Cystocele (Fallen Bladder)

What is a cystocele?

Cystocele is the name for a hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

What are the results of a cystocele?

In addition to discomfort, the resulting dropped bladder can cause two kinds of problems to occur, including the following:

• urine leakage
• incomplete emptying of the bladder

The dropped bladder stretches the opening into the urethra, and urine may leak when a woman does any action that causes pressure on the bladder, such as coughing.

What are the grades of cystoceles?

grade 1	mild - the bladder droops only a short way into the vagina.
grade 2	more severe - the bladder has sunk into the vagina far enough to reach the opening of the vagina.
grade 3	most advanced - the bladder bulges out through the opening of the vagina.

What causes a cystocele?

A cystocele may result from the following:

• heavy lifting
• straining muscles during childbirth
• repeated straining during bowel movements
• menopause
  The hormone estrogen helps keep the muscles around the vagina strong, but, with menopause, the body stops making estrogen and the muscles around the vagina and bladder may become weakened.

How is a cystocele diagnosed?

In addition to a complete medical history and physical examination (which may reveal the fallen part of the bladder through the vagina), diagnostic procedures for a cystocele may include a cystourethrogram (also called a voiding cystogram). This is an x-ray of the bladder during urination and with the bladder and urethra filled with contrast medium to determine the shape of the bladder and any obstructions.

Other tests and procedures may be necessary to determine if there are any problems in the other areas of the urinary system.

Treatment for cystoceles:

Specific treatment for cystoceles will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• activity modification (i.e., avoiding heavy lifting or straining that could cause the cystocele to worsen)
• pessary - a device placed in the vagina to hold the bladder in place.
• surgery (to move the bladder back into a more normal position)
• estrogen replacement therapy (may help to strengthen the muscles around the vagina and bladder)

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