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: 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]

• 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]

• Sneezing

  In addition, in cases such as sters-like burning cough, sneezing, climbing stairs, laughing, administration can be seen. [drabdullaharmagan.com]

  The weakening of the muscular wall in this condition can cause urine to leak from the bladder when there is an increase in internal abdominal pressure, such as in sneezing or coughing.ʺ The National Institute of Diabetes and Digestive and Kidney Diseases [empowher.com]

  This can cause urine to leak when you cough, sneeze, or lift something heavy. A cystocele can also cause discomfort in the pelvis and make it hard to fully empty your bladder. [fairview.org]

  […] of the pelvic floor include: To support the pelvic organs, specifically the uterus, the bladder, and the rectum To help provide sphincter control for the bladder and bowel To withstand increases in pressure that occur in the abdomen such as coughing, sneezing [advanced-trainings.com]

  In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs or moves in any way that puts pressure on the bladder. [urogyn.org]

• Lower 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]

  abdominal 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 [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]

• Low Back 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]

• Suggestibility

  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. [symptoma.com]

  PURPOSE: Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that cystoceles may recur if associated apical prolapse is not corrected. [ncbi.nlm.nih.gov]

  He may suggest avoiding heavy lifting or straining. A pessary device may be tried if symptoms are more bothersome which is placed inside the vagina to help hold the bladder in place during the day time. [empowher.com]

  Imaging during strain is suggested to improve detection 3. Additional features that may be detected during dynamic pelvic floor MRI are changes in the urethral angle and involuntary loss of urine into the urethra during defecation. [radiopaedia.org]

  There are various treatments available which your physician may suggest. Never be afraid to ask questions. Your physician may refer you to a gynaecologist, urologist or urogynaecologist, who are experts and specialise in these symptoms. [incostress.com]

• 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

  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]

• 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]

• 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]

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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