What You Need to Know

  • Factors that increase your risk of a cystocele are childbirth, age, obesity, chronic constipation and heavy lifting.
  • Signs and symptoms can include the feeling that something has dropped out of your vagina, leaking urine or a feeling of incomplete emptying of your bladder.
  • In more advanced cases, the vaginal wall that supports the bladder will drop out of the opening of the vagina, causing an obvious vaginal bulge.
  • Tests for a cystocele may include a pelvic exam and urodynamics, a group of tests to evaluate bladder function.
  • Women with moderate to advanced symptoms may opt for a vaginal pessary, a support device that is inserted into the vagina, or cystocele repair surgery.

What is a cystocele?

When the wall between the bladder and the vagina weakens, the bladder may drop or sag into the vagina. This disorder in women is called a cystocele.

Cystoceles are grouped into grades:

Grade 1

Mild. The bladder droops only a short way into the vagina.

Grade 2

More severe. The bladder has sunk into the vagina far enough to reach the opening of the vagina.

Grade 3

Most advanced. The bladder bulges out through the opening of the vagina.

What causes a cystocele?

A cystocele may be caused by the following:

  • Advancing age

  • Overweight

  • Child birth

  • Heavy lifting

  • Straining muscles during childbirth

  • Chronic coughing

  • Constipation

  • Repeated straining during bowel movements

  • Previous pelvic surgery

  • Weak muscles around the vagina caused by lack of estrogen after menopause

What are the symptoms of a cystocele?

Symptoms of cystocele include:

  • Feeling of pelvic heaviness or fullness

  • Bulge in the vagina that you can feel

  • Aching or a feeling of pressure in the lower belly or pelvis

  • Lower back pain

  • Frequent urinary tract infections

  • Need to urinate often or urgently

  • Leakage of urine

  • Incomplete emptying of the bladder

  • Constipation

  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement

  • Pain during sex

  • Problems putting in tampons or vaginal applicators

  • Pelvic pressure that gets worse with standing, lifting, or coughing or as the day goes on

How is a cystocele diagnosed?

Your healthcare provider will review your medical history and do a physical and pelvic exam. Other tests may include:

  • Cystourethrogram (also called a voiding cystogram). This is an X-ray of the bladder taken while the woman is urinating and with the bladder and urethra filled with contrast dye. It shows the shape of the bladder and any blockages.

  • MRI can be used to determine the extent of bladder prolapse

Other tests may be needed to find out if there are any problems in the other areas of the urinary system.

How is a cystocele treated?

Treatment depends on the grade of the cystocele and may include:

  • Activity changes. Avoiding certain activities, such as heavy lifting or straining during bowel movements, that could cause the cystocele to worsen.

  • Kegel exercises. Regular, daily exercises of the pelvic muscles to make them stronger.

  • Pessary. This is a device placed in the vagina to hold the bladder in place.

  • Surgery. May be used to move the bladder back into a more normal position

  • Hormone replacement therapy. This may help to strengthen the muscles around the vagina and bladder. If you are thinking about hormone replacement therapy, talk to your healthcare provider about the risks and benefits first.

Key points about cystocele

  • A cystocele is when the wall between the bladder and the vagina weakens. This can cause the bladder to drop or sag into the vagina.

  • It may be caused by things that increase pressure on the pelvic muscles.

  • Treatment depends on the severity of the cystocele. It may include avoiding certain activities, surgery, or other methods.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

#TomorrowsDiscoveries: Pelvic Floor and Women’s Health – Dr. Victoria Handa

Dr. Victoria Handa and her team at the Johns Hopkins Women's Center for Pelvic Health and Reconstructive Surgery study how childbirth leads to long-term physical and functional changes in a woman’s body.

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