Anterior vaginal prolapse or cystocele is a condition in which the bladder falls out of its usual position, putting pressure on the vaginal walls. This is due to the stretching and weakening of the supporting tissues in this area.
There are no data on the number of women who have anterior vaginal prolapse or cystocele. Many of them do not show symptoms or do not consult the doctor. It is estimated that more than half of patients who have given birth have some degree of pelvic organ prolapse.
The disorder is also known as prolapse of the anterior vaginal wall, prolapsed bladder et fallen bladder. In this article we will focus on the causes and treatment of this pathology.
When do we speak of anterior vaginal prolapse?
When we talk about the organs of the pelvis, we are referring to the bladder, the uterus and the intestines. They are all held in place by the muscles and connective tissues of the pelvic floor.
When these muscles and tissues don’t do their job well, the bladder can shift. Once this happens, the bladder itself begins to push against the anterior wall of the vagina and anterior vaginal prolapse or cystocele occurs.
All of this causes a feeling of pressure in the pelvis and sometimes a bulge in the vagina, which may or may not be felt. There are also problems with urination, such as difficulty urinating, frequent urination, feeling that the bladder has not been completely emptied, or incontinence.
Also read: 6 facts about urinary incontinence you should know
Causes of cystocele
Anterior vaginal prolapse, or cystocele, is caused by stretching or weakening of the muscles, tendons, and tissues that hold the bladder in place. Now why is this happening?
Sometimes it’s just the passage of time. With age, muscles and tendons become more fragile. However, anterior vaginal prolapse or cystocele can occur at any age, as a result of chronic stress or trauma.
The most common cause of this condition is childbirth. It also occurs in people with frequent constipation or chronic cough.
Likewise, he It is possible for this to happen after surgery in the pelvic area. Or also in people who have underlying diseases, such as Ehlers-Danlos syndrome.
Read also: Vaginal pessary: type, care and risks
Risk factors
It can be said that the main risk factors for developing anterior vaginal prolapse or cystocele are:
- Multiple pregnancies.
- Babies with a high birth weight.
- Vaginal birth, especially if assisted by instruments.
- Menopause. During this stage, the production of estrogen decreases, which facilitates the loss of elasticity of the tissues.
- Previous pelvic hysterectomy or reconstructive surgery.
- Lift heavy objects frequently.
- Obesity.
Non-surgical treatments
If the case of anterior vaginal prolapse or cystocele is mild, it may not require a specific approach. Factors such as age, general health, severity of disease, desire to have future children, and sexual activity are taken into account to determine the best treatment.
In principle, you can opt for the conservative and non-invasive. There are two options: pelvic floor exercises and the use of a vaginal pessary.
Pelvic floor exercises
They are better known askegel exercises et their purpose is to strengthen the pelvic floor muscles. They consist of making contractions of the muscles in the area, maintaining them and repeating them 10 times a day.
Your physical therapist or doctor can teach you the correct way to do them.
Pessaire vaginal
A pessary is a rubber or plastic ring that is inserted into the vagina to support the vaginal wall. In this way, support is offered to the bladder.
The device does not cure anterior vaginal prolapse or cystocele, but it does relieve symptoms. This device should be removed and cleaned periodically.
Surgical treatment
If non-surgical treatments for anterior vaginal prolapse or cystocele do not work or if the case is very serious, the option of surgery should be considered. The procedure can be cystocele repair, placement of a urethral sling, or both.
Repair surgery for anterior vaginal prolapse or cystocele
This surgery is also called anterior colporrhaphy. The goal is to return the bladder to its normal position.
Also tense the muscles and tissues involved, with stitches, to prevent further displacement. If there is incontinence, it can be corrected in the same procedure.
Surgery to place the urethral tape
This is another option for correcting a previous vaginal prolapse or cystocele. It consists of place a piece of mesh around the urethra, connecting the ends with the pubis. This mesh is permanent and its objective is the same as in the previous case: to put the bladder back in its place and prevent it from moving.
Can it be avoided?
Anterior vaginal prolapse or cystocele as such cannot be prevented, but it is possible to take certain measures to reduce the risk of its occurrence. The most effective are Kegel exercises, which every woman should do often.
Likewise, it is advisable to maintain an adequate weight, control chronic coughs and constipation, and lift heavy objects with the correct technique. Surgery corrects the previous vaginal prolapse or cystocele, although in some cases it recurs.
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