This book describes Cystocele, Diagnosis and Treatment and Related Diseases
A cystocele (also termed a prolapsed, herniated, dropped, or fallen bladder where the urine or “water” is stored) happens when ligaments that maintain the bladder up and the muscle between a woman’s vagina and bladder stretches or weakens, permitting the bladder to sag into the vagina.
There are 3 grades of cystocele:
- Grade 1 (mild): The bladder drops only a short way into the vagina.
- Grade 2 (moderate): The bladder drops to the opening of the vagina.
- Grade 3 (severe): The bladder bulges through the opening of the vagina.
Causes
The organs inside a woman's pelvis are the uterus, the bladder and rectum (lowest intestinal part).
Normally, these are propped up and kept in position by certain structures such as ligaments and the muscles at the bottom of the pelvis (pelvic floor muscles).
Genitourinary (GU) prolapse happens when these normal support structures are weakened and are no longer effectual
The effect is that one (or more) of the organs inside the pelvis prolapses (falls down) into vagina.
The space available for the organ to drop down into is the vagina
A prolapse of the bladder into the vagina is a cystocele
This is the most frequent form of GU prolapse
A uterine prolapse is the second most frequent form of GU prolapse.
Risk factors for a cystocele are: - Childbirth: Vaginal births, which may require straining the muscles of the floor of the pelvis.
- Family history of cystocele or a congenital disorder
- Obesity or women who are overweight.
- Intense physical activity, including lifting heavy objects.
- Hysterectomy because the surgery may have weakened the ligaments and pelvic floor muscles
- Constipation and repeated muscle straining during bowel movements
- Increased pressure inside the abdomen
- Frequent coughing or Women who have persistent (chronic) lung problems
- Aging or Increasing age
- Drop in the hormone estrogen
Symptoms - The need to pass urine often, both during the day and at night, having to run to the bathroom often to pass water, or just a feeling as if the patient has to urinate a lot.
- Unwanted leakage of urine (incontinence) leaking of urine on coughing, sneezing, laughing, straining or lifting
The prolapsed (fallen) bladder may stretch the opening of the urethra (the tube through which urine passes). - Incomplete emptying of the bladder
- Frequent urinary tract infections.
- Feeling of fullness, heaviness, or pain in the pelvic area or lower back.
- The bladder bulging into or out of the vagina or the need to use the finger to push back the prolapse to enable urine to pass
There is a feeling of a lump in the vagina or having a feeling of something 'dragging' or 'coming down'
Diagnosis
A Grade 2 or Grade 3 cystocele can be diagnosed from a history of symptoms and from a vaginal examination.
Other test may be needed to detect Grade 1 cystocele - Cystourethrogram
- Urodynamics
- Cystoscopy (cystourethroscopy)
- Fluoroscopy
Types of treatment:
Watchful waiting
If the woman has little symptoms, the woman may choose to wait to see how her symptoms develop.
In some women, symptoms do not get any worse over time, and they may even get better.
Lifestyle changes
a. Lose weight
b. Stop smoking
c. Kegel exercises
Pessary
If symptoms are moderate, a device called a pessary may be inserted into the vagina and kept there in place to hold the bladder
Surgery
A serious cystocele may need reconstructive surgery called an anterior repair to move the bladder into a normal position.
In this form of surgery, an incision or cut is made in the wall of the vagina and the tissue that divides the bladder from the vagina is made tighter.
TABLE OF CONTENT
Introduction
Chapter 1 Cystocele
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Uterine Prolapse
Chapter 8 Rectocele
Epilogue
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