Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its normal position in the pelvis and pushes on the wall of the vagina.
The organs of the pelvis — including the bladder, uterus and intestines — are normally held in place by the muscles and connective tissues of the pelvic floor. Anterior prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. This can happen over time, during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting.
Anterior prolapse is treatable. For a mild or moderate prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.
A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder give way.
In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:
Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.
A prolapsed bladder can be uncomfortable, but it is rarely painful. It can make emptying your bladder difficult, which may lead to bladder infections. Make an appointment with your doctor if you have any signs or symptoms that bother you or impact your daily activities.
Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse).
Causes of stress to the pelvic floor include:
These factors may increase your risk of anterior prolapse:
Diagnosis of anterior prolapse may involve:
Treatment depends on whether you have symptoms, how severe your anterior prolapse is and whether you have any related conditions, such as urinary incontinence or more than one type of pelvic organ prolapse.
Mild cases — those with few or no obvious symptoms — typically don't require treatment. Your doctor may recommend a wait-and-see approach, with occasional visits to monitor your prolapse.
If you do have symptoms of anterior prolapse, first line treatment options include:
Pelvic floor muscle exercises. These exercises — often called Kegel exercises or Kegels — help strengthen your pelvic floor muscles, so they can better support your bladder and other pelvic organs. Your doctor or a physical therapist can give you instructions for how to do these exercises and can help you determine whether you're doing them correctly.
Kegel exercises may be most successful at relieving symptoms when the exercises are taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time. These exercises can help improve your symptoms, but may not decrease the size of the prolapse.
If you still have noticeable, uncomfortable symptoms despite the treatment options above, your doctor may recommend surgical treatment.
If you're pregnant or thinking about becoming pregnant, your doctor may recommend that you delay surgery until after you're done having children. Pelvic floor exercises or a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of recurrence — which may mean another surgery at some point.
Pessaries come in many shapes and sizes. The device fits into your vagina and provides support to vaginal tissues displaced by pelvic organ prolapse. Your doctor can fit you for a pessary and help you decide which type would best suit your needs.
Kegel exercises are exercises you can do at home to strengthen your pelvic floor muscles. A strengthened pelvic floor provides better support for your pelvic organs and relief from symptoms associated with anterior prolapse.
To perform Kegel exercises, follow these steps:
Ask your doctor for instructions on how to properly perform a Kegel, and for feedback on whether you're using the right muscles. Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.
To help keep an anterior prolapse from progressing, you can also try these lifestyle modifications:
Make an appointment with your family doctor or gynecologist if you have signs or symptoms of anterior prolapse that bother you or interfere with your normal activities.
Here's some information to help you prepare for your appointment and know what to expect from your doctor.
For anterior prolapse, some basic questions to ask your doctor include:
Besides the questions you prepare in advance, don't hesitate to ask other questions during your appointment if you need clarification.
During your appointment, your doctor may ask a number of questions, such as: