in as your study companion. 

With video tutorial teaching by specialists, quick revision programs (QRPs), and in-depth study notes, we help you get exam-ready to crack exams.

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