Cystocele
A dropped bladder that bulges into the front wall of the vagina
Quick Facts
- Type: Pelvic organ prolapse
- What drops: The bladder, into the vaginal wall
- Common causes: Childbirth, aging, straining
- Specialist: Gynecology or urogynecology
Overview
A cystocele, also called an anterior vaginal prolapse or dropped bladder, occurs when the wall of tissue and muscle that supports the bladder weakens or stretches, allowing the bladder to sag downward and bulge into the front wall of the vagina. It is one of the most common forms of pelvic organ prolapse.
Cystoceles are often mild and may cause no symptoms, while more advanced ones can cause a noticeable bulge and discomfort. They most often develop after childbirth and around or after menopause, when supporting tissues are weaker. A cystocele is not dangerous, but it can affect comfort, bladder function, and quality of life, and a range of treatments can help.
Symptoms
Mild cystoceles often cause no symptoms. When symptoms occur, they may include:
- A feeling of fullness, pressure, or heaviness in the pelvis or vagina
- A bulge of tissue at or near the vaginal opening
- Discomfort that worsens with standing, lifting, coughing, or at the end of the day
- Difficulty fully emptying the bladder
- Frequent urination, urgency, or leaking
- Recurrent urinary tract infections
- Discomfort during sexual activity
Symptoms often ease when lying down. A sudden inability to urinate is uncommon but should prompt urgent care.
Causes
A cystocele develops when the muscles, ligaments, and connective tissue that support the bladder and vaginal wall become weak or stretched:
- Childbirth: Especially vaginal deliveries, large babies, or difficult deliveries.
- Aging and menopause: Lower estrogen levels weaken supporting tissues.
- Repeated straining: From chronic constipation, heavy lifting, or chronic cough.
- Increased pressure: From obesity or a previous pelvic surgery such as a hysterectomy.
Risk Factors
- Vaginal childbirth, particularly multiple or difficult deliveries
- Menopause and older age
- Being overweight
- Chronic constipation or straining
- Chronic cough, including from smoking
- Heavy lifting
- A family tendency toward weak connective tissue
Diagnosis
A cystocele is usually diagnosed with a pelvic examination:
- Pelvic exam: The clinician looks for a bulge in the front vaginal wall, sometimes while you bear down or stand, and grades how far the bladder has dropped.
- Bladder function tests: To check how well the bladder empties and whether there is leakage, if symptoms suggest it.
- Urine tests: To look for infection.
Additional imaging is occasionally used to evaluate the bladder or other pelvic organs.
Treatment
Treatment depends on how severe the cystocele is and how much it bothers you:
- Watchful waiting: Mild cystoceles with few symptoms may simply be monitored.
- Pelvic floor exercises: Kegel exercises strengthen the supporting muscles and can relieve mild symptoms.
- Pessary: A removable device inserted into the vagina to support the bladder and relieve the bulge.
- Lifestyle measures: Treating constipation, managing weight, and avoiding heavy lifting.
- Estrogen therapy: Vaginal estrogen may help after menopause in some cases.
- Surgery: To repair and support the vaginal wall for bothersome or advanced cystoceles.
Prevention
- Do pelvic floor exercises, especially after childbirth
- Maintain a healthy weight
- Prevent constipation with fiber, fluids, and not straining
- Avoid heavy lifting or use proper technique
- Treat a chronic cough and avoid smoking
When to See a Doctor
See a doctor if you notice a bulge in the vagina, pelvic pressure, or bladder symptoms that bother you, as treatments can improve comfort and function. Seek prompt care if you suddenly cannot urinate, have signs of a urinary tract infection such as fever, pain, or burning, or if the bulge becomes painful, since these need timely evaluation.
Frequently Asked Questions
What is a cystocele?
A cystocele, or dropped bladder, occurs when the tissue supporting the bladder weakens and the bladder bulges into the front wall of the vagina. It is a common type of pelvic organ prolapse, often related to childbirth and aging.
Is a cystocele dangerous?
A cystocele is not dangerous in itself, but it can cause discomfort, bladder problems, and recurrent urinary tract infections. Advanced cases can interfere with emptying the bladder, so bothersome symptoms are worth treating.
Can a cystocele be treated without surgery?
Yes. Many cystoceles improve with pelvic floor exercises, a supportive pessary, treating constipation, weight management, and sometimes vaginal estrogen. Surgery is usually reserved for more bothersome or advanced cases.
What causes a dropped bladder?
It is caused by weakening of the muscles and tissues that support the bladder, most often from childbirth, menopause, aging, chronic straining or constipation, chronic cough, heavy lifting, and obesity.
Do Kegel exercises help a cystocele?
Pelvic floor (Kegel) exercises strengthen the muscles that support the bladder and can relieve mild symptoms and help prevent worsening. They are often recommended as a first step, sometimes with a physical therapist's guidance.
References
- Mayo Clinic. Anterior vaginal prolapse (cystocele) — Symptoms and causes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Cystocele (prolapsed bladder).
- MedlinePlus, U.S. National Library of Medicine. Cystocele.
- Office on Women's Health, U.S. Department of Health and Human Services. Pelvic organ prolapse.