Cystocele (Anterior Prolapse)

WHAT IS ANTERIOR PROLAPSE (CYSTOCELE)? Anterior prolapse, also called cystocele or a prolapsed bladder, is when the bladder drops from its normal position in the pelvis and pushes on the front wall of the vagina. The pelvic floor, the tissue between the bladder and front vaginal wall, has a variety of muscles, connective tissues, and ligaments. When these work together, they give support to the bladder as well as the other organs, such as the uterus, bowel, and ureter.  The combined force of the pelvic floor tissues makes a hammock from the tailbone to the pubic bone, which holds the bladder and other pelvic organs in place. It is therefore vital to keep these muscles strong. When the pelvic floor becomes weak or if too much pressure is put on the pelvic floor, anterior prolapse occurs. That is to say, the bladder falls or collapses, which means that the bladder bulges into the vagina.   A prolapsed bladder occurs when the muscles that aid the pelvic organs have been strained. This can happen over time, due to virginal childbirth, heavy lifting, or violent coughing, or during times of chronic constipation. Anterior prolapse (fallen bladder) is treatable. Oftentimes, nonsurgical treatment is effective for mild or moderate prolapse. However, in most severe cases, surgery may be recommended to keep the vaginal and other pelvic organs in their proper position. CYSTOCELE GRADING Cystocele can be classified into 3 grades and they include:

• Grade 1 Cystocele; which is the mild form of anterior vaginal wall prolapse.
• Grade 2 Cystocele; is the moderate form of anterior wall prolapse.
• Grade 3 Cystocele; is a severe form of anterior prolapse, where the bladder drops further past the uterus. 

Taking Responsible Steps A prolapsed bladder can be very uncomfortable and sometimes socially embarrassing, even though it is rarely painful. Urinary incontinence may lead to social embarrassment.  It can make emptying your bladder difficult, which may lead to bladder infections. Taking immediate steps can put an end to these inconveniences. Make an appointment with your now, if you have any signs or symptoms of anterior prolapse. RISK FACTORS OR COMPLICATIONS OF CYSTOCELE. The following factors below may increase your risk of anterior prolapse:

• Hysterectomy. 

Uterus removal may contribute to the weakening of your pelvic floor, although this seems somewhat rare to an extent.

• Obesity. 

Overweight women are at a higher risk of having an anterior prolapse.

• Pregnancy and childbirth.

Multiple pregnancies and mothers who had high-birth weight babies are at high risk of having a prolapsed bladder too.

• Aging.

Risk increases with age. After menopause, when the estrogen level decreases, the pelvic floor becomes weakened. 

• Sex or gender.

Only women have cystoceles; men do not.  

• Genetics.

Some women are born with weaker connective tissues, making them good candidates for anterior prolapses. DIAGNOSIS OF A CYSTOCELE The diagnosis of a fallen bladder may include all or some of the below:

• A pelvic examination by your doctor.
• Filling out a questionnaire. The form guides your doctor when assessing your medical history, the degree of your prolapse, and how much it affects your quality of life. It also helps with treatment decisions.
• Bladder tests to assess the emptying of your bladder
• Urine test to know if there is any bladder infection.

TREATMENT Treatment depends on whether you have symptoms, how obvious your anterior prolapse–mild, moderate, severe. For mild cases, your doctor can recommend a Wait–and–See approach, with occasional visits to monitor your condition. First-line treatment options include:

• Pelvic floor muscle exercises (often called Kegel exercises). Help strengthen your pelvic floor muscles. Consult a physical therapist.
• Pessary (a supportive device).  

A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. It is not a cure, but the extra support to help relieve symptoms. Your doctor will teach you how to fix, clean, and reinsert it on your own. Surgical Options Despite the options above, your doctor may recommend surgery if you still have noticeable uncomfortable symptoms. It is performed vaginally.

• Lifting back the prolapsed bladder: 

The prolapsed bladder is lifted back into place using stitches and removing any excess vaginal tissue. Your doctor then uses a special type of tissue graft to strengthen vaginal tissues and increase support if your vaginal tissues are very thin.

• Removing a prolapsed uterus and repairing the damaged pelvic floor.

If your anterior prolapse is associated with a prolapsed uterus, your uterus may be removed (hysterectomy), and the damaged pelvic floor muscles, ligaments, and other tissues repaired.

• Urethral suspension

If your anterior prolapse is accompanied by stress incontinence (loss of bladder control), your doctor may recommend one of several procedures to support the urethra (urethral suspension) and ease symptoms of incontinence. Kegel Exercises (Kegels) These are exercises that can be done at home to strengthen your pelvic floor muscles. A strengthened pelvic floor provides solid support for your pelvic organs, thereby relieving accompanying symptoms of the anterior prolapse.  Steps for Kegel exercises are:

• Tighten (contract) your pelvic floor muscles – the muscle you use for urinating
• Hold the contraction for 5 seconds, and then relax for 5 seconds (To make it less difficult, you may start holding for 2 seconds and relaxing for 3 seconds).
• Work up to holding the contraction for 10 seconds at a time.
• Do three sets of 10 repetitions of the exercise each day.

Ask your doctor (or physical therapist) for instructions on whether you are using the right muscles. LIFESTYLE REMEDIES To check further progress of anterior prolapse, you can adopt the following lifestyle modifications:

• Treat and prevent constipation. Take more of high fiber foods.
• Control coughing. Get treatment for a chronic cough or bronchitis. Don’t smoke.
• Avoid heavy lifting, and lift correctly. When you are lifting, it’s better to use your legs instead of your waist or back.
• Manage your weight. Determine your ideal weight and get advice on weight-loss strategies.

SUCCESS RATE FOR ANTERIOR PROLAPSE Success rates for cystocele repair 70 – 90%, however, there is a chance that the prolapse may recur or another part of the vaginal wall may prolapse. Cystocele is treatable.  For a moderate or mild cystocele, non-surgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their positions. Cystocele and Rectocele These two conditions are connected to the vaginal wall. However, cystocele or anterior prolapse occurs the bladder drops from its original place and pushes on the front wall of the vagina. Whereas, rectocele or posterior prolapse occurs when the wall between the rectum and the vagina becomes weakened making the vaginal wall bulge.

Symptoms

SYMPTOMS OF ANTERIOR PROLAPSE

Mild cases of cystocele may not show signs or symptoms, but moderate to severe may. When signs and symptoms appear, they may include the following:

• A feeling of pressure on your  pelvic and vagina
• A feeling or sight of a bulge of tissue in your vagina
• Difficulty in starting a urine stream
• A frequent urge to urinate
• Loss of bladder control (urinary incontinence)
• A feeling that you have not completely emptied your bladder
• A severe discomfort when coughing, straining, bearing down, or lifting weights.
• Vaginal bleeding
• Vaginal discharge.

These symptoms may be more noticeable when you are standing for a long time, but feel relief when lying down.

Causes

CAUSES OF CYSTOCELE

Your pelvic floor (which consists of muscles, ligaments, and connective tissues) is that which supports your bladder and other pelvic organs. 

Pressure from the pelvic organs, as well as strains resulting from the trauma of childbirth, chronic strains from heavy lifting, violent coughing, and constipation, over time,e can render the pelvic floor weak. 

When this happens, your bladder can slip down lower than normal and bulge into your vagina. 

Stress to the pelvic floor may be caused by the following reasons:

• Obesity or overweight
• Strenuous bowel movements
• Pregnancy and vaginal childbirth
• Lifting heavy weights repeatedly
• A chronic cough or bronchitis
• Strenuous exercises, over time.

FAQ

How can I stop cystoceles from getting worse?

The following can help your prolapse from getting worse:

• Do Kegel exercise every day to strengthen your muscles. 
• Prevent or correct constipation
• Reach and stay at a healthy weight
• Avoid activities that stress your pelvic muscles, such as heavy lifting.

How do you fix a prolapse without surgery?

You might be able to relieve some symptoms on your own without surgery.  You can do exercises at home that make your pelvic muscles stronger. If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse.

What should you not do with a prolapse? 

If you have pelvic organ prolapse, avoid things that could make it worse. That means don’t lift, strain, or pull. If possible, try not to be on your feet for long periods. Some women find that they feel more pressure when they stand a lot.

Is walking good for bladder prolapse?

Walking is the best exercise during bladder prolapse surgery recovery, doing pelvic floor exercise, resting each day. 

Does prolapse cause discharge?

Moderate to severe prolapse may cause symptoms such as the feeling that you’re sitting on a ball, vaginal bleeding, and increased discharge.