The pelvic floor is comprised of ligaments, muscles, and connective tissues. It works to support the pelvic organs, including the bladder. Over time, these tissues can weaken. Chronic pelvic floor muscle straining and vaginal childbirth might also contribute to them weakening. Other factors that may play a role include:
Aging might impact the strength of the pelvic floor muscles in women. The risk is highest following menopause due to a significant decline in estrogen production. This hormone contributes to pelvic floor muscle strength.
When this condition is mild, it is possible for patients to not experience any symptoms. However, when they do occur, they may include:
Feeling of pressure or fullness in the vagina or pelvis
After urinating, feeling as though the bladder is not completely empty
Urinary leakage or pain when having sexual intercourse
Heightened discomfort when coughing, lifting, straining, or bearing down
Tissue bulge through the vaginal opening (in severe cases)
The symptoms might appear alleviated when the patient is lying down. They may seem worse after prolonged standing.
Doctors usually perform a few tests to determine if a prolapse is present and to assess the degree of severity. A pelvic exam is commonly performed, both when the patient is standing and lying down. Urine and bladder testing are also common.
In mild cases, watchful waiting and self-care methods, such as performing Kegel exercises, might be the ideal course of treatment. If these fail to help the patient, doctors might recommend a pessary. This is a type of supportive device that is inserted into the vagina to give the bladder additional support. If low estrogen levels are a possible factor in pelvic floor weakness, patients may benefit from replacement therapy. In the case of a cystocele, a pill, ring, or cream inserted into the vagina that contains this hormone is generally considered first.
In most moderate to severe cases, doctors and their patients might discuss surgery. The purpose of the procedure is to lift the bladder and put it back into the proper place. During the procedure, the surgeon may also tighten the pelvic floor and remove any excess tissue. If the vaginal tissues are especially thin, the surgeon might reinforce the tissues via the use of a tissue graft.
Some patients may experience incontinence due to this condition. There are different treatments to explore to alleviate this issue to prevent accidental urine loss or leakage. Some options include Kegel exercises, a procedure for urethral suspension, and certain medications.
Patients who suspect a cystocele should see their doctor right away. There are different treatment methods to discuss, as well as possible preventative measures to reduce the risk of recurrence.