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(A-Z listing includes diseases, conditions, tests and procedures)


Cystocele: 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?

Cystocele, or anterior vaginal prolapse, is a type of pelvic organ prolapse. Pelvic organ prolapse may occur when a woman’s pelvic muscles and connective tissues are weak. When this weakening occurs, vaginal and bladder support diminishes, and a woman can develop a cystocele. A cystocele is when the bladder bulges into the vagina.

In some women, the bladder bulges into the vagina only when they cough, laugh or strain to have a bowel movement. In other women, the bladder bulges all the time. It can even bulge down enough to be seen or felt outside of the vagina.

What causes a cystocele?

Risk factors are things that happen to a woman that may increase her risk of developing this problem. Risk factors for cystocele are:

  • Age

  • Vaginal delivery, especially vaginal delivery of a large baby

  • Delivery with the help of forceps or vacuum

  • Constipation and chronic straining to have bowel movements

  • Chronic cough, like with COPD (chronic obstructive pulmonary disease)

  • Repeated heavy lifting

#TomorrowsDiscoveries: Pelvic Floor and Women’s Health

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. Watch to learn more.

What are the symptoms of a cystocele?

Symptoms of a cystocele include:

  • Feeling of pelvic heaviness or fullness

  • Bulge in the vagina that you can see or feel

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

  • Leakage of urine or difficulty emptying the bladder

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

  • Sexual difficulties

  • Problems with inserting tampons or applicators

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

How is a cystocele diagnosed?

When investigating whether or not you have a cystocele, your doctor will ask about your symptoms, as well as your complete medical and surgical history, including your obstetric history. You will undergo a physical exam, which will include a pelvic exam. This exam can give the doctor information about your pelvic muscles and if there is any prolapse, like a cystocele. Sometimes, the exam includes a measurement of how well your bladder empties. If you have difficulties emptying your bladder, another useful test is a urodynamic study. This allows the doctor to measure how well the bladder empties and fills.

Other tests and procedures may be necessary to determine if there are any problems in the other areas of the urinary system.

How are cystoceles graded?

Doctors can do a pelvic exam to determine the severity of the cystocele. More severe prolapse is when the bladder bulges outside of the vagina. The severity of prolapse is graded, from 0 to 4:

  • Stage 0: Perfect support. Very few women have perfect support of their bladder.

  • Stage 1: Small amount of bulge. Almost all women have a small amount of bulge, but most don’t have any symptoms or any problems.

  • Stage 2: Bulge that comes to within 1 centimeter of the opening of the vagina. Some women notice symptoms with stage 2 support.

  • Stages 3 and 4: The bulge comes out of the vagina, more than 1 centimeter from the opening of the vagina. Most women have symptoms with stage 3 and 4 prolapse.

What treatment options exist for cystoceles?

There are many different options available for treating cystoceles:

  • No treatment: If you have a mild cystocele or do not have any symptoms, you may not need treatment. Without treatment, prolapse can get better, stay the same or get worse over time. If you and your doctor choose to “wait and see,” you can choose to have treatment in the future.

  • Pelvic floor muscle exercises: If you have a mild cystocele, you may have some improvement in your symptoms after doing pelvic floor muscle exercises. Pelvic floor muscle exercises can also be called Kegel exercises. Pelvic floor physical therapists are specially trained to help you strengthen your pelvic floor and improve symptoms of a cystocele.

  • Pessary: A pessary is a silicone device that is inserted into the vagina. It can help support the bladder. Pessaries come in different shapes and sizes. Pessaries are fitted by your doctor in the office. Some women have good results with a pessary for years. You can learn to care for the pessary yourself, or you can come to the office every few months.

  • Surgery: Some women’s first choice for treatment is surgery, but other women want to try nonsurgical options first. Many surgeries exist for correcting cystocele. The most common one is done through an incision in the vagina.

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