Overview

Anterior prolapse, also known as a cystocele (SIS-toe-seel), occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder.

Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease.

For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.

Symptoms

In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:

  • A feeling of fullness or pressure in your pelvis and vagina
  • Increased discomfort when you strain, cough, bear down or lift
  • A feeling that you haven't completely emptied your bladder after urinating
  • Repeated bladder infections
  • Pain or urinary leakage during sexual intercourse
  • In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg

Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.

When to see a doctor

A severely prolapsed bladder can be uncomfortable. It can make emptying your bladder difficult and may lead to bladder infections. Make an appointment with your doctor if you have any signs or symptoms that bother you.

Causes

Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse).

Possible causes of anterior prolapse include:

  • Pregnancy and vaginal childbirth
  • Being overweight or obese
  • Repeated heavy lifting
  • Straining with bowel movements
  • A chronic cough or bronchitis

Risk factors

These factors may increase your risk of anterior prolapse:

  • Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse.
  • Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep the pelvic floor strong — decreases.
  • Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
  • Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
  • Obesity. Women who are overweight or obese are at higher risk of anterior prolapse.

Prevention

To reduce your risk of developing anterior prolapse, try these self-care measures:

  • Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles, and this is especially important after you have a baby.
  • Treat and prevent constipation. High-fiber foods can help.
  • Avoid heavy lifting, and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk to your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

Anterior prolapse (cystocele) care at Mayo Clinic

Sept. 27, 2014
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