Cystocoele (Fallen Bladder)
A cystocoele occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.
A bladder that has dropped from its normal position may cause two kinds of problems—unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.
A cystocoele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocoele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocoele occurs when the bladder bulges out through the opening of the vagina.
A cystocoele may result from muscle straining while giving birth. Other kinds of straining—such as heavy lifting or repeated straining during bowel movements—may also cause the bladder to fall. The hormone oestrogen helps keep the muscles around the vagina strong. When women go through menopause (when they stop having periods), their bodies stop making oestrogen, so the muscles around the vagina and bladder may grow weak.
A doctor may be able to diagnose a grade 2 or grade 3 cystocoele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible. A voiding cystourethrogram (sis-toe-yoo-REETH-roe-gram) is a test that involves taking x rays of the bladder during urination. This x ray shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.
Treatment options range from no treatment for a mild cystocoele to surgery for a serious cystocoele. If a cystocoele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocoele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary—a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.
Large cystocoeles may require surgery to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynaecologist, a urologist, or a urogynaecologist. The patient should be prepared to stay in the hospital for several days and take 4 to 6 weeks to recover fully.
