Anterior vaginal prolapse (cystocele)

Overview

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Anterior prolapse (cystocele)

Anterior prolapse (cystocele)

Anterior prolapse happens when the bladder drops and pushes on the vagina. Also called a cystocele, it happens when the muscles and tissues that support the bladder get weak.

Anterior vaginal prolapse happens when the bladder drops from its place in the pelvis and pushes on the front wall of the vagina. The condition also is called a cystocele (SIS-toe-seel) or a prolapsed bladder.

Muscles and connective tissues of the pelvic floor hold the organs of the pelvis in place. These organs include the bladder, uterus and rectum. Anterior prolapse happens when the pelvic floor becomes weak or when there's too much pressure on the pelvic floor. This can happen with aging, during vaginal childbirth, or with ongoing constipation, hard coughing or heavy lifting.

Treatments for anterior prolapse include watchful waiting, devices that hold the organs in place, called pessaries, and exercises to strengthen pelvic floor muscles. Some people have surgery.

Symptoms

People with mild anterior prolapse may not see or feel any symptoms. When there are symptoms, they may include:

• A feeling of fullness or pressure in the pelvis and vagina.
• A bulge of tissue in the vagina that you can see or feel.
• More pelvic pressure when you strain, cough, bear down or lift objects.
• Problems urinating. These may include having trouble starting a urine stream, feeling that the bladder isn't empty after urinating, feeling a need to urinate often or leaking urine, also called urinary incontinence.

You may notice symptoms more after standing for long periods. Symptoms may go away when you lie down.

When to see a doctor

A prolapsed bladder may cause discomfort, but it's rarely painful. It can make emptying the bladder hard, which may lead to bladder infections. Make an appointment with your healthcare professional if you have symptoms that bother you or affect your daily life.

Causes

The cause of anterior vaginal prolapse is a weakened pelvic floor. The pelvic floor has muscles, ligaments and connective tissues that support the bladder and other pelvic organs.

Aging, giving birth or straining a lot can cause the weakness. When this happens, the bladder can slip down and push into the vagina, causing a bulge.

Causes of stress to the pelvic floor include:

• Pregnancy and vaginal childbirth.
• Being overweight or obese.
• Repeated heavy lifting.
• Straining when passing stool.
• A long-term cough or bronchitis.

Risk factors

These factors may raise the risk of anterior prolapse:

• Pregnancy and childbirth. People who have had a vaginal delivery or had a delivery with tools such as forceps have a higher risk of anterior prolapse. Other risk factors are having more than one pregnancy and having infants with high birth weights.
• Aging. The risk of anterior prolapse goes up as you age. This is mainly true after menopause due to having less of the sex hormone estrogen.
• Hysterectomy. Having the uterus removed may add to weakness in the pelvic floor. But this does not always happen.
• Certain genes passed through families, called inherited. Some people are born with weaker connective tissues. This makes them more likely to have anterior prolapse.
• Obesity. People who are overweight and those with obesity are at higher risk of anterior prolapse.