Causes & management of cystocele

Causes & management of cystocele

Cystocele or bladder prolapse occurs when the ligaments and muscles supporting the urinary bladder weaken, leading to falling of the bladder into the vagina.
According to grades of bladder descent into vagina, there are 3 degrees of cystocele as follow:
•    Mild degree: the urinary bladder slightly drops down into the vagina.
•    Moderate degree: the urinary bladder drops down till the vaginal opening.
•    Severe degree: the urinary bladder bulges through the opening of the vagina.
There are many risk factors which increase the incidence of cystocele, the most significant ones includes the following:
1.    Multiple vaginal deliveries.
2.    Increased intra-abdominal pressure as in chronic cough or constipation.
3.    Menopause and decreased estrogen level, which lead to laxity of ligaments and muscles supporting the urinary bladder.
4.    Obesity.
Classic clinical picture of cystocele includes the following symptoms:
    Feeling something bulging or protrudes through the vaginal orifice which is usually accompanied with pelvic heaviness and pain.
    Dysuria and retention of urine which may lead to hydroureter and hydronephrosis.
    Recurrent UTI and vaginal infection.
    Dyspareunia.
Proper diagnosis and assessment of cystocele requires applying the following investigations:
•    Urodynamic studies: for assessment of the functional capacity of the urinary bladder.
•    Cysto-urethroscopy.
Initial management of cystocele (especially in mild degree) includes the following tips:
    Weight reduction.
    Kegel exercise to strengthen the muscles and ligaments supporting the bladder.
    Hormonal replacement therapy (estrogen).
In moderate and severe degrees of cystocele there are other advanced therapeutic options, such as:
1.    Vaginal ring pessary: it aims to lift the urinary bladder as well as to promote extension of the upper part of the vagina.
2.    Reconstructive surgery for repair of cystocele (anterior colporrhaphy).


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