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Treatments and drugs
By Mayo Clinic staffCystocele treatment depends on the severity of the condition. Mild cases — those with few or no obvious symptoms — may require no treatment or simple self-care measures such as Kegel exercises to strengthen your pelvic floor muscles. A physical therapist who specializes in pelvic floor disorders may be helpful in teaching these exercises. If self-care measures aren't effective, treatment may include:
- Pessary. A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, your doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery. But some women may use pessaries for years.
- Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.
When surgery is necessary
If you have noticeable, uncomfortable symptoms, cystocele may require surgery. This surgery is elective and designed to relieve symptoms related to the cystocele.
In most cases, surgery consists of a vaginal repair. In this procedure, a surgeon elevates the prolapse back into place, removing redundant tissue and tightening the muscles and ligaments of your pelvic floor. While the benefits of this type of surgery can last for many years, there's some risk of recurrence. This is partly because of downward forces of gravity resulting in stretching of tissues again.
If the cystocele recurs, you may need surgery again. In some cases, especially where the tissues needed to support the vagina are unusually thin, using a special type of tissue graft may help thicken the vaginal tissues and increase support. If the cystocele is associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) to help correct the problem and prevent recurrence.
When possible, avoid surgical treatment until you're done having children. A pessary may help to relieve symptoms in the meantime. If the prolapse is so uncomfortable that you need a vaginal repair, you can still have children — though a cesarean delivery is sometimes recommended.
Dealing with incontinence
If your cystocele is accompanied by stress incontinence, your doctor may recommend one of a number of procedures to support the urethra (urethral suspension).
- Lentz GM. Anatomic Ddefects of the abdominal wall and pelvic floor. In: Katz VL, et al., eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby; 2007. http://www.mdconsult.com/das/book/body/172806660-4/0/1524/131.html?tocnode=53759383&fromURL=131.html#4-u1.0-B978-0-323-02951-3..50023-6_663. Accessed Nov. 24, 2009.
- Abed M, et al. Urinary incontinence and pelvic organ prolapse: Diagnosis and treatment for the primary care physician. The Medical Clinics of North America. 2008;92:1273.
- Mahajan ST. Anterior vaginal wall support abnormalities: Evaluation and treatment. http://www.uptodate.com/home/index.html. Accessed Nov. 24, 2009.
- Urinary incontinence in women. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/. Accessed Nov. 24, 2009.
- Gebhart JB (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 6, 2009.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 30, 2009.
