Cystocele

Cystocele refers to the condition when the bladder bulges into the vagina often due to excessive pressure on the pelvic floor such as during childbirth or lifting heavy objects. ^[1]

Causes

The condition often results from too much muscle straining usually during childbirth. Other activities which may lead to cystocele include heavy lifting, frequent straining to pass bowel motions and extreme coughing often due to a chronic lung disease. Smoking is an identified risk factor. Estrogen is a hormone that helps maintain the pelvic floor muscles strong. Thus, when this hormone declines such as after menopause, the woman gets a relatively higher chance of developing cystocele. Moreover, the condition can occur by itself. In some cases, it can come along with other abnormalities like uterine prolapsed or rectocele. ^[1]

Grading

The symptoms depend upon the degree of prolapse. A grading system is made to better assess cystocele. Grade 1 is the mildest wherein the bladder sags only a short way into the vagina. The next grade 2 is assigned when the bladder has reached the vaginal entrance. And grade 3 refers to the most severe when the bladder has already protrude out through the vaginal opening. ^[2]

Signs and Symptoms

The patient may complain of leaking urine when she coughs or laughs. She may also feel incomplete emptying of the bladder or she may need to strain to start urination. The urine flow also is likely to be discontinuous. ^[1] Some patients sense fullness inside the vagina or bulging in the vaginal opening that goes away upon lying down. Pain during sexual intercourse and repeated bacterial infections are also being reported. ^[1]

Diagnosis

The patient’s history is an indispensable tool to identify probable risk factors such as vaginal deliveries and occupation that may involve strenuous activities. In physical examination, the health care provider assesses the pelvic floor and check for prolapse. Laboratory exam that may be needed include voiding cystourethrogram. ^{[1] [3]}

Treatment

Treatment may be in the form of physiotherapy or exercises to improve the strength of the pelvic floor muscles. Estrogen replacement therapy or a vaginal support called pessary may be recommended in some patients. Repair may also be done on a surgical procedure.

References:

1.http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cystocele

2.http://medicalcenter.osu.edu/patientcare/healthcare_services/urinary_bladder_kidney/urogenital_disorders/overview_urogenital_disorders/cystocele_fallen_bladder/Pages/index.aspx

3.http://kidney.niddk.nih.gov/kudiseases/pubs/cystocele/