Anterior prolapse, cystocele, or a dropped bladder refers to the bulging of bladder into vagina due to the weakening of the wall in between the two organs. The tissue present between the bladder and vaginal wall stretches and causes a bulge of the bladder.
Cystocele leads to leakage or incomplete emptying of urine. It is caused by straining of pelvic muscles as in vaginal child birth, heavy lifting, or strained bowel movements. The condition may cause complications after menopause when the level of estrogen drops. Mild symptoms of cystocele may not require specific treatment, while surgery is suggested for serious cystocele.
Symptoms often worsen after standing for a long duration, and relieves while resting. Urine leakage may also happen with slight pressure on the bladder, as in sneezing, coughing, and even walking.
Stretching and weakening of the muscles and supportive tissues between vagina and bladder cause Anterior prolapse (Cystocele). As the tissue is weak, bladder sags from its normal position and bulges into the vagina. Weakening of pelvic muscles and supportive tissues may be caused by:
Age is a major risk factor for anterior prolapse as muscles and supportive tissues of the pelvic region weakens with aging. Risk of cystocele increases with vaginal childbirth. Uterus removal or hysterectomy weakens the pelvic floor muscles leading to bladder bulge.
Women with a genetic makeup for weak connective tissue have increased chances for anterior prolapse. Obesity also increases the risk of developing this condition.
4 Making a Diagnosis
The diagnosis of Anterior Prolapse (Cystocele) is done by number of tests.
Tissue bulge into vagina is revealed in physical examination. The degree of prolapse is checked by asking the patient to sit as in during bowel movement.
The amount of urine left in the bladder after urination, called postvoid residual is measured with an ultrasound of bladder. Postvoid residual can be measured using a catheter too. X-ray examination of the bladder also reveals bladder bulging into vagina.
Mild form of Anterior prolapse (Cystocele) may not require any specific treatment. Patients are suggested to avoid lifting heavy weights and straining that could worsen the symptoms of bladder bulge. Moderately bothersome cystocele is treated with pessary.
Pessary is a device that supports the vaginal wall and holds bladder in its place. Pelvic floor, or Kegel, exercises help in strengthening the walls of pelvic floor and also in holding the organs in their proper position. Estrogen therapy is suggested for women after menopause as lack of estrogen weakens the pelvic floor muscles.
Surgery is suggested for treatment of large cystocele. Surgery tightens the tissue around vagina and aligns bladder back in its position. In this procedure, called anterior colporrhaphy, an incision is made on the wall of vagina and the supportive tissue tightened, providing more support for the bladder. Stress incontinence, or urine leakage due to slight pressure, is treated with urethral suspension.
Risk of anterior prolapse can be prevented by self-management. This includes:
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