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].

• Pain

  If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may still occur after surgery. Symptoms of urinary incontinence or retention may return or get worse following surgery. [uwhealth.org]

  Lower back pain. Need to urinate often or urgently, especially after strenuous activity (stress incontinence). Needing to push organs back up into the vagina to empty the bladder or have a bowel movement. Pain during sex. [uchealth.org]

  Although serious complications are not common with the mesh, the mesh has been shown to cause the following problems: Pain with sexual intercourse Pain in the legs, abdomen or buttocks Widespread pelvic and vaginal pain Inability to walk These complications [uciurology.com]

• Falling

  Other kinds of straining-such as heavy lifting or repeated straining during bowel movements-may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. [empowher.com]

  This worked well in some patients to prevent the bladder from falling into or out of the vagina. However, future problems with the mesh were not foreseen at the time and the mesh has been proven to cause complications. [uciurology.com]

  Overview A cystocele occurs when the bladder falls from its normal position into the pelvic and pressing against the vaginal wall. It is often referred to as an anterior vaginal prolapse, herniated or a prolapsed bladder. [vejthani.com]

  Pelvic Prolapse is when pelvic supporting tissues have torn away from their normal attachments and pelvic organs fall down. [advancedwomenshealthcare.us]

  If the pelvic floor becomes weakened or damaged — for example, during childbirth — the bladder can fall and start bulging into the vagina. This is called cystocele, or prolapsed bladder. It is one type of pelvic organ prolapse. [rush.edu]

• 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: Stanton SL, Dwyer PL, editors. Urinary tract infection in the female. London: Martin Dunitz; 2000. pp. 227–36. [ Google Scholar ] 4. Bruce AW, Reid G, McGroarty JA, Taylor M, Preston C. [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]

• Collapse

  It is also referred to as an anterior prolapse as the front (or anterior) vaginal wall has collapsed allowing the bladder to bulge downward into the vagina. [gynecologicsurgery.com]

  This collapse causes the bladder to put pressure on the walls of the vagina, it can also cause the bladder to protrude out of the vagina. A cystocele is easily diagnosed during a physical exam especially if it is visible to the eye. [urologyaustin.com]

  Up to one third of women with Marfan syndrome have a history of vaginal wall collapse. [en.wikipedia.org]

• Malaise

  Patients who are reliant on self-catheterisation in order to void may suffer only from lower abdominal pain or systemic malaise in the absence of specific lower urinary tract symptoms. [doi.org]

• Chronic Cough

  These include, process of childbirth through the vaginal route, constipation, lifting of heavy load, menopause, and chronic cough. [symptoma.com]

  A cystocele may be caused by: Advancing age Overweight Child birth Heavy lifting Straining muscles during childbirth Chronic coughing Constipation Repeated straining during bowel movements Previous pelvic surgery Weak muscles around the vagina caused [uchealth.org]

  Vaginal childbirth, chronic constipation, chronic coughing, or heavy lifting can increase the risk of cystocele, and which causes the pelvic floor to weaken or stretches that could lead to cystocele. Many treatments are available for cystocele. [vejthani.com]

  Control coughing. Get treatment for a chronic cough or bronchitis, and don’t smoke. Avoid weight gain. Talk to your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them. [alaskaurology.com]

• Abdominal Pain

  You have severe lower abdominal pain. You have a bad-smelling discharge coming from your vagina. When should I call my doctor? You have a fever. You have chills or feel weak and achy. You have lower abdominal pain or back pain that does not go away. [drugs.com]

  pain.[1] When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream.[1] Those with long term problems are at risk of urinary tract infections.[1] Causes include blockage of the urethra, nerve [en.wikipedia.org]

  Patients who are reliant on self-catheterisation in order to void may suffer only from lower abdominal pain or systemic malaise in the absence of specific lower urinary tract symptoms. [doi.org]

• Muscle Strain

  Other kinds of straining-such as heavy lifting or repeated straining during bowel movements-may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. [empowher.com]

  A cystocele may result from muscle straining while giving birth. Other kinds of straining — such as heavy lifting or repeated straining during bowel movements — also may cause the bladder to fall. [urogyn.org]

  A cystocele may result from muscle straining while giving birth. Other kinds of straining — such as heavy lifting or repeated straining during bowel movements — may also cause the bladder to fall. [medigoo.com]

  A cystocele may result from muscle straining while giving birth. Other kinds of straining -- such as heavy lifting or repeated straining during bowel movements -- may also cause the bladder to fall. [medicinenet.com]

  Constipation and/or repeated muscle straining during bowel movements. Frequent coughing. Aging and a drop in the hormone estrogen. [my.clevelandclinic.org]

• Irritability

  However, some patients will present with renal failure, sepsis, or bladder necrosis, although others will remain asymptomatic.(1-4) We report a patient who presented with irritative voiding symptoms and a large, right-sided hydrocele. [ncbi.nlm.nih.gov]

  Vaginal irritation is also a possible side effect, although certain vaginal gels can help to reduce such side effects. Women who are past the age when the menopause normally occurs may need to use oestrogen cream for the irritation. [digitimer.com]

  Bladder Irritants Uti Treatment Over The Counter Uti Treatment Without Antibiotics Painful Bladder Syndrome Baking Soda For Uti How To Get Rid Of A Uti In 24 Hours Apple Cider Vinegar Uti How Long Does A Uti Last [play.google.com]

  The pessary should be removed so that the vagina can be examined for irritation, pressure sores or allergic reaction. Having to change the size of the pessary at least once after the initial fitting is not uncommon. [aafp.org]

  Diseases associated with constipation include hypothyroidism, certain types of cancer, and irritable bowel syndrome. [en.wikipedia.org]

• Seizure

  Calcium feedback hemostasis is impaired, and children with OPT are at risk of developing hypocalcemia with attendant tetanic seizures and secondary hyperparathyroidism. [ncbi.nlm.nih.gov]

  Prolonged labour may result in maternal exhaustion, fetal distress, and other complications including obstetric fistula.[113] Eclampsia[edit] Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. [en.wikipedia.org]

• Urinary Incontinence

  There are several types of surgery to correct stress urinary incontinence. These surgeries lift the urethra and/or bladder into their normal position. To learn more about these surgical procedures, see the topic Urinary Incontinence in Women. [uwhealth.org]

  If you have urinary incontinence related to anterior prolapse – specifically stress urinary incontinence or leakage during strenuous activity – you may need a procedure to support the urethra to ease the symptoms of incontinence. [uchealth.org]

  incontinence Hodge* Mild cystocele 2 to 4 Medium Hodge with support* Mild cystocele 2 to 4 Medium Stress urinary incontinence Smith, Risser* Mild cystocele 2 to 4 Medium Stress urinary incontinence Introl† Stress urinary incontinence Call manufacturer [aafp.org]

  In addition, urinary incontinence should be evaluated. As a result of all these, it is necessary to add urinary incontinence surgery in addition to cystocele surgery. In severe cases, the treatment is definitive surgery. [drabdullaharmagan.com]

• Dyspareunia

  Postoperative voiding difficulties, dyspareunia, or pain were not observed. [ncbi.nlm.nih.gov]

  This suggests that if 7% developed de novo dyspareunia after mesh repair, then 2% to 8% would experience de novo dyspareunia after native tissue repair. 2.8.2 Dyspareunia (one to two years) Studies provided no evidence of a postoperative difference in [doi.org]

• Pelvic Pain

  No data was given for nocturia or frequency in that RCT study [ 17 ] and no data for chronic pelvic pain or faecal incontinence. [ncbi.nlm.nih.gov]

  If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may still occur after surgery. Symptoms of urinary incontinence or retention may return or get worse following surgery. [uwhealth.org]

  People with a severe cystocele may have: Problems controlling the flow of urine or fully emptying the bladder Pelvic pain or pressure Pain during sex Tissue bulging out of vagina People with a severe rectocele may have: Pain or pressure in the vagina [lahey.org]

• Urinary Stress Incontinence

  According with the type of urinary incontinence, 72 patients had urinary stress incontinence, 41 mixed urinary incontinence, 8 with urge incontinence. [ncbi.nlm.nih.gov]

  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]

  : Preoperative screening for latent stress incontinence in women with cystocele. Neurourol. Urodyn., 4: 3–7, 1985. Google Scholar 16) Gardy, M. Kozminski, M. De Lancey, J. Elkins, T. Mecguire, E.J. : Stress incontinence and cystoceles. J. [journals.sagepub.com]

  Stress Incontinence Urinary stress incontinence can occur during activities, such as exercising, sneezing, or coughing. This is when a small amount of urine leaks from the urethra. A variety of things can contribute to stress incontinence. [uospc.com]

• Urinary Urgency

  Keywords cystocele; urge symptoms; urinary incontinence; urinary urgency; overactive bladder; pelvic organ prolapse About this article Title The impact of cystocele repair on urge symptoms in women with pelvic organ prolapse Journal Ginekologia Polska [journals.viamedica.pl]

  Ellerkmann and colleagues noted that 63% of patients present with bulge symptoms, 73% urinary incontinence, 86% urinary urgency or frequency, 62% voiding dysfunction [6]. [irispublishers.com]

  Other possible adverse effects of prolapse surgery include injuries to adjacent organs, urinary problems (retention of urine, stress incontinence, urinary infection, urinary urgency), pain during sex (dyspareunia), and the formation of blood clots. [ourbodiesourselves.org]

  Other side effects of prolapse surgery may include injuries to adjacent organs, urinary problems (retention of urine, stress incontinence, urinary infection, urinary urgency), pain during sex (dyspareunia) and the formation of blood clots. [womhealth.org.au]

  Vaginal estrogen and immediate-release oxybutynin were similar in improvement of urinary urgency, frequency, and urgency urinary incontinence in women with overactive bladder, but oxybutynin had higher rates of side effects and discontinuation. [doi.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.

• Estrogen Decreased

  Later, during menopause, estrogen decreases and the vaginal walls weaken, exposing the tear. [lowcountryurology.com]

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.

1. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013; 24:1783.
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.
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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.
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