Treatment depends on how severe your cystocele is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (prolapsed uterus). Mild cases — those with few or no obvious symptoms — typically don't require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles.
If self-care measures aren't effective, your doctor may recommend these options:
- Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
- Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.
When surgery is necessary
If you have noticeable, uncomfortable symptoms, the cystocele may require surgery.
- How it's done. Often, the surgery is performed vaginally and involves lifting your prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of your pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.
- If you have a prolapsed uterus. For a cystocele associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues.
If you're thinking about becoming pregnant, delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of cystocele recurrence — which may mean another surgery at some point.
Dealing with incontinence
If your cystocele is accompanied by stress incontinence, your doctor may recommend one of a number of procedures to support the urethra (urethral suspension).
Apr. 14, 2012
- McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9026. Accessed Feb. 14, 2012.
- Abed M, et al. Urinary incontinence and pelvic organ prolapse: Diagnosis and treatment for the primary care physician. Medical Clinics of North America. 2008;92:1273.
- Mahajan ST. Anterior vaginal wall support abnormalities: Evaluation and treatment. http://www.uptodate.com/index. Accessed Feb. 13, 2012.
- Urinary incontinence in women. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/. Accessed Feb. 13, 2012.
- Hagen S, et al. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. http://www.thecochranelibrary.com/view/0/index.html. Accessed Feb. 14, 2012.
- Leu PB, et al. Cystocele repair with interpositional grafting. Urologic Clinics of North America. 2011;38:47.
- Bladder prolapse (cystocele). American Urological Association Foundation. http://www.urologyhealth.org/urology/index.cfm?article=118. Accessed Feb. 28, 2012.
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