What Is the Best Treatment for Cystocele?

Cystocele is the prolapse of the bladder.

Cystocele, or bladder prolapse, is a condition in which the bladder sags down into the vagina due to the weakening of the supporting structure between the bladder and the vagina. Pelvic organ prolapse is a condition in which the structures that support the pelvic organs (the pelvic floor) become weak. The pelvis is the area between the hip bones and harbors the pelvic organs which include the uterus, cervix, vagina, intestines, rectum, urinary bladder and urethra. Any of these organs can sag or slip downwards (prolapse) when their supporting muscles and ligaments become weak, torn or stretched.

There are many different kinds of  pelvic organ prolapse, including

• Uterine prolapse: This refers to the prolapse of the uterus and cervix (neck of the uterus) down the vagina. In severe cases, the prolapsed parts may come out through the vaginal opening.
• Vaginal vault prolapse: This type of prolapse can occur in women who have had a hysterectomy (surgery for the removal of the uterus). Following hysterectomy, the top of the vagina is repaired to form a vaginal vault. During vault prolapse, the vaginal vault drops down into the vaginal canal.
• Cystocele: In this condition, the bladder bulges into the vagina.
• Rectocele: When the rectum (the last part of the large bowel) bulges into the vagina, it is called rectocele.
• Enterocele: This refers to the bulging of the small bowel against the vaginal wall. This can occur along with vaginal vault prolapse.

Depending on the severity, cystocele may be

Grade 1: This is also called mild cystocele. In this condition, the bladder sags only a short way into the vagina.

Grade 2: This is a more severe condition in which the bladder slips down further to reach the opening of the vagina.

Grade 3: This is the most severe condition in which the bladder sags so low that it comes out of the vagina.

The symptoms of cystocele may vary. Some women with this condition may not have any symptoms or pain. The most common symptom is a bulge through the vagina that may be felt or seen. Other symptoms of cystocele may include

• Frequent urge to urinate
• Inability to empty the bladder
• Loss of bladder control or urinary incontinence
• Feeling pressure or fullness in the vagina
• Discomfort or pain while passing urine 
• Discomfort or pain during sexual intercourse
• Frequent urinary tract infections 
• Pain in the vagina, lower belly, groin, pelvic area or lower back
• Feeling some mass jutting out of the vagina

The treatment of cystocele may vary depending on various factors such as the severity of the disease and the presence of symptoms or any underlying medical conditions. Treatment options include

• Watchful waiting: In the absence of symptoms, the doctor may suggest no treatment. They may keep the patient under observation for the development of any symptoms or complications. 
• Conservative (nonsurgical) therapy: This may include
  • Kegel exercises (pelvic floor strengthening exercises)
  • Physical therapy
  • Vaginal pessary (a vaginal support device)
  • Medications such as estrogen replacement therapy
• Surgery: Surgery options include
  • Open surgery
  • Laparoscopic surgery (using a long flexible instrument called a laparoscope)
  • Robot-assisted laparoscopic surgery