Bladder prolapse or cystocele

Bladder prolapse (or cystocele) refers to a lowering of the bladder into the vagina.

In this disease, the wall between the bladder and vagina is weakened, which causes a displacement of the bladder from its anatomical position.

In some cases, bladder emptying can be triggered by coughing, laughing or sneezing lightly.
One can divide cystocele into three degrees:

  • Grade 1 (the bladder lowers slightly into the vagina),
  • Grade 2 (the bladder falls almost into the vaginal entrance),
  • Grade 3 (the bladder protrudes from the vaginal entrance).


Causes of bladder prolapse

In some cases, pregnancy can also cause bladder prolapse due to pressure from the child on the bladder.
In most women, the vaginal wall regains its strength after giving birth after a while.
However, in women who have given birth to many children, the vaginal wall may not be able to return to its full strength.
These women are at risk of prolapse.

Estrogen is a hormone responsible for maintaining the health of the vaginal muscles and a strong vaginal wall.
After menopause, estrogen production is stopped.

Muscle weakening of the pelvic floor can cause the problem.
This situation may occur in the case of a person who has to lift heavy loads at work.
It can occur due to very high pressure effects during defecation.
Long-lasting cough or long-term constipation can affect the strength of the pelvic muscles.

Symptoms of bladder prolapse

  • The patient may feel a feeling of fullness in the vagina and pelvis
  • Feeling of incomplete emptying after urination (micturition)
  • Sensation of a foreign body emerging from the vagina
  • Urinary incontinence (triggered by coughing, laughing, sneezing, etc.)
  • Urine leakage during sexual intercourse
  • Backache
  • Vaginal pain during sexual intercourse
  • Pain in the lower abdomen
  • Urinary bladder infection (recurrent)

Diagnosis of bladder prolapse

The responsible doctor is the gynecologist.
If the doctor suspects a cystocele, he checks the complete medical history of the woman together with the physical signs.

To confirm a bladder abnormality, a micturition cystourethrogram is usually taken.

Micturition cystourethrography is an examination in which an X-ray of the bladder is taken during micturition.
This helps the doctor to examine the shape of the bladder.
In addition, problems related to urine flow can be detected.

What should you do? Therapy for bladder prolapse

The therapy of cystocele depends on the severity of the disease. In mild cases without symptoms, therapy consists of some Kegel exercises and perianal rehabilitation.

In moderate cases, the use of a pessary is recommended.
This device is a rubber ring that is inserted into the vagina and holds the bladder in its normal position.
Depending on suitability and convenience, the doctor may determine a pessary for the patient.

Doctors also recommend estrogen therapy for the women who suffer from the symptoms of menopause.
It helps to keep the pelvic floor muscles strong, because they could be degenerated after menopause due to the lack of estrogen.

Sometimes doctors may also recommend removal of the uterus (hysterectomy) if there is a prolapse of this organ along with the bladder prolapse. In case of recurrent cystoceles, surgery is recommended.

In more serious cases, surgery is recommended, in which the doctor returns the bladder to its normal position.
As a rule, it is the gynecologist or urologist who performs this operation.

Natural remedies for cystocele

Treatments for first-degree bladder prolapse include osteopathy, which can help reduce
pressure on the bladder The osteopath must decrease ptosis (lowering) of the visceral organs that press on the bladder.
After that, he must reduce the tension of the ligaments (ligaments) that push the bladder downwards.

Bladder prolapse surgery

The operation is indicated when the bladder prolapse is clearly visible from the vagina and the patient has problems carrying out her daily activities.

One should not confuse the operation of a uterine prolapse with that of a urinary bladder.
However, if a patient suffers from both conditions, the doctor may perform a single operation to solve these problems.
In both cases, the operation takes about 1 hour.

What happens during the operation of cystocele?

In the serious cases of bladder prolapse, the problem can only be solved by surgical intervention to move back the organs that have lowered and restore the supporting structures.

The operation is performed under spinal anesthesia (the patient remains awake from the upper half of the body) or under general anesthesia.
The procedure is quite simple:

  • The surgeon makes an incision in the vagina and then inserts a biocompatible and non-absorbable mesh into the tissue to support the vagina.
    This mesh can be positioned in the front or rear wall or in both walls of the vagina, depending on the type of prolapse.
  • An additional mesh can be inserted in the upper wall of the vagina or in the cervix to support the vagina.

After surgery, antibiotics are given to prevent bladder infection.

In general pelvic prolapse, there is a novel surgical technique called P.O.P.S. (Pelvic Organs Prolapse Suspension).

This procedure is performed laparoscopically and makes it possible to simultaneously detach the lowering of the uterus, bladder and rectum by inserting a prosthesis.

Postoperative convalescence in case of bladder prolapse

Women who have experienced open surgery for bladder prolapse have longer convalescence than those who choose the minimally invasive technique of laparoscopy.
During the recovery period after the operation of a cystocele, the doctor checks the medication and urinary habits of the patient, who can be discharged home as soon as she can urinate painlessly.

In the recovery period after the correction of a cystocele, it is recommended to maintain complete rest and avoid lifting heavy weights.
The suture material on the wound is absorbed within 8-12 days, but full recovery occurs only after six weeks.

Physical activity: Daily walks are recommended after surgery.
Sitting or lying in bed for long periods of time should be avoided because it can increase the risk of clot formation in the legs and also the development of pneumonia.
Climbing stairs is possible, but you should limit yourself to a few steps.
You should not drive for at least 2 weeks after the operation.
You should not lift heavy objects (over 20 kilograms) or do sports (jogging, swimming, treadmill, bicycle) for six weeks or until the doctor allows it.
Most patients can return to their full activity about 3 weeks after surgery.

Sexual activities: If surgery required an incision in the vagina, the patient may feel pain during sexual intercourse.
Therefore, the patient should refrain from sexual activity for up to 4-6 weeks after surgery.

Maintain good habits for the intestines, completely avoid exertion and not practice sexual intercourse for a month and a half.

As after any type of surgery, there are side effects and complications in this case.
Some of the risk factors are: infection, pain in the operating area, and pain during sexual intercourse.

Serious complications from bladder prolapse surgery include:

  • Haemorrhage
  • Blood clot
  • effects of anaesthesia,
  • Violation of bladder, ureters and other internal parts.

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