Cystocele – Bladder Prolapse

What is prolapse?

In medical terms, ‘Prolapse’ is a condition where the organs fall down or move out of their original place. Though prolapse is used to refer to conditions when organs fall through vagina or rectum, it can also refer to the valves that gets misaligned in the heart.  Even a slip disc is referred to prolapse.

Types of Prolapse: (Limiting to Gynecology)

1. Rectocele
2. Rectal Prolapse
3. Cystocele (Bladder Prolapse)
4. Uterine Prolapse

Cystocele/Bladder Prolapse

Cystocele (bladder prolapse) also called ‘Anterior Prolapse’ is a condition when the bladder of a female bulges and falls onto the vaginal track / vagina. This happens when the pelvic floor muscles, tissues and the supporting ligaments become weak and can’t hold the bladder in it’s place. This is also called ‘Prolapsed Bladder’.

When the condition of cystocele is in the beginning stages, non surgical treatments may be an option but when the condition grows out of proportion, surgery will be the only way to keep vagina, bladder in their appropriate positions.

What are the symptoms of cystocele (bladder prolapse)?

As said, when the condition is mild, there may not be any symptoms but when the bulging of the bladder is more, following symptoms may be seen:

1. Pressure on the pelvis and vagina
2. Discomfort when you strain, cough, lift or bend
3. A feeling that your bladder is not empty even after urinating.
4. Repeated infections of the bladder
5. Pain during intercourse/sex
6. Urine leakage during sex as the vagina is pushed that in turn compresses the bulged bladder.
7. In extreme cases, the bulged bladder falls on the vagina and the walls of vagina fall out of it and the person may feel that she is sitting on an egg or ball.

Who can treat cystocele (bladder prolapse)?

If you have a family physician, take his/her advise and meet a good urogynecologist who can treat your problem. Else, search for an expert urologist or urogynecologist near you. In case of doubt, you can go for a second opinion with another urologist.

When should you see your urogynecologist?

Your body will tell you that there is something wrong. You will not be comfortable; you may feel pain or the feeling of bulging in your pelvis or when having sex. All these are the hints that tell you to see a good urogynecologist near you and get proper medical advice.

What actually causes Cystocele (bladder prolapse) or Anterior Prolapse?

As said, when the condition is mild, there may not be any symptoms but when the bulging of the bladder is more, following symptoms may be seen:

1. Pregnancy and Vaginal Child birth
2. Overweight or Obese condition
3. Heavy weight lifting
4. Straining with bowel movements
5. Severe cough and bronchitis.
6. Aging – As you age, muscles weaken; prolapse occurs.
7. Hysterectomy – hysterectomy of other organs can weaken the support of your pelvic floor and can result in cystocele.
8. Genetics – If your muscles are genetically weak by birth, there are higher chances of acquiring prolapse condition during your lifetime.

Mitigating the risk of bladder prolapse:

As said, when the condition is mild, there may not be any symptoms but when the bulging of the bladder is more, following symptoms may be seen:

1. Regular exercise, especially ‘Kegels Exercise’ to strengthen pelvic muscles. Watch our video below (after this article) to know how.
2. Constipation also causes prolapse – get it treated.
3. Avoid heavy lifting and lift weights correctly with your legs instead of your back.
4. Cough and bronchitis – must be addressed by a specialist.
5. Avoid weight gain – proper diet, regular workout can keep you physically and mentally strong even as you age.

Treatment for Cystocele (bladder prolapse)

Laser Anterior Repair

Cystocele is descent/prolapse of the anterior vaginal wall dragging the bladder behind it. The pubocervical fascia of the bladder weakens and this causes the bladder descent. Repair is usually done by separating the epithelium and adventitia from the bladder. This is where the laser comes in. Usually there is an uneven separation compromising the repair. The HoYag laser does the job with minimal blood loss and tissue damage. The layers open out beautifully for repair.

Laser Anterior Repair with Mesh

The Holmium Yag laser can be combined with Mesh for repair of the Anterior vaginal wall. The fascial weaking can be repaired with sutures as in the above technique or needs bolstering when it is very weak. In fact there is a lot of data to say that mesh repair is better than no mesh in the case of the anterior vagina.

Laparoscopic Laser Paravaginal Repair

Cystoceles are believed to be caused by specific breaks in the pubocervical fascia. One such break could be in the lateral attachments to the whiteline. These are called paravaginal defects. These defects are better repaired Laparaoscopically. At the Laser Pelvic Surgery Institute, we use the Ho Yag laser for separating fascial planes and to define these breaks. The breaks are then sutured with a delayed absorbable suture.