Anterior vaginal prolapse or cystocele: causes and treatment

Anterior vaginal prolapse or cystocele is a relatively common problem. It is more common in women who have given birth naturally.

Last update: 02 October, 2022

Anterior vaginal prolapse or cystocele is a condition in which the bladder falls from its usual position and creates pressure on the walls of the vagina. This is due to the stretching and weakening of the supporting tissues in that area.

There are no data on the number of women who have anterior vaginal prolapse or cystocele. Many of them do not experience symptoms or do not consult a doctor. It is estimated that more than half of the patients who have given birth have some degree of pelvic organ prolapse.

The disorder is also known by the names of anterior vaginal wall prolapse, prolapsed bladder Y sagging bladder. In this article we will focus on the causes and treatment of this pathology.

When do we talk about anterior vaginal prolapse?

When speaking of the pelvic organs, reference is made to the bladder, the uterus, and the intestines. They are all held in place by the muscles and connective tissues in the pelvic floor.

When these muscles and tissues do not do their job well, the bladder can slip out of place.. Once this happens, the bladder itself begins to push against the anterior wall of the vagina and the anterior vaginal prolapse or cystocele occurs.

All this causes a feeling of pressure in the pelvis and sometimes a lump in the vagina, which may or may not be felt. There are also problems with urination, such as difficulty passing urine, frequent need to go to the bathroom, feeling that the bladder has not been completely emptied, or incontinence.

Prolapse increases pelvic pressure. This means that urine cannot be held for a long time.

Causes of cystocele

Anterior vaginal prolapse, or cystocele, is caused by stretching or weakening of the muscles, tendons, and tissues that hold the bladder in place. Now, why does this happen?

Sometimes it’s just about the passage of time. With aging, muscles and tendons become more brittle. However, anterior vaginal prolapse or cystocele can occur at any age, from chronic stress or trauma.

The most common cause of this condition is labor. It also occurs in people with frequent constipation or chronic cough.

Likewise, it may occur after surgery in the pelvic area. Or also in people who have underlying diseases, such as Ehlers-Danlos syndrome.

Risk factor’s

It can be stated that the main risk factors for developing anterior vaginal prolapse or cystocele are the following:

  • Multiple pregnancies.
  • High birth weight babies.
  • Vaginal delivery, especially if assisted with instruments.
  • Menopause. During this stage, estrogen production decreases, which facilitates the loss of tissue elasticity.
  • Hysterectomy or previous pelvic reconstructive surgery.
  • Frequent heavy lifting.
  • Obesity.

Non-surgical treatments

If the case of anterior vaginal prolapse or cystocele is mild, it may not require a specific approach. Factors such as age, general health, severity of condition, desire to have children in the future, and sexual activity are taken into account to determine the best treatment.

In principle, you can opt for the conservative and non-invasive. There are two options: pelvic floor exercises and the use of a vaginal pessary.

Pelvic floor exercises

They are better known as kegel exercises Y its purpose is to strengthen the pelvic floor muscles. They consist of making contractions of the muscles in the area, maintaining them and repeating 10 times a day.

Your physical therapist or doctor can teach you the correct way to do them.

vaginal pessary

A pessary is a rubber or plastic ring that is inserted into the vagina to support the wall of the vagina. In this way, the bladder is supported.

The device does not cure anterior vaginal prolapse or cystocele, but it does relieve symptoms. This appliance should be removed and cleaned periodically.

Kegel exercises have been shown to be effective in reducing the effects of urinary incontinence and vaginal prolapse.

surgical treatment

If non-surgical treatments for anterior vaginal prolapse or cystocele do not work or the case is very severe, the option of surgery should be considered. Procedure may be cystocele repair, urethral sling placement, or both.

Anterior vaginal prolapse or cystocele repair surgery

This surgery is also called anterior colporrhaphy. The goal is to return the bladder to its normal position.

Also tighten the muscles and tissues involved, with stitches, to prevent further displacement. If there is incontinence, it can be corrected in the same procedure.

Urethral sling surgery

It is another option to correct anterior vaginal prolapse or cystocele. Consists in place a piece of mesh around the urethra, connecting the ends with the pubis. This mesh is permanent and its objective is the same as in the previous case: to return the bladder to its place and prevent it from moving.

Can it be prevented?

Anterior vaginal prolapse or cystocele as such cannot be prevented, but it is possible to take some measures to reduce the risk of its appearance. The most effective are Kegel exercises, which every woman should practice often.

Likewise, it is convenient to maintain an adequate weight, control chronic cough and constipation, and lift heavy objects with the correct technique. Surgery corrects the anterior vaginal prolapse or cystocele, although in some cases it recurs.

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