A cystocele is a prolapse of the bladder. In this case, the urinary bladder bulges toward the anterior vaginal wall.
What is a cystocele?
A cystocele is when a woman’s urinary bladder bulges out into the vagina. The reason for this is an insufficient pelvic floor, in which there is usually a connection with vaginal prolapse or prolapse. If the urethra is also involved in the protrusion, which is not infrequently the case, physicians speak of a urethrocystocele. Other names for a cystocele are bladder prolapse, bladder hernia or bladder prolapse. A cystocele is almost always seen in the female gender. It is characterized by invagination into the anterior wall of the vagina. Sometimes the prolapse extends to the entrance of the vagina (introitus vaginae) or even further. In most patients, this represents a secondary consequence in uterine or vaginal prolapse. In men, a cystocele occurs extremely rarely. It may occur with an inguinal hernia or a femoral hernia.
Causes
Composed of ligaments, muscles, and tissues, the pelvic floor is the most important part of the body. These have the function of supporting the urinary bladder as well as other organs. Over the years, a weakening of the connection that is made between the pelvic floor muscles as well as the ligaments that are located above them is possible. This weakness is mostly caused by childbirth or injuries that result in overexertion. Due to the weakening, the muscles of the pelvic floor are no longer able to fix the urinary bladder. As a result, it sags in the lower direction, forming a cystocele. The main causes of cystocele formation, in addition to the birth process and pregnancy, include obesity, strenuous movements of the bowel, chronic coughing, and lifting heavy weights. The number of births also plays a decisive role, because the more children are born to a woman, the greater the risk of developing a cystocele. Another risk factor for a prolapsed bladder is a deficiency of the hormone estrogen. This has a strengthening effect on the female pelvic floor muscles. With the age-related decrease in the number of the hormone, the risk of cystoceles formation increases. Thus, women after menopause are often affected by bladder prolapse. Weakening of the muscles of the pelvic floor is also possible due to surgical removal of the uterus.
Symptoms, complaints and signs
It is not uncommon for a cystocele to be asymptomatic, so affected women do not experience any symptoms. In most cases, the cystocele is mild. In more severe cases, however, symptoms such as a feeling of pressure in the pelvic region or a feeling of fullness may become apparent. This is especially the case after long periods of standing. The discomfort increases with exertion, lifting weights, bending over or coughing. Furthermore, inflammation of the bladder, frequent urination, pain or urine leakage during sexual intercourse and urinary incontinence are also conceivable in the context of a cystocele. In the case of a large cystocele, urinary retention may also occur. Sometimes even bladder tissue leaks out of the vaginal opening. In this case, the affected person feels as if she were sitting on an egg.
Diagnosis and course of the disease
If a cystocele is suspected, the attending physician performs an examination of the pelvic floor. During this examination, the physician checks whether there has been any protrusion of the bladder into the vagina. During the vaginal examination, the doctor lowers the bladder floor with a speculum. In addition, the outer vaginal vault and the anterior wall of the vagina are bulged. With an abdominal press and a filled bladder, the diagnosis of cystocele is easier. The difference between whether the defect is lateral or central plays a role in precise diagnosis. In the case of a dilatation cystocele, there is a smooth spreading of the vaginal wall. In the case of a displacement cystocele, on the other hand, there are vaginal grooves in which only the lateral furrows are flattened. A lateral defect can be detected by lifting the furrows with a grain forceps. Sonography (ultrasound examination) can confirm the diagnosis. The course of a cystocele depends on its severity. Mild forms, in which there are no symptoms, do not require special treatment. In severe cases, however, medical treatment is necessary.
Complications
In most cases, this condition results in various symptoms of the bladder. Those affected usually experience a feeling of pressure on the bladder, which significantly reduces and limits the quality of life. A feeling of fullness in the pelvic area can also occur and is particularly noticeable after standing for a long time. Furthermore, without treatment, inflammation of the bladder or urinary tract can occur. A frequent urge to urinate can also occur and make the daily life of the affected person considerably more difficult. Pain occurs during defecation or urination. The pain can also occur during sexual intercourse and may have a negative effect on the relationship with the partner. Without treatment, the disease can lead to irreversible damage. The symptoms are usually corrected without complications with the help of surgery. Pelvic training can prevent this condition. The life expectancy of the patient is also not negatively affected. If the tissue of the bladder is already damaged, a transplantation of the tissue can take place in the process.
When should you go to the doctor?
A characteristic feature of cystocele is a period of no symptoms. Despite the presence of the disease, the affected individuals often do not notice the changes that take place in the organism due to the initial minor effects. The process usually lasts for several months. For this reason, it is recommended to attend regular check-ups as well as preventive examinations. Once or twice a year, the health condition should be checked and documented by a physician. This enables early detection and thus timely diagnosis. When the first symptoms appear, the disease is usually already advanced. Disturbances when going to the toilet, especially when urinating, should therefore be examined by a doctor as soon as possible. If urinary incontinence occurs, there is cause for concern. If it is not due to a one-time situation, a doctor is needed. Pain, swelling or other irregularities in the abdominal area should be investigated and treated. If physical endurance decreases or there are irregularities in the performance of physical exertion, a physician should be consulted. If daily responsibilities cannot be performed without discomfort, the affected person needs help. Behavioral abnormalities, an inner restlessness as well as a withdrawal from social life are understood as warning signals. If pain occurs or sleep disturbances occur, a physician should be consulted.
Treatment and therapy
If a cystocele has been diagnosed, regular check-ups with a physician must take place. In this way, any worsening of the prolapsed bladder can be detected. To prevent the cystocele from worsening, preventive exercise can be performed. If treatment of the bladder prolapse is necessary, a pessary is inserted into the vagina to support the bladder. This is a small ring made of rubber or plastic. The doctor explains to the patient how to insert and clean the pessary. In some cases, the targeted administration of estrogen can also be useful. In this way, the pelvic floor is strengthened by the hormone. Sometimes a surgical intervention cannot be avoided. In this case, an anterior vaginoplasty is performed in the case of a dilatation cystocele. If it is a displacement cystocele, a paravaginal colpopexy is performed. In this procedure, the surgeon reattaches the vagina to the lateral wall of the pelvis. Sometimes the use of special graft tissue is also necessary.
Prevention
To prevent cystocele from occurring in the first place, regular pelvic floor muscle exercises are recommended. This involves, among other things, Kegel exercises. It is also advisable not to lift loads that are too heavy.
Aftercare
If the cystocele must be treated with the help of a surgical intervention, aftercare takes place. As a rule, kidney and residual urine sonography is already performed on the day of surgery for control. In order to determine possible complications, a physical examination follows in the further course. This may also include a gynecological examination. During the first period after the operation, heavy physical strain should be avoided at all costs. This means that heavy loads must not be lifted.It is also considered useful to keep the stool soft, which is possible through a targeted diet. In this way, stronger abdominal clenching can be avoided. If there is excess weight, it is recommended to reduce it according to the body mass index (BMI). In some cases, vaginal irrigation and sexual intercourse must be avoided for a certain period of time after the surgical procedure. An important part of aftercare is regular training of the pelvic floor. The exercises, which mainly include Kegel exercises, must be performed consistently. The control examinations with the doctor are indispensable, which must also be visited regularly. If, in the course of follow-up treatment, abnormalities are detected that indicate possible complications, such as postoperative bleeding, bruising, and bladder or bowel emptying disorders, these must be reported to the attending physician as soon as possible so that he or she can take appropriate therapeutic measures.
What you can do yourself
If there is a risk of a cystocele occurring again, various self-help measures can be taken to reduce the risk. First and foremost, these include strengthening the pelvic floor. Strengthening the pelvic floor is particularly recommended after the birth of a child. For this purpose, Kegel exercises are performed at regular intervals. If these exercises take place consistently, the weakening of the pelvic floor can be remedied in most cases. Preventive exercises are also useful, even if a cystocele does not yet exist. Appropriate offers can be found in fitness centers, sports clubs or self-help groups, among others. To prevent a recurrence of anterior prolapse, it is important not to lift objects that are too heavy. The same applies to proper lifting. For example, when lifting, the back and waist should not be strained, but instead the legs. It is also considered important to counteract constipation of the intestines. To achieve this, a diet rich in fiber is useful. If a chronic cough or bronchitis is present, these conditions should definitely be treated professionally to prevent prolapse of the urinary bladder. Avoiding severe obesity is another self-help measure. The determination of the ideal weight can be done by the doctor. The medical professional will also give sensible advice on weight reduction, which can then be applied in everyday life.
