Cystocele

Overview

A cystocele (pronounced SIS-toe-seel) is a condition where the bladder bulges into the front wall of the vagina. This happens when the muscles and tissues that hold the bladder in place become weak or stretched.

Cystocele is quite common, especially after menopause or childbirth. Many women have some degree of prolapse, but not everyone has symptoms.

It mainly affects women, especially those who have given birth vaginally, are postmenopausal, or have had a hysterectomy. It can also happen to women who are overweight or have a chronic cough.

Symptoms

Common symptoms

• A feeling of fullness or pressure in the vagina or pelvis
• A bulge or lump that you can feel inside the vagina or see at the vaginal opening
• A sensation that something is 'falling out' of the vagina
• Urinary problems, such as leaking urine when you cough, sneeze, or exercise (stress incontinence), frequent urination, or a sudden strong urge to urinate
• Discomfort or aching in the lower belly or back
• Difficulty completely emptying the bladder

Symptoms in children

• Cystocele is extremely rare in children. If symptoms occur, they are more likely related to other conditions. Always seek medical advice if a child has pelvic pressure or urinary issues.

Symptoms in older adults

• In older adults, symptoms may be more noticeable due to age-related weakening of pelvic muscles.
• Older women may also have other pelvic floor issues, such as a prolapsed uterus or rectum, which can happen together.
• Urinary symptoms like incontinence or repeated urinary tract infections are common.

Causes

Main causes

• Weakening of the pelvic floor muscles and connective tissues, which can happen due to childbirth, especially a difficult or instrumental delivery.
• Natural aging and lower estrogen levels after menopause, which can reduce tissue strength.
• Increased pressure on the pelvis from chronic coughing, constipation, or heavy lifting.

Risk factors

• Having given birth vaginally, especially multiple times
• Being overweight or obese
• A hysterectomy (removal of the womb)
• Chronic conditions that increase abdominal pressure, such as a long-term cough, constipation, or obesity
• Age (postmenopausal women are at higher risk)
• Genetics – a family history of prolapse may increase risk

When to see a doctor

See a doctor urgently if:

• If you cannot pass urine at all
• If you have severe pelvic pain that comes on suddenly

Book a routine appointment if:

• If you notice a bulge in your vagina or a feeling of pressure that bothers you
• If you have urinary problems like leakage or frequent infections
• If you experience discomfort during sex or daily activities

Diagnosis

A doctor will ask about your symptoms and medical history, and then do a pelvic exam to feel for a bulge in the front wall of the vagina.

Tests that may be done

• Pelvic exam – the doctor may ask you to cough or bear down to see how much the bladder moves.
• Bladder function tests – to check how well you empty your bladder.
• Imaging tests like ultrasound or MRI – sometimes used to get a clearer picture, but not always needed.

What to expect at your appointment

The exam is usually quick and does not hurt, but it may feel a bit uncomfortable. You will be asked to empty your bladder first. Your doctor will explain the findings and discuss treatment options based on the severity of the prolapse and your symptoms.

Treatment

Treatment for cystocele depends on how much it bothers you. If you have no symptoms, you may not need any treatment. If symptoms are mild, self-care and exercises often help. For more advanced cases, various non-surgical and surgical options are available.

Self-care at home

• Do pelvic floor exercises (Kegel exercises) regularly to strengthen the muscles that support the bladder.
• Avoid heavy lifting and straining during bowel movements.
• Maintain a healthy weight to reduce pressure on the pelvis.
• Treat and prevent constipation with a high-fiber diet and plenty of fluids.

Medical treatments

If self-care is not enough, a doctor may suggest a vaginal pessary – a silicone device that is inserted into the vagina to support the bladder. Pessaries come in different sizes and shapes and need to be fitted by a healthcare professional. Another option is pelvic floor physiotherapy, where a specialist teaches you exercises and techniques to strengthen your pelvic muscles. For some women, topical estrogen cream may be recommended to improve tissue strength, but it is only available on prescription.

When is surgery considered?

Surgery may be considered if the prolapse is severe or if non-surgical treatments do not relieve symptoms. The type of surgery depends on the individual case and may involve repairing the vaginal wall with stitches or using a mesh (though mesh use is now limited in many countries due to risks). Your doctor will explain the options, benefits, and risks.

Living with this condition

Living with a cystocele often means making small adjustments to protect your pelvic floor. Most women can manage with simple lifestyle changes and exercises. If you use a pessary, you will need to clean it regularly and have it checked by your doctor.

Lifestyle tips

• Do pelvic floor exercises every day – aim for three sets of 8–12 squeezes, held for a few seconds each.
• Avoid heavy lifting, and if you must lift, use your legs and not your back.
• Sit down to urinate and take your time to empty your bladder fully.
• Stay active with gentle exercises like walking, swimming, or cycling – these do not put too much pressure on the pelvis.

Diet and exercise

Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains to prevent constipation and straining. Drink enough water. Regular, gentle physical activity can help maintain a healthy weight and strengthen your pelvic floor. Avoid high-impact exercises like running or jumping if they worsen your symptoms.

Mental health and emotional wellbeing

Having a cystocele can affect your self-esteem and sex life. It is normal to feel frustrated or embarrassed, but remember that this is a medical condition and help is available. Talking to your partner, a counselor, or a support group can make a big difference.

Prevention

You cannot always prevent a cystocele, but you can reduce your risk by keeping your pelvic floor muscles strong, maintaining a healthy weight, and avoiding chronic constipation or heavy lifting.

Complications

If left untreated

• Worsening of the prolapse – the bulge may become larger and more uncomfortable.
• Urinary problems such as frequent infections, difficulty emptying the bladder, or complete urinary retention.
• Sores or ulcers on the vaginal wall where the bladder rubs against it.

Long-term outlook

For most women, a cystocele can be managed very well with simple treatments. Even if you need surgery, the outlook is good, and most women feel much better after treatment. Your doctor can help you find the best approach for your situation.

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