Diagnosis

Diagnosis of anterior prolapse may involve:

  • A pelvic exam. You may be examined while lying down and while standing up. During the exam, your doctor looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. You'll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you'll be asked to contract them, as if you're trying to stop the stream of urine.
  • Filling out a questionnaire. You may fill out a form that helps your doctor assess the degree of your prolapse and how much it affects your quality of life. Information gathered also helps guide treatment decisions.
  • Bladder and urine tests. If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection, if it seems that you're retaining more urine in your bladder than is normal after urinating.

Treatment

Treatment depends on how severe your anterior prolapse is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (uterine prolapse).

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, anterior prolapse treatment might involve:

  • A supportive device (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 — especially 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, anterior prolapse may require surgery.

  • How it's done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of the 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 anterior prolapse 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, your doctor may recommend that you 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 recurrence — which may mean another surgery at some point.

Dealing with incontinence

If your anterior prolapse is accompanied by stress incontinence — involuntary loss of urine during strenuous activity — your doctor may recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms.

Treatment at Mayo Clinic

Urologists and urogynecologists at Mayo Clinic provide expert care for female patients of all ages who suffer from problems of the pelvic floor.

Mayo physicians are leaders in clinical research that enhances the capability to offer the most advanced treatments available. Many of the urologists across all Mayo Clinic campuses have advanced training and subspecialty certification in female pelvic medicine and reconstructive surgery from the American Board of Urology. Urogynecologists at Mayo Clinic also have advanced training and certification in female urology.

Specialty services offered through urology and urogynecology include:

  • Pelvic organ prolapse with or without incontinence diagnosis and treatment
  • Urodynamic evaluation
  • Stress urinary incontinence diagnosis and treatment
  • Minimally invasive injection therapies
  • Management of mesh complications
  • Urge urinary incontinence diagnosis and treatment
  • Overactive bladder diagnosis and treatment
  • Botox injections of the urinary tract
  • Neuromodulation for the urinary tract

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Kegel exercises strengthen your pelvic floor muscles, which support the uterus, bladder and bowel. A strengthened pelvic floor provides better support for your pelvic organs and relief from symptoms associated with anterior prolapse.

To perform Kegel exercises, follow these steps:

  • Tighten (contract) your pelvic floor muscles — the muscles you use to stop urinating.
  • Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
  • Work up to holding the contraction for 10 seconds at a time.
  • Do three sets of 10 repetitions of the exercises each day.

Ask your health care provider for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time.

Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.

Preparing for your appointment

Make an appointment with your family doctor or gynecologist if you have signs or symptoms of anterior prolapse that bother you or interfere with your normal activities.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

  • Write down any symptoms you've had, and for how long.
  • Make note of key medical information, including other conditions for which you're being treated and the names of medications, vitamins or supplements you regularly take.
  • Bring a friend or relative along, if possible. Having someone else there may help you remember important information or provide details on something that you missed during the appointment.
  • Write down questions to ask your doctor, listing the most important ones first in case time runs short.

For anterior prolapse, some basic questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • Are there any other possible causes?
  • Do I need any tests to confirm the diagnosis?
  • What treatment approach do you recommend?
  • If the first treatment doesn't work, what will you recommend next?
  • Am I at risk of complications from this condition?
  • What's the likelihood that the anterior prolapse will recur after treatment?
  • Should I follow any activity restrictions?
  • What can I do at home to ease my symptoms?
  • Should I see a specialist?

Besides the questions you prepare in advance, don't hesitate to ask other questions during your appointment if you need clarification.

What to expect from your doctor

During your appointment, your doctor may ask a number of questions, such as:

  • When did you first notice your symptoms?
  • Do you have urine leakage (urinary incontinence)?
  • Do you have frequent bladder infections?
  • Do you have pain or leak urine during intercourse?
  • Do you have a chronic or severe cough?
  • Do you experience constipation and straining during bowel movements?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?
  • Does your mother or a sister have any pelvic floor problems?
  • Have you delivered a baby vaginally? How many times?
  • Do you wish to have children in the future?
  • What else concerns you?

Anterior prolapse (cystocele) care at Mayo Clinic

May 22, 2018
References
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