A cystocele is the condition in which the bladder prolapses toward the front wall of the vagina as a result of weakening of its support tissues. Weakening of the pelvic floor muscles and connective tissues causes the bladder to shift downward from its anatomical position.
This condition is seen more frequently especially in women who have had vaginal births, in the post-menopausal period and in individuals whose pelvic support tissues have weakened.
A cystocele can be a progressive condition and over time can significantly affect both urinary function and daily life comfort.
Causes
A cystocele usually arises from weakening of the pelvic floor support:
Birth and obstetric factors
- Vaginal births
- Difficult births and a prolonged labor process
- A history of multiple births
Age-related changes
- Decrease in estrogen after menopause
- Loss of connective tissue elasticity
- Muscle weakening
Other risk factors
- Chronic constipation and straining
- Heavy lifting
- Obesity
- Chronic cough (COPD, etc.)
Symptoms
A cystocele may be mild at first and becomes more pronounced as it progresses:
Pelvic area symptoms
- Feeling of fullness and pressure in the vagina
- Feeling that “something is coming down”
- Discomfort that increases when standing for a long time
Urinary symptoms
- Difficulty urinating
- Feeling that the urine is not fully emptied
- Frequent urinary tract infections
- Urinary incontinence (may accompany)
Advanced stage symptoms
- Feeling of an outward vaginal bulge
- Discomfort during sexual intercourse
- Restriction in daily activities
Diagnostic Methods
The diagnosis of a cystocele is usually made with clinical evaluation:
Physical examination
- Vaginal examination
- Evaluation of the pelvic organs
Additional examinations
- Ultrasonography
- Urodynamic tests (in accompanying urinary problems)
- Bladder emptying evaluation
Treatment Methods
Treatment is planned according to the degree of prolapse and the patient’s complaints:
Conservative (non-surgical) treatment
- Pelvic floor exercises (Kegel)
- Lifestyle adjustments
- Weight control
- Prevention of constipation
Medical and supportive methods
- Use of a vaginal pessary (a device that supports the bladder)
- Local treatments containing estrogen (in suitable patients)
Surgical treatment
- Anterior vaginal wall repair
- Pelvic floor reconstruction
- Accompanying urinary incontinence surgery when necessary
Surgical treatment is the most effective permanent solution in advanced cystocele.
The Importance of Cystocele
An untreated cystocele can over time lead to:
- Bladder emptying disorders
- Recurrent infections
- Sexual dysfunction
- A decrease in vaginal quality of life
- Restriction in daily activities
Frequently Asked Questions
Does a cystocele correct itself?
No. A cystocele is usually a progressive condition and does not correct itself.
Is a cystocele dangerous?
It is not a life-threatening condition, but when it progresses it can cause serious impairment of quality of life.
Is surgery essential?
In mild cases, exercise and a pessary may be sufficient. In advanced cases, surgery may be required.
Does a cystocele cause urinary incontinence?
Yes. It can be seen especially together with stress-type urinary incontinence.
Do pelvic exercises work?
In mild and moderate cases, pelvic floor exercises can reduce the symptoms.
What is a pessary?
It is a medical device placed inside the vagina that supports the bladder and reduces the prolapse.
Does it recur after surgery?
With the correct technique and appropriate patient selection, the risk is low but not completely zero.
Does it affect sexual life?
Yes. In advanced cases there can be pain, discomfort and reduced satisfaction.
Does it occur after childbirth?
Yes. Pelvic support can weaken especially after vaginal birth.
Does a cystocele progress?
Yes. If left untreated, its degree can increase over time.
Clinical Summary
A cystocele is the prolapse of the bladder into the vagina as a result of weakening of the pelvic floor support. While it can be brought under control with conservative methods in the early stage, successful and permanent results can be achieved with surgical treatment in advanced cases.
