Cystocele

A **cystocele** is also called a **prolapsed bladder or anterior vaginal wall prolapse**. This is a medical condition when a woman's bladder bulges into her vagina. Sometimes it may bulge out through her vagina. Some women may have a cystocele with no symptoms. Some have problems with urination. Other problems may be incontinence (not being able to stop urination). Some women may have repeated urine infections if they have a cystocele. Other parts may also bulge into the vagina.

Women are at risk of having a cystocele if they have given birth, have a hard time with passing stool, have a chronic cough, lift heavy objects, or have had other surgeries of the reproductive organs. Other things which may cause cystocele is a family history of cystocele or being overweight. The reason why the bladder may bulge into the vagina is that the wall of the vagina becomes weak.

Sometimes a cystocele exists but does not cause difficulties. Women who have more serious problems may be treated with a vaginal pessary or surgery. Doing exercises with the pelvic muscles can help. Older women have cystocele more often then younger women.

## Signs and symptoms

A woman may have a cystocele if she has:
- a vaginal bulge or something coming out of the vagina
- a feeling that something is heavy in the vagina
- a hard time starting urination
- a feeling of that all the urine is not out of the bladder
- not being able to stop urination
- a hard time stopping stool
- urinary tract infections

### Complications

Cystocele can make sexual intercourse difficult or painful.  Even if cystocele is treated, there is about a 50% chance that it will happen again.

## Cause

A cystocele happens when muscles and attachments become weak because of childbirth or other causes.  Different parts of the vagina can become weak. Other parts of the reproductive system can bulge out of the body.

Some women have diseases that might cause the bladder to bulge out of the vagina. These diseases are Marfan syndrome and Ehlers-Danlos syndrome.

### Risk factors

There are many things that increase the chances of having a cystocele. Here are some things which might cause cystocele:
- a job of heavy lifting
- preganancy and childbirth
- hard coughing (smoking)
- family women with cystocele
- surgery to the reproductive organs
- older age
- constipation and being overweight

## Diagnosis

The doctor or nurse will examine the vagina and the bulge. The amount of urine that stays in the bladder and does not come out will be measured. An ultrasound might be used. Another test that might be used is called a a voiding cystourethrogram. Sometimes the woman may have an x-ray.

## Prevention

Cystocele may not be serious enough to make a woman see the doctor. If this is true, things can be done to stop the cystocele from becoming worse:
- stopping smoking
- losing weight
- exercises of muscles holding up the reproductive organs
- treatment of strong or chronic cough
- eating high fiber foods
- avoiding constipation and pushing to hard

## Treatment

A woman may choose no treatment for a cystocele that is not serious. A woman may choose surgery for a cystocele that is more serious. If the cystocele is bothersome a doctor might suggest using a pessary (a device placed in the vagina to hold the bladder in place).

### Non-surgical

Cystocele can sometimes be treated:
- Pessary - This is a device that is inserted into the vagina but is still able to be removed. This device may not work in all women.
- Pelvic floor muscle exercises - Pelvic floor exercises can help hold the reproductive organs in.
- Dietary changes - eating foods that contain a lot of fiber

### Surgery

Many times surgery can repair the cystocele. Many doctors who fix a cystocele are gynecologists. Surgery to fix a cystocele will depend on many things. Surgery doesn't work 10-50% of the time. In some cases a doctor may use surgical mesh to fix the cystocele.The doctor who fixes the cystocele may fold the weak tissue and then stitch it back in place.  The woman is usually put to sleep during surgery and the medicine to cause the sleep can be different for each woman. It may take four to six weeks to heal.

After surgery there may be some problems.
- bad reactions to the medication used to put the woman to sleep
- bleeding
- infection
- painful intercourse
- not being able to stop urine
- constipation
- bladder injuries
- infection
- more surgery

## Epidemiology

In the US, more than 200,000 surgeries are done to fix reproductive organs bulging out of the vagina. Most of these surgeries are for cystocele. between ages of 70–79 years old. Since the number of women getting older keeps getting larger, the number of women with reproductive organs bulging out of the vagina will increase by 46% by the year 2050.