Cystocele
Encyclopedia
A cystocele is a medical condition that occurs when the tough fibrous wall between a woman's bladder
and her vagina
(the pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina. Urethrocele
s often occur with cystoceles.
helps keep the elastic tissues around the vagina strong, a cystocele may not occur until menopause
, when levels of estrogen decrease.
There are no muscles around the vagina, except the bulbocavernosus
muscles at the entrance to the vagina. The levator muscle passes around the vagina and the rectum and inserts into the levator plate, which can elevate rectum, the vagina and the bladder neck together. It is this muscle that is exercised by Kegel exercise
s. Elevation of the levator plate may partially compensate for the herniation.
A bladder that has dropped from its normal position may cause two kinds of problems: unwanted urine leakage and incomplete emptying of the bladder. The pubocervical fascia provides back support to the mid urethra, allowing compression when abdominal pressure is increased. This prevents urine loss with sudden increases in pressure, as with cough
s, sneeze
s, laughs
, or moves in any way that puts pressure on the bladder. If this compression is lost by tissue tears, then stress incontinence results.
If the base of the bladder herniates, then urine will sump down into the inside of the hernia, and bladder emptying will be impaired.
A doctor may be able to diagnose a grade 2 or 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible.
shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.
, a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers
.
Large cystoceles may require surgery to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynecologist, urologist or urogynecologist.
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
and her vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
(the pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina. Urethrocele
Urethrocele
A urethrocele is the prolapse of the female urethra into the vagina. Weakening of the tissues that hold the urethra in place cause it to move and to put pressure on the vagina, leading to the descent of the anterior distal wall of the vagina. Urethroceles often occur with cystoceles,...
s often occur with cystoceles.
Presentation
This condition may cause discomfort and problems with emptying the bladder. The elastic tissues of the vagina may compensate for this tear for some time after the injury occurs. Because the hormone estrogenEstrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
helps keep the elastic tissues around the vagina strong, a cystocele may not occur until menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
, when levels of estrogen decrease.
There are no muscles around the vagina, except the bulbocavernosus
Bulbospongiosus muscle
Bulbospongiosus is one of the superficial muscles of the perineum. It has a slightly different origin, insertion and function in males and females. In males, it covers the bulb of the penis...
muscles at the entrance to the vagina. The levator muscle passes around the vagina and the rectum and inserts into the levator plate, which can elevate rectum, the vagina and the bladder neck together. It is this muscle that is exercised by Kegel exercise
Kegel exercise
A pelvic floor exercise, more commonly called a Kegel exercise , consists of contracting and relaxing the muscles that form part of the pelvic floor, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective...
s. Elevation of the levator plate may partially compensate for the herniation.
A bladder that has dropped from its normal position may cause two kinds of problems: unwanted urine leakage and incomplete emptying of the bladder. The pubocervical fascia provides back support to the mid urethra, allowing compression when abdominal pressure is increased. This prevents urine loss with sudden increases in pressure, as with cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
s, sneeze
Sneeze
A sneeze is a semi-autonomous, convulsive expulsion of air from the lungs through the nose and mouth, usually caused by foreign particles irritating the nasal mucosa...
s, laughs
Laughter
Laughing is a reaction to certain stimuli, fundamentally stress, which serves as an emotional balancing mechanism. Traditionally, it is considered a visual expression of happiness, or an inward feeling of joy. It may ensue from hearing a joke, being tickled, or other stimuli...
, or moves in any way that puts pressure on the bladder. If this compression is lost by tissue tears, then stress incontinence results.
If the base of the bladder herniates, then urine will sump down into the inside of the hernia, and bladder emptying will be impaired.
Classification
A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.A doctor may be able to diagnose a grade 2 or 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible.
Diagnosis
In more complex instances, additional testing will be requested. A "voiding cystourethrogram" (sis-toe-yoo-REETH-roe-gram) is a test that involves taking x-rays of the bladder during urination. This x-rayX-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.
Treatment
Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessaryPessary
A pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
, a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers
Genital ulcer
A Genital ulcer is an ulcer located on the genital area, usually caused by a sexually transmitted disease such as genital herpes, syphilis, chancroid, or thrush. Some other signs of having genital ulcers include enlarged lymph nodes in the groin area, or vesicular lesions, which are small, elevated...
.
Large cystoceles may require surgery to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynecologist, urologist or urogynecologist.