Cystocele Repair

A cystocele often occurs when the supportive tissue located between a woman’s bladder and vaginal wall weakens and expands, leading to the protrusion of the bladder into the vagina. A cystocele is also known as a prolapsed bladder.

Symptoms:

• Fullness or pressure in the pelvis and vagina, particularly when standing for a prolonged period of time
• Experiencing great discomfort when you strain, cough, or lift objects
• A bulge of tissue which protrudes through the opening of the vagina
• Experiencing the feeling that you haven’t fully emptied your bladder even after urinating
• Persistent bladder infections
• Pain or leakage of urine during sexual intercourse

Causes

• Pregnancy and vaginal childbirth
• Overweight or obesity
• Repeated lifting of heavy objects
• Excessive straining
• Bronchitis
• Ageing
• Having a hysterectomy

Diagnosis

The diagnosis of cystocele is usually performed with a pelvic exam.

Treatment

The treatment generally depends on the severity of the cystocele and if you have any associated conditions such as a prolapsed uterus. Mild cases usually don’t require treatment. You could either go for a wait-and-see approach and occasional visits to your doctor to check whether your prolapse is worsening. You could even adopt certain self-care measures, such as exercises to enhance the strength of your pelvic floor muscles.

If self-care measures don’t prove effective, your doctor may suggest either of these options:

• Pessary- A vaginal pessary refers to a plastic or rubber ring which is inserted into the vagina to support the bladder. Pessaries are a temporary alternative to surgery.
• Estrogen therapy- This involves using a vaginal cream, pill or ring if you’ve already undergone menopause. Estrogen helps to strengthen the pelvic muscles.

When surgery is necessary

If you have obvious, uncomfortable symptoms, then the cystocele may require immediate surgery.

• How it’s done. The surgery is done vaginally and involves lifting the prolapsed bladder back into position. The excess tissue is removed and the muscles and ligaments of the pelvic floor are tightened. A special type of tissue graft is used to strengthen the vaginal tissues and provide enhanced support if the vaginal tissues are extremely thin.
• If you have a prolapsed uterus. If the cystocele is associated with a prolapsed uterus, the doctor may recommend the removal of the uterus besides repairing the damaged pelvic floor muscles, ligaments and tissues.

If the cystocele is accompanied by stress incontinence, the doctor may recommend various procedures to support the urethra including urethral suspension (Tension-free vaginal sling procedure)