Fallen Bladder (Cystocele)

Abnormal position of the bladder.

A cystocele, or fallen bladder, occurs when the wall between a woman’s bladder and her vagina weakens, which allows the bladder to droop into the vagina.

Cystocele may result from too much straining, such as during childbirth, heavy lifting, or repetitive straining during bowel movements. This condition may also occur in women who go through menopause. When women go through menopause, their bodies stop making estrogen—a hormone that helps keep the muscles around the vagina strong. The decline in estrogen may cause the muscles around the vagina and bladder to become weak.
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A cystocele may be mild, severe, or advanced.

In mild cystocele—grade 1—the bladder droops only a short way into the vagina. A cystocele is classified as severe—grade 2—if the bladder drops far enough to reach the opening of the vagina. Advanced—grade 3—cystocele occurs when the bladder bulges out of the opening of the vagina.
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Signs and Symptoms

Women with mild cases of cystocele may not experience symptoms. However, grade 2 and 3 cystocele may cause symptoms, such as:
 A feeling of incompletely emptying the bladder

 Urine leakage while coughing, sneezing, or laughing

 A bulge that may protrude through the opening of the vagina
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The doctor may be able to diagnose cystocele (grade 2 and 3) from
 A description of your symptoms

 Physical examination—the fallen bladder will be visible with grade 2 or grade 3 cystocele

 Imaging tests, such as voiding cystourethrogram. This test involves taking x rays of the bladder during urination
Other tests may be needed to find out problems in other parts of the urinary tract.
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Mild cystocele may not require special treatment. However, surgery may be recommended for a more serious cystocele.

If a cystocele does not cause symptoms or complications, the doctor may only recommend avoiding activities, such as heavy lifting or straining that could worsen the condition.

In a more bothersome cystocele, the doctor may recommend a pessary. A pessary is a device that is placed in the vagina to hold the bladder in place. However, pessaries must be removed regularly to avoid infections or ulcers. (Learn more about pessaries.)

In advanced cystoceles, surgery may be needed to move and keep the bladder in a more normal position.

Your doctor will be happy to answer your questions regarding cystocele or explain about treatment options that are available.

National Kidney and Urologic Diseases Information Clearinghouse (August 2007). Cystocele (Fallen Bladder) (NIH Publication No. 07–4557). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/cystocele/index.htm. Accessed: October 5, 2008

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