Mild cases of cystocele seldom produce any symptoms. In severe cases, cystocele presents with the following signs and symptoms [7]:

• Pain during intercourse followed by leakage of urine in some cases
• Feeling of pressure on the pelvic region
• Prone to frequent bladder infections
• Discomfort increases when during activities such as coughing, bending down or lifting heavy objects
• Incontinence
• Feeling of incomplete bladder emptying which causes increase in urge to urinate

Symptoms of cystocele are more experienced and evident, when the affected individuals stand for longer duration [8].

• Recurrent Urinary Tract Infection

  Preliminary study on the prevention of recurrent urinary tract infections in adult women using intravaginal lactobacilli. Int Urogynecol J. 1992;3:22–5. CrossRef Google Scholar 5. Franco AVM. Recurrent urinary tract infections. [doi.org]

  Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000; 30 :152–6. doi: 10.1086/313596. [ PubMed ] [ CrossRef ] [ Google Scholar ] 16. Olsen AL, Smith VJ, Bergstrom JO, et al. [ncbi.nlm.nih.gov]

  With regard to urinary function, it is important to note any symptoms of urinary obstruction from the prolapse, which can include frequency, urgency with or without urge incontinence, weak stream, hesitancy, recurrent urinary tract infections, a sensation [urologytimes.com]

• Nocturnal Awakening

  These include: Involuntary escape of urine in moments of stress on the pelvic floor, such as hearty laughter, sneezing or coughing Frequency of urination Nocturnal awakening for the purpose of urination more than once or twice a night Urge incontinence [news-medical.net]

• Myalgia

  We did have two patients that suffered from vaginal pain postoperatively and were found to have levator myalgia and pelvic floor spasm on exam. [hindawi.com]

• Meningism

  Low suspicion for traumatic orbital CSF fistula can lead to delay in diagnosis, which increases the risk of meningitis. [ncbi.nlm.nih.gov]

  In 2014 it was estimated that about one in 2000 newborn babies have GBS bacterial infections within the first week of life, usually evident as respiratory disease, general sepsis, or meningitis.[134] Untreated sexually transmitted infections (STIs) are [en.wikipedia.org]

• Foot Drop

  Pain at the buttock and back of the thigh that radiates downward, with or without foot drop, suggests sciatic nerve injury. This complication usually occurs after prolonged use of free-hanging stirrups. [emedicine.medscape.com]

• Urinary Incontinence

  We tested the feasibility of using a larger graft to correct cystocele with or without stress urinary incontinence. [ncbi.nlm.nih.gov]

  Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 1981;57:357–362 PubMed Google Scholar 9. Shull BL, Baden WF. A six-year experience with paravaginal defect repair for stress urinary incontinence. [link.springer.com]

• Pelvic Pain

  Medium-term analysis of 79 patients (84%) after 36 months showed a satisfaction rate of 98.7% (78/79), a mesh contraction rate of 5.1% (4/78), only one case of vaginal mesh exposure (1.3%), no cases of chronic pelvic pain, and a postoperative dyspareunia [ncbi.nlm.nih.gov]

  Don’t let bladder problems or pelvic pain keep you from doing things you love. At Lehigh Valley Health Network (LVHN), our urologists are trained in the diagnosis and treatment of pelvic floor disorders. [lvhn.org]

  At Rush, you also have the option of contacting the Program for Abdominal and Pelvic Health, which is designed to address the full range of issues related to pelvic conditions, including pelvic pain. [rush.edu]

• Urinary Stress Incontinence

  Patients with urinary stress incontinence show greater frequency of cistocele I, urethrocele II. 13 patients had low urethal close pressure. [ncbi.nlm.nih.gov]

  This often provides relief if you suffer from urinary stress incontinence as well. This must take place in a hospital, with anesthesia, and may require an overnight stay. The recovery time on this surgery is usually four to six weeks. [obgynecologistnyc.com]

  The size of the cystocele or vaginal protrusion may bear no relation to the sense of pelvic heaviness, or severity of urinary stress incontinence. Some women are oblivious to large protrusions from the vagina. [glowm.com]

  : The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet. Gynecol. Scand., 68: 545–549, 1989. Google Scholar Medline 13) Bump, R.C. Fantl, J.A. [journals.sagepub.com]

• Dysuria

  A 81 YO women;multipara and without any past medical history; complainig since 6 months of urinary frequency and dysuria ;was admitted to our emergency department for anuria; Clinical examination revealed a complete hysterocele with a grade 3 cystocele [webmedcentral.com]

  Lastly, a bulge in the area of the urethra should be evaluated for a possible urethral diverticulum, especially if the patient complains of the 3 "Ds" of a diverticulum: dysuria, dyspareunia, and postvoid dribbling. [medscape.com]

  Investigations for UTI Most patients, but not all, will present with dysuria, frequency, urgency, nocturia and urge incontinence. Malodorous urine and haematuria may be present. [doi.org]

• Bladder Spasm

  Bladder spasms While you’re recovering, you may experience bladder spasms that can cause urine leakage. While they may feel uncomfortable or even painful, try not to take any medication for them. [mskcc.org]

The following methods are employed for diagnosis of cystocele:
Pelvic examination: A preliminary pelvic examination will be carried out at 2 different positions – in the standing position and supine position. During the examination, tissue bulge into the vagina will be noticed, which is an indication of cystocele. Individuals would also be asked to exert pressure, to measure the strength of pelvic muscle, and to analyze the degree of prolapse that has occurred.

Urine and bladder function tests: These tests help in determining how well the bladder gets emptied after urination. In addition, signs of urine or bladder infection will also be checked through urine samples.

Questionnaire: The affected individual will be asked to fill out the questionnaire, which will help in determining the degree of prolapsed, and its affect on the quality of life. The results that are obtained help in determining the future course of treatment.

Mild cases of cystocele do not require any treatment. However, the condition is constantly monitored to determine the disease progression. Such individuals are advised to practice exercises that would help in strengthening the pelvic muscles. When these are not effective, then the following methods are used for treating cystocele:

Pessary: Pessary is a supportive device, made up of plastic or rubber ring, which is inserted into the vagina. It is a removable device that provides support to the bladder. The individuals can clean the device, and reinsert it by themselves.

Estrogen therapy: It is the method of choice in cases, when menopause has set in. Estrogen is used in form of vaginal pill or cream which helps in strengthening the pelvic muscles [9].

Surgery: When the above mentioned methods of treatment do not work, and the disease has progressed to more advanced stages, then surgery is the last resort. Surgical intervention is used for placing the bladder back into its position. This is done by tightening the muscles and ligaments of the pelvic floor.

In mild cases requiring minimal treatment, the prognosis is favorable. In cases when surgical intervention becomes necessary, the outcome after the procedure is excellent, as long as the woman avoids all those activities that exert pressure on the pelvic muscles [6].

Older aged women are more prone to contract this condition, than their younger counterparts, probably due to weakening of the muscles with advancing age. Some theories suggest that menopause may increase the risk of developing cystocele. However, studies still need to be done, to further establish a strong link between these factors. The various causative factors for development of cystocele include the following:

• Strenuous activities, such as child birth, through the normal process or lifting of heavy objects
• History of constipation that is continuing for several years
• Obesity or overweight
• History of chronic cough which is violent in nature
• Strain that occurs during bowel movements [2]

Cystocele is considered to be a major health concern, amongst the elderly population. It has been estimated that, about 200,000 operations are performed every year in the US for pelvic organ prolapsed. Cystocele is the most common form of pelvic organ prolapse [3].

Anatomically, the pelvic floor constitutes of ligaments, and muscles, along with pelvic organs. Advancing age, and certain traumatic or strenuous conditions, can cause the ligaments and muscles of the pelvic floor to weaken. Such a kind of event can cause the bladder to slip from its original position. The bladder moves down and bulges into the vagina. Such a type of condition is also referred to as anterior prolapse [4].

There have been pieces of evidence, suggesting that cystocele may not develop in women before menopause. This is so because; the hormone estrogen is responsible for maintaining the elasticity of the vaginal tissues. After menopause, when the levels of estrogen undergo a significant decline, the elasticity of the tissue also reduces favoring the development of cystocele [5].

Several self care tips can be adopted, to prevent the onset of cystocele. These include:

• Practicing kegel exercises on a regular basis, helps in strengthening the pelvic muscles, which in a way, prevents the development of cystocele.
• Having a fiber rich diet to help keep constipation at bay
• Avoiding in lifting heavy loads; if it is unavoidable, then, learning the correct way of lifting will be helpful.
• Chronic coughs should be promptly treated
• It is also advised to avoid putting on weight, which would in turn, put pressure on pelvic muscles [10].

Such a type of medical condition gives rise to several uncomfortable symptoms. Cystocele occurs, when the muscles of the vaginal walls and bladder, undergo strenuous situations, such as process of child birth, or long standing history of constipation, lifting heavy objects or coughing violently [1].

Definition: Cystocele is a condition, wherein the bladder slips from its original position, and bulges into the vagina, due to weakening of the muscles of pelvic floor. Post menopausal and elderly women are more prone to contract this condition.

Cause: Weakening of the pelvic muscles and tissues of vaginal wall, causes cystocele to develop. Several factors which exert pressure on these muscles cause them to loosen. These include, process of childbirth through the vaginal route, constipation, lifting of heavy load, menopause, and chronic cough.

Symptoms: Symptoms of cystocele include urinary incontinence, pain during intercourse, feeling of pressure in the pelvic region as well as vagina, frequent bladder infections, and discomfort experienced during coughing or bending.

Diagnosis: A preliminary pelvic examination is done to diagnose the condition. In addition, bladder and urine tests would follow, to check for infections and assess the bladder emptying capacity.

Treatment: In the initial stages, no treatment is required, except that the individual is asked to practice pelvic muscle strengthening exercises. When these do not work, then they are given pessary support devices, to be placed in the vagina. Surgery is the last resort, and employed in advanced cases.

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2. Rortveit G, Brown JS, Thom DH, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 2007; 109:1396.
3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. April 1997;89(4):501-6.
4. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175:10.
5. Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. Oct 2003;62(4 Suppl 1):45-51.
6. Pakbaz M, Mogren I, Lofgren M. Outcomes of cystocele repair surgery in relation to different anesthesia methods. Acta Obstet Gynecol Scand. 2010;89:876-81.
7. Marinkovic SP, Stanton SL. Incontinence and voiding difficulties associated with prolapse. J Urol 2004; 171:1021.
8. Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol 2000; 182:1021.
9. Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev 2010; :CD007063.
10. Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 2009; 113:81.