Cystocele: symptoms, causes, to treatment options

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Definition

What is a cystocele?

Cystocele is a condition in bladder disease when the insulating wall between these organs and the vagina weakens causing the bladder to drop or fall into the vaginal area.

The bladder is a pouch-like organ in the pelvis that functions to collect urine. The female bladder is supported by a muscular wall located at the front of the vagina. However, these walls can weaken with age.

Pregnancy, childbirth, and pelvic surgeries such as hysterectomy can also weaken the vaginal walls. If the condition is very weak, the vaginal wall will no longer be able to support the bladder so that the bladder falls into the vagina.

Cystocele is a fairly common medical condition. About 40% of women over 50 years of age will experience decreased pelvic organs, and 10% of them will need surgery to remove organs or experience urinary incontinence (leaky urine).

Not all women with a decreased bladder have the same condition. Cystocele is divided into four levels based on the extent to which the bladder descends into the vagina, namely:

• Level 1 (mild): Only a small portion of the bladder descends into the vagina.
• Level 2 (moderate): The bladder descends a little further until it touches the vaginal opening.
• Level 3 (severe): A portion of the bladder has been sticking out of the body through the vaginal opening.
• Level 4 (complete): The entire bladder is outside the vagina, and is usually accompanied by the descent of other organs such as the uterus, rectum, and intestines.

A drooping bladder (cystocele) usually causes difficulty urinating, discomfort, and stress incontinence. Stress incontinence is the discharge of urine every time you cough, sneeze, or push.

Not only the bladder, other body organs can also fall into the vagina, including the uterus, small intestine and rectum. If left untreated, cystocele can interfere with bowel movements resulting in damage to the rectum or feces out of sight.

Symptoms

What are the symptoms of a cystocele?

The first symptom of a cystocele that women experience is the appearance of pressure in the vagina or bladder. In addition, the characteristics of a cystocele that usually appear are:

• Pain or discomfort in the pelvis, lower abdomen, and when sitting.
• There is tissue discharge from the vagina (sometimes bleeding and painful when pressed).
• There is a lump in the vagina.
• Difficulty urinating
• The feeling of not urinating completely (anyang-anyangan).
• Stress incontinence (urinating when sneezing, coughing, straining, etc.).
• Frequent bladder infections.
• Pain during sex.
• Bedwetting during sex.
• Lower back pain.

Some women who have a mildly drooping bladder sometimes don't show any symptoms. There may be symptoms not listed above. Consult a doctor if you feel suspicious symptoms.

Cause

What causes the bladder to drop?

Cystocele is a condition caused by several factors at once. Without realizing it, you may have a number of conditions that weaken your pelvic floor muscles as well as the ligaments (connective tissue) that support your bladder, urethra, uterus, and rectum.

These conditions cause the supporting muscles to break away from the ligaments or pelvic bones. In fact, these muscles should stick firmly.

In general, a number of conditions that can weaken the pelvic muscles are:

• Pregnancy and vaginal delivery. This is the main cause of cystocele. Labor puts a lot of pressure on the supporting muscles of the bladder.
• Old age. As you get older, the weaker your body muscles.
• Menopause. The hormone estrogen, which maintains the strength and health of vaginal tissue, is no longer produced after a woman enters menopause.
• Have had pelvic surgery, for example a hysterectomy (removal of the uterus).

Triggers

Who is more at risk of developing a cystocele?

The risk of having a cystocele is greater in people with the following conditions:

• Have a family history of cystocele.
• Experiencing obesity.
• Suffering from a respiratory disease so he often coughs
• Suffering from constipation so that he often pushes.
• Frequent strenuous physical activity.
• Frequent lifting of heavy objects.

Diagnosis

How to diagnose a cystocele?

To determine whether your bladder is descending into your vagina, your doctor will ask about your symptoms. The doctor then continues with an examination of the pelvic area and intimate organs.

If the results of the examination are not clear, the doctor will usually perform an examination with a cystouretrogram or X-ray that is done when urinating. This examination aims to see the shape of the bladder and the cause of the bladder dropping.

In certain cases, the doctor may need to look inside the urethra and bladder through cystoscopy. This procedure involves a long, small tube with a camera that is inserted into the urinary tract.

The doctor may also check or perform X-rays of several parts of the stomach. After the diagnosis, you may also need to undergo nerve, muscle, and urine flow tests to determine the most appropriate treatment.

If deemed necessary, the doctor can continue the examination with urodynamic tests or urodynamic videos. Also known as a bladder EKG, this test is usually done to measure the relationship between pressure and volume in the bladder.

Treatment

How to treat cystocele?

Level 1 (mild) cystocele that does not cause pain or discomfort usually does not require any medical treatment. Your doctor may only ask you to avoid activities that risk making your condition worse, such as straining or lifting heavy objects.

For more serious cases, the doctor will consider a number of factors such as age, physical condition, treatment chosen, and severity. From here, the new doctor determines the most appropriate treatment and the need for surgery.

The following are treatment options for cystocele:

1. Pesarium

A pessary is a device that is placed in the vagina to reposition the bladder. Pessaries are usually used with estrogen creams to prevent infection and erosion of the vaginal walls.

Some types of pessaries can be installed on their own to make it easier for the patient. However, there are also types of pesarium that must be removed, cleaned and replaced by medical personnel.

2. Estrogen hormone therapy

Estrogen plays an important role in maintaining the strength of the vaginal muscles, including the muscles that support the bladder. Estrogen therapy aims to strengthen and care for the vaginal muscles after menopause so that it can help with cystocele.

3. Cystocele operation

Surgery is a suitable option when the cystocele cannot be repaired with a pessary. The doctor will make incisions in the bladder and vagina. Then, the area that has decreased is closed and the vaginal walls are strengthened again.

Depending on the procedure, the surgery can be performed either under general, regional, or local anesthesia. For minor surgery, many patients are allowed to go home on the same day.

After surgery, patients can return to normal activities after six weeks. However, during the first six months, you need to reduce strenuous activity so that the bladder does not come under heavy pressure.

4. Electrical stimulation

In electrical therapy, the doctor will place an electric conduit on the weak vaginal or pelvic muscles. The device will conduct low-voltage electricity which acts like a signal to the nervous system to make muscles contract.

There are also electric stimulators that can magnetically stimulate nerves from the outside of the body without having to insert them into the vagina. In addition to activating the pelvic muscles, this method can also cure urinary incontinence or an overactive bladder.

5. Biofeedback

Principle biofeedback is to monitor muscle activity in the pelvic area and vagina by attaching sensors to the area. The doctor will ask you to do activities to strengthen these muscles, then monitor their contractions.

6. Kegel exercises

This exercise has long been known as a way to strengthen the pelvic muscles. Kegel exercises can be used to treat mild or moderate cystocele, or to support treatment of more severe cystocele.

Prevention

How to prevent cystocele?

Here are some simple steps that can help you prevent cystocele:

• Eat foods high in fiber and lots of fluids to prevent constipation.
• Not straining during bowel movements.
• Women who often experience constipation need to see a doctor immediately for treatment.
• Maintain a healthy body weight to prevent obesity.

Cystocele is the lowering of the bladder due to weakening of the vaginal muscle wall. This condition not only disrupts the urinary system, but can also affect other organs in the pelvic area.

As with other bladder diseases, treatment will be optimal if this condition is detected as early as possible. If you experience symptoms of a decreased bladder, consult a doctor immediately to get the right treatment.