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A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina.[1] Symptoms may include trouble starting urination, incomplete urination, urinary incontinence, or frequent urination.[1] Complications may include urinary retention.[1]

Cystocele
Synonyms Prolapsed bladder, dropped bladder[1]
Cystocele.jpg
A cystocele protruding through the vagina in a 73-year-old woman.
Pronunciation
Specialty Urogynecology
Symptoms Trouble starting urination, incomplete urination, urinary incontinence, frequent urination[1]
Complications Urinary retention[1]
Types Grade 1, 2, 3[1]
Risk factors Childbirth, constipation, chronic cough, heavy lifting, being overweight[1]
Diagnostic method Based on symptoms and examination[1]
Similar conditions Bartholin cyst, nabothian cyst, urethral diverticulum[2]
Treatment Lifestyle changes, pelvic muscle exercises, vaginal pessary, surgery[1]
Frequency ~33% of women > 50 years old[3]

Causes include childbirth, constipation, chronic cough, heavy lifting, and being overweight.[1] The underlying mechanism involves weakening of the muscles and connective tissue between the bladder and vagina.[1] Diagnosis is often based on symptoms and examination.[1]

If the cystocele causes few symptoms, lifestyle changes may be recommended.[1] In those with significant symptoms pelvic muscle exercises, a vaginal pessary, or surgery may be recommended.[1] The condition becomes more common with age.[1] About a third of women over the age of 50 are affected to some degree.[3]

Contents

Signs and symptomsEdit

This condition may cause discomfort and problems with emptying the bladder. The elastic tissues of the vagina may compensate for this tear for some time after the injury occurs. Because the hormone estrogen helps keep the elastic tissues around the vagina strong, a cystocele may not occur until menopause, when levels of estrogen decrease.

There are no muscles around the vagina, except the bulbocavernosus muscles at the entrance to the vagina. The levator muscle passes around the vagina and the rectum and inserts into the levator plate, which can elevate rectum, the vagina and the bladder neck together. It is this muscle that is exercised by Kegel exercises. Elevation of the levator plate may partially compensate for the herniation.

A bladder that has dropped from its normal position may cause two kinds of problems: unwanted urine leakage and incomplete emptying of the bladder. The pubocervical fascia provides back support to the mid urethra, allowing compression when abdominal pressure is increased. This prevents urine loss with sudden increases in pressure, as with coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder. If this compression is lost by tissue tears, then stress incontinence results.[4]

If the base of the bladder herniates, then urine will sump down into the inside of the hernia, and bladder emptying will be impaired.

DiagnosisEdit

In more complex instances, additional testing will be requested. A voiding cystourethrogram is a test that involves taking x-rays of the bladder during urination. This x-ray shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.[4]

ClassificationEdit

A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.[4]

A doctor may be able to diagnose a grade 2 or 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible.

TreatmentEdit

Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele.[4] If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary,[5] a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.

Large cystoceles may require surgery[6] to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynecologist, urologist or urogynecologist.

ReferencesEdit

  1. ^ a b c d e f g h i j k l m n o p "Cystocele (Prolapsed Bladder)". National Institute of Diabetes and Digestive and Kidney Diseases. March 2014. Archived from the original on 4 October 2017. Retrieved 25 October 2017. 
  2. ^ Federle, Michael P.; Tublin, Mitchell E.; Raman, Siva P. (2016). ExpertDDx: Abdomen and Pelvis E-Book. Elsevier Health Sciences. p. 626. ISBN 9780323443128. Archived from the original on 2017-10-25. 
  3. ^ a b Firoozi, Farzeen (2014). Female Pelvic Surgery. Springer. p. 73. ISBN 9781493915040. Archived from the original on 2017-10-25. 
  4. ^ a b c d "Cystocele (Fallen Bladder)". Archived from the original on 2007-10-07. Retrieved 2007-11-21. 
  5. ^ "Cystocele: Treatment - MayoClinic.com". Archived from the original on 2007-12-17. Retrieved 2007-11-21. 
  6. ^ Handel LN, Frenkl TL, Kim YH (2007). "Results of cystocele repair: a comparison of traditional anterior colporrhaphy, polypropylene mesh and porcine dermis". J. Urol. 178 (1): 153–6; discussion 156. doi:10.1016/j.juro.2007.03.041. PMID 17499285. 

External linksEdit