Cystocele

Cystocele

A cystocele is a bladder prolapse. The bladder bulges towards the front of the vagina.

What is a cystocele?

A cystocele is when a woman’s bladder bulges out into the vagina. The reason for this is a weak pelvic floor, which is usually associated with a sagging or prolapsed vagina. If the urethra is also involved in the protrusion, which is not uncommon, physicians speak of a urethrocystocele. For liver cyst definition and meaning, please visit howsmb.com.

Other names for a cystocele are bladder prolapse, bladder hernia or bladder prolapse. A cystocele is almost always present in females. It is characterized by invagination in the front wall of the vagina. Sometimes the prolapse extends to the entrance of the vagina (introitus vaginae) or even further.

In most patients, this is secondary to a prolapsed uterus or vagina. Cystoceles are extremely rare in men. This can occur with a hernia or a femoral hernia.

Causes

The pelvic floor is made up of ligaments, muscles and tissue. These have the function of supporting the urinary bladder and other organs. Over the years, a weakening of the connection between the pelvic floor muscles and the ligaments that sit over them is possible. This weakness is usually caused by childbirth or injuries that result in overexertion.

Due to the weakening, the musculature of the pelvic floor is no longer able to fix the urinary bladder. As a result, it sags in the lower direction, forming a cystocele. In addition to the birth process and pregnancy, the main causes for the development of a cystocele include obesity, strenuous movements of the intestines, chronic coughing and lifting heavy loads.

The number of births also plays a crucial role, because the more children a woman gives birth to, the greater the risk of a cystocele developing. Another risk factor for a bladder prolapse is a lack of the hormone estrogen. This has a strengthening effect on the female pelvic floor muscles.

With age-related decline in the number of the hormone, the risk of cystocele formation increases. Postmenopausal women are often affected by bladder prolapse. A weakening of the muscles of the pelvic floor is also possible through the surgical removal of the uterus.

Symptoms, Ailments & Signs

It is not uncommon for a cystocele to be asymptomatic, so that the affected women do not feel any symptoms. Usually these are slightly pronounced cystoceles. In more severe cases, however, symptoms such as a feeling of pressure in the pelvic region or a feeling of fullness can become noticeable. This is especially the case after standing for a long time.

The discomfort increases with exertion, lifting loads, bending over or coughing. In addition, inflammation of the bladder, frequent urge to urinate, pain or urination during sexual intercourse and urinary incontinence are also conceivable as part of a cystocele. A large cystocele can also cause urinary retention. Sometimes even blister tissue comes out of the vaginal opening. The affected person feels as if they were sitting on an egg.

Diagnosis & course of disease

If there is a suspicion of a cystocele, the doctor treating you will perform an examination of the pelvic floor. The doctor checks whether the bladder has pushed into the vagina. During the vaginal examination, the doctor uses a speculum to lower the bottom of the bladder. In addition, the outer vaginal vault and the front wall of the vagina are bulged.

With abdominal compression and a full bladder, the diagnosis of the cystocele is easier. The difference whether the defect is lateral or central plays a role in precise diagnosis. In the case of a stretch cystocele, the vaginal wall is smooth. In the case of a displaced cystocele, on the other hand, there are vaginal wrinkles in which only the lateral furrows are flattened.

A lateral defect can be identified by lifting the furrows with forceps. The diagnosis can be confirmed by means of a sonography ( ultrasound examination ). The course of a cystocele depends on its severity. Mild forms that do not show any symptoms do not require any special treatment. In severe cases, however, medical treatment is necessary.

Complications

In most cases, this disease causes various bladder problems. Those affected usually feel a feeling of pressure on the bladder, which significantly reduces and restricts 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.

If left untreated, the disease can also cause inflammation of the bladder or urinary tract. A frequent urge to urinate can also occur and make everyday life of the person affected significantly more difficult. Pain occurs with bowel movements or urination. The pain can also occur during sexual intercourse and possibly have a negative effect on the relationship with the partner. If left untreated, the condition can cause irreversible damage.

The complaints are usually remedied without complications with the help of a surgical intervention. Training the pelvis can prevent this disease. The life expectancy of the patient is not negatively affected. If the tissue of the bladder is already damaged, a transplant of the tissue can take place.

When should you go to the doctor?

A period of freedom from symptoms is characteristic of a cystocele. Despite the present illness, the affected persons often do not notice the changes taking place in the organism due to the initially minor effects. The process usually takes several months. For this reason, it is advisable to take part in regular check-ups and check-ups. The state of health should be compared and documented by a doctor once or twice a year. This enables early detection and thus a timely diagnosis. When the first symptoms appear, the disease is usually already advanced. Disorders when going to the toilet, especially when urinating, should therefore be examined by a doctor as soon as possible.

Urinary incontinence is a cause for concern. If this is not due to a one-off situation, a doctor is needed. Pain, swelling, or other abnormalities in the abdomen should be evaluated and treated. If physical resilience decreases or if there are irregularities in the performance of physical exertion, a doctor should be consulted. If the everyday obligations cannot be fulfilled without problems, the person concerned needs help. Behavioral problems, inner restlessness and withdrawal from social life are understood as warning signals. If pain occurs or if you have trouble sleeping, you should consult a doctor.

Treatment & Therapy

If a cystocele has been diagnosed, regular check-ups by the doctor must take place. In this way, a possible worsening of the bladder prolapse can be recognized. To prevent the cystocele from getting worse, preventive training can be carried out. If the prolapsed bladder needs to be treated, a pessary is placed in 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 surgery is unavoidable.

In the case of a stretch cystocele, an anterior vaginal plastic surgery takes place. If the cystocele is displaced, paravaginal colpopexy occurs. The surgeon fixes the vagina back to the side wall of the pelvis. Sometimes the use of special transplant tissue is necessary.

Prevention

To prevent a cystocele from occurring in the first place, regular exercises of the pelvic floor muscles are recommended. This includes kegel exercises. In addition, it makes sense not to lift heavy loads.

Aftercare

If the cystocele has to be treated with the help of a surgical procedure, follow-up treatment takes place. As a rule, a kidney and residual urinary sonography is carried out on the day of the operation as a check. A physical examination is then carried out to determine possible complications. This may also include a gynecological examination.

In the initial period after the operation, heavy physical exertion must be avoided at all costs. This means that no heavy loads may be lifted. It also makes sense to keep the stool soft, which is possible through a targeted diet. In this way, you can avoid more abdominal clenching.

If you are overweight, it is recommended to reduce it depending on your body mass index (BMI). In some cases, vaginal douching and sexual intercourse must be avoided for a period of time after the surgical procedure. Regular training of the pelvic floor is an important part of aftercare.

The exercises, which include kegel exercises in particular, must be carried out consistently. The check-ups at the doctor’s are indispensable and must also be visited regularly. If there are any abnormalities during the follow-up treatment that indicate possible complications such as bleeding, bruising or bladder or bowel emptying disorders, these must be reported to the treating doctor as soon as possible so that he can take appropriate therapeutic measures.

You can do that yourself

If there is a risk of having a cystocele again, there are a number of self-help measures that can be taken to reduce the risk. This primarily includes 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 are carried out consistently, the weakening of the pelvic floor can be rectified in most cases. Preventive exercises are just as useful, even if there is no cystocele. Appropriate offers can be found in fitness centers, sports clubs or self-help groups.

In order to avoid another anterior prolapse, it is important not to lift objects that are too heavy. The same goes for proper lifting. When lifting, you shouldn’t strain your back and waist, but your legs instead.

It is also important to prevent constipation in the intestines. To achieve this, a high-fiber diet makes sense. If there is a chronic cough or bronchitis, these conditions should be treated professionally in order to prevent a prolapse of the urinary bladder.

Another self-help measure is to avoid being very overweight. The doctor can determine the ideal weight. The doctor also gives useful advice on weight loss, which can then be applied in everyday life.

Cystocele