Anterior Vaginal Prolapse (Cystocele)

A cystocele, often referred to as an anterior vaginal prolapse or a prolapsed bladder, occurs when the bladder slips out of its normal position in the pelvis and presses on the vaginal wall.

The muscles and connective tissues of the pelvic floor normally hold the organs of the pelvis, such as the bladder, uterus, and intestines, in place. When the pelvic floor weakens or is subjected to excessive pressure, anterior prolapse happens. Over time, vaginal delivery, persistent constipation, severe coughing, or hard lifting are all examples of what might cause this.

Treatable anterior prolapse. Nonsurgical therapy is frequently successful for mild or moderate prolapse. To retain the vagina and other pelvic organs in their normal locations in more severe situations, surgery may be required.

Cystocele: Causes

The muscles, ligaments, and connective tissues that make up your pelvic floor support your bladder and other pelvic organs. Your ligaments and pelvic organ connections may get looser over time, as a result of delivery trauma, or as a result of persistent pressure. Your bladder may then sag lower than usual and protrude into your vagina as a result (anterior prolapse).

The following factors can strain the pelvic floor −

  • Both pregnancy and vaginal delivery

  • Being fat or overweight

  • Heavy lifting repeatedly

  • Struggle when going to the bathroom

  • Chronic bronchitis or cough

Cystocele: Symptoms

You might not experience any symptoms or see any indicators of anterior prolapse in moderate situations. When they appear, signs and symptoms may include −

  • A sensation of heaviness or pressure in your vagina and pelvis

  • A tissue protrusion in your vagina that you can sometimes see or feel

  • heightened pelvic pressure while stooping, coughing, hunching over, or lifting

  • Having difficulties commencing a pee stream, feeling as though your bladder is still partially full after urinating, needing to urinate frequently, or leaking urine are all examples of urination issues (urinary incontinence).

After prolonged standing, signs and symptoms are frequently more evident and may disappear when you lie down.

When to Visit a Doctor?

Even though a prolapsed bladder might be inconvenient, it seldom hurts. It could be challenging to clear your bladder, which could result in bladder infections. If you have any symptoms or indications that disturb you or interfere with your normal activities, schedule a visit with your healthcare professional.

Cystocele: Risk Factors

The major risk factors include −

  • Conceiving and giving birth. Anterior prolapse is more likely to occur in women who have had vaginal or instrument-assisted deliveries, numerous pregnancies, or pregnancies with large-for-gestational-age babies.

  • Aging. As you become older, your chance of anterior prolapse rises. This is particularly true during menopause when your body produces less estrogen, which keeps the pelvic floor robust.

  • Hysterectomy. Your pelvic floor may become weaker after having your uterus removed, however, this is not always the case.

  • Genetics. Some women are more prone to anterior prolapse because their connective tissues are thinner from birth.

  • Obesity. Obese or overweight women are more likely to get anterior prolapse.

Cystocele: Diagnosis

To diagnose anterior vaginal prolapse (cystocele) −

  • Pelvic examination. You could be inspected while laying down or even standing. Your doctor checks for a tissue protrusion into your vagina, a sign of pelvic organ prolapse, during the examination. To assess how much bearing down as though having a bowel movement impacts the degree of prolapse, you'll probably be asked to do so. You'll be asked to contract your pelvic floor muscles to stop the flow of pee to measure the strength of these muscles.

  • Completing a questionnaire. You can complete a questionnaire to assist your doctor in evaluating your medical background, the severity of your prolapse, and how much it impairs your quality of life. Decisions about therapy are also influenced by this knowledge.

  • Pee and bladder testing. You could have a test to determine how fully and effectively your bladder empties if you have a major prolapse. If it appears that you're holding more pee in your bladder than is typical after urinating, your doctor may also do a test on a urine sample to search for indications of a bladder infection.

Cystocele: Treatment

Treatment is based on your symptoms, the severity of your anterior prolapse, and any associated disorders you may have, such as urinary incontinence or several types of pelvic organ prolapse.

Most mild instances, especially those with little or no overt symptoms, don't need to be treated. Your doctor might advise waiting it out while making sporadic appointments to check on your prolapse.

If you do experience anterior prolapse symptoms, the first-line therapies include −

  • Exercises for the pelvic floor muscles. These exercises, often known as Kegels or Kegels, help your pelvic floor muscles get stronger so they can support your bladder and other pelvic organs more effectively. When Kegel exercises are shown by a physical therapist and reinforced with biofeedback, they may be most effective in reducing symptoms. These activities can help your symptoms go better.

  • A helping mechanism (pessary). A vaginal pessary, which supports the bladder, is a ring made of plastic or rubber that is put into the vagina. Although a pessary does not correct or cure the prolapse itself, the additional support it offers may aid with symptoms. Pessaries are frequently used by women in place of surgery when the danger of the procedure is too great.

When is Surgery Required?

Even after using the aforementioned treatments, you can still experience bothersome symptoms, necessitating surgery to correct the prolapse.

  • How to do it. The procedure, which is frequently carried out vaginally, entails pulling the prolapsed bladder back into place with sutures and trimming off any extra vaginal tissue. If your vaginal tissues appear to be particularly thin, your doctor may decide to fortify them and provide support using a specific type of tissue transplant.

  • If your uterus has prolapsed. Your doctor could advise a hysterectomy if the anterior prolapse is brought on by a prolapsed uterus in addition to treating the injured pelvic floor muscles, ligaments, and other tissues.

  • If incontinence is a problem. Your doctor may also suggest one of a variety of treatments to support the urethra (urethral suspension) and lessen your incontinence symptoms if your anterior prolapse is accompanied by stress incontinence, which is the spilling of pee during vigorous exercise.

You may need to postpone surgery until after you've finished having children if you're pregnant or considering getting pregnant. In the meanwhile, pessary or pelvic floor exercises may help you feel better. The results of surgery can persist for many years, but there is a chance that the prolapse will recur, necessitating another surgery.

Cystocele: Prevention

Vaginal prolapse is not always avoidable. You may follow healthy lifestyle practices to lower your chance of getting vaginal prolapse. These may consist of −

  • Doing regular exercise (performing Kegel exercises).

  • Maintaining a healthy diet and body weight.

  • Not being a smoker (smoking cigarettes can cause you to cough more).

  • Using safe lifting procedures while transporting large goods.


The use of clinical prediction models or the development of pertinent genetic testing may make it simpler to identify women who are more likely to get pelvic organ prolapse. Finding a group at high risk might enable targeted alteration of risk variables, such as obstetric events, by suggesting cesarean delivery.

Preoperatively, a comparable screening procedure might be used to determine the likelihood of mesh problems and recurrence of pelvic organ prolapse, including the identification of levator ani abnormalities.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 02-Mar-2023


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