Causes of Cystocele:

• Chronic constipation
• Heavy lifting
• Menopause and decreased estrogen levels
• Pregnancy and childbirth
• Aging / Menopause
• Hysterectomy
• Genetics
• Obesity
• Iatrogenic: Complicated operative deliveries and previous pelvic floor repair operations may be a contributory factor i.e. hysterectomy.
• Pelvic organ cancers e.g. cervical cancer e.t.c

Symptoms of Cystocele:

• Feeling of fullness or pressure in the pelvis
• Urinary incontinence or retention
• Frequent urinary tract infections
• Difficulty emptying the bladder
• A vaginal bulge
• The feeling that something is falling out of the vagina
• The sensation of pelvic heaviness or fullness
• Difficulty starting a urine stream and A feeling that you haven’t completely emptied your bladder after urinating plus Frequent or urgent urination

STAGES OF BLADDER PROLAPSE

1. Grade 1 (mild): Only a small portion of the bladder drops into the vagina.
2. Grade 2 (moderate): The bladder drops enough to be able to reach the opening of the vagina.
3. Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
4. Grade 4 (complete): The entire bladder protrudes completely outside the vagina

Diagnosis of Cystocele:

Initial Assessment:

Pelvic Examination: This helps to examine the vagina and cervix to look for any bulging or prolapse. Assess the size and location of the prolapse to determine its severity. • Abdominal Examination: This helps rule out any abdominal or pelvic masses that might be contributing to the prolapse by pushing down on the pelvic organs.

Further Diagnostic Tests:

• Urinalysis: A urine test can identify any urinary tract infections that could be contributing to bladder symptoms.
• Voiding Cystourethrogram (VCUG): This test involves filling the bladder with contrast dye and taking X-rays as the patient urinates. VCUG can help visualize the bladder and urethra, identifying any abnormalities like prolapse, narrowing, or leaks.
• Cystoscopy: This procedure involves inserting a thin, flexible scope with a camera into the urethra and bladder. It allows the doctor to visualize the inside of the bladder and urethra, looking for any structural problems or blockages.

Imaging Tests (May be used to confirm diagnosis and plan treatment):

• CT Scan of the Pelvis: This scan provides detailed images of the pelvic organs and surrounding structures, helping to underpin the extent of the prolapse.

• Ultrasound of the Pelvis: This non-invasive imaging technique uses sound waves to create pictures of the pelvic organs, aiding in the assessment of prolapse and potential causes.

• MRI Scan of the Pelvis: MRI provides very detailed images, allowing for a thorough examination of the pelvic floor muscles and ligaments.

Evaluating Associated Conditions: • Stress Incontinence Test: To assess whether the cystocele is causing urinary leakage, the doctor may ask the patient to cough with a full bladder. This helps determine if the bladder leaks during increased pressure on the pelvic floor.

Treatment of a Cystocele:

Mild Cases (Grade 1): These often don’t require medical or surgical intervention. Lifestyle changes can help alleviate symptoms:

○ Weight Loss: If overweight or obese, shedding extra pounds can reduce strain on the pelvic floor.

○ Avoiding Heavy Lifting: Limit activities that put pressure on the pelvic floor.

○ Treating Constipation: Regular bowel movements are important to avoid straining.

More Severe Cases (Grades 2-3): If symptoms significantly impact daily life, treatment options include:

○ Pelvic Floor Exercises (Kegels): Strengthening these muscles can improve support for the pelvic organs.

○ Hormone Treatment (Estrogen Replacement Therapy): This can improve tissue elasticity and support in some women. ○

Vaginal Pessaries: These are removable devices that fit inside the vagina to support the prolapsed organs.

○ Surgery: This is considered for significant prolapses or those not responding to other treatments. Surgical options include repairs of the pelvic floor muscles and ligaments, or in rare cases, Colpocleisis (a procedure that permanently reduces the size of the vagina).

Preventing a Cystocele:

• Regular Pelvic Floor Exercises: Strengthening these muscles daily can help prevent prolapse.
• Avoiding Heavy Lifting: Reduce strain on the pelvic floor by limiting activities that require heavy lifting.
• Maintain a Healthy Weight: Being overweight or obese puts extra stress on the pelvic floor.
• Regular Bowel Movements: Prevent constipation and straining by consuming enough fiber and staying hydrated.
• Moderate Exercise: Regular physical activity can help keep the pelvic floor muscles strong and improve overall health.