Cystocele (Fallen Bladder)

A cystocele (SIS-tuh-seal) occurs when the wall between a woman's bladder and her vagina weakens and lets the bladder drop into the vagina. This condition may cause discomfort and problems with emptying the bladder.  It is vitally important to recognize cystocele as a disorder of anterior vaginal wall support.  The bladder does not fall or cause any problems with anterior vaginal wall support.  The bladder simply sits on the anterior vaginal wall and fills the space vacated by the prolapsed anterior vaginal wall.

Anterior vaginal wall support disorders may result from pelvic muscle straining during vaginal childbirth. Other kinds of straining--such as heavy lifting or repeated straining during bowel movements--may also cause the anterior vaginal wall to prolapse and the bladder to fill the space.  Estrogen may help keep the pelvic muscles around the vagina strong. When women go through menopause (when they stop having periods), their bodies stop making estrogen, so the muscles around the vagina and bladder may weaken from disuse.

Treatment options range from no treatment for a mild anterior vaginal wall support disorders to surgery for large anterior vaginal support disorders.  If the anterior vaginal wall support disorder is not bothersome, your physician may only recommend avoiding heavy lifting or straining that could cause the prolapse to worsen.  Alternately, your physician may recommend a pessary--a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes so the doctor can find the most comfortable fit for the patient.  Click on the following link to view information on pessaries.

Estrogen replacement therapy (ERT) may be recommended for postmenopausal women to help strengthen the muscles around the vagina and bladder. ERT may be used alone, with a pessary, or before and after surgery. Your physician will talk with you about advantages and possible risks of taking estrogen.

Large anterior vaginal wall support disorders may require surgery to move the anterior vagina back into a more normal position and keep it there.  This will restore the normal position for the bladder which sits on the anterior vaginal wall.  After a thorough examination, your physician will discuss treatment options with you.  Please feel free to ask questions during this time.  You do not have to have surgery.  Women usually consider surgery when:

·      Pain or discomfort interferes with daily activities

·      Intercourse becomes painful

·      You can feel or see something bulging out of your vagina or just inside your vagina

·      You have any unusual bleeding or discharge

·      A pessary has not relieved symptoms

·      Urine leakage complicates your vaginal bulge

However, the decision is up to you.  Many women over 50 had routine surgery to “tack up” the bladder when they had a hysterectomy.  This surgical procedure was not very effective, and we have learned better, more successful and lasting ways of supporting the anterior vaginal wall.  If you decide to have surgery, your physician will discuss the various surgical options.  (see FAQ – If my surgery is successful, for how long will it be effective?)