Do you perhaps feel like something is about to fall out down there? Do you feel a “ball” protruding from the vagina? Do you have an unpleasant sensation with it? Do you have problems with urination and possibly with sexual intercourse?
When we talk about cystocele, we refer to a bulge through the vaginal entrance that appears when lifting heavy objects and during other activities. This is a common condition that becomes bothersome when it widens the vaginal opening and presents as a hemispherical, egg-shaped structure that rubs against underwear, causing discomfort. Vaginal discharge and difficulties with urination may also be present.
The most common cause of bladder prolapse is pelvic floor damage during vaginal delivery, and the extent of this damage determines when the cystocele will manifest in the future. The greater the degree of pelvic floor birth injury, the sooner the cystocele will appear and the larger it will be. Heredity significantly influences the occurrence of cystocele (e.g., weakness of connective tissue, uterine or bladder prolapse in the mother) as well as other factors that heavily strain the pelvic floor (heavy physical work, carrying heavy loads, chronic cough, gynecological surgeries).
A cystocele occurs when the bladder support (fascia) weakens, or stretches too much, or detaches from the lateral pelvic wall. The fascia is connective tissue that does not contain muscle tissue, which means that muscle strengthening methods (Kegel exercises, electrical and magnetic stimulations) will not help at all.
How can we treat a cystocele?
Prof. Dr. But explains:
“A cystocele can only be corrected surgically, where two factors are crucial for the success of the operation. The first is the type of cystocele, and the second is the position of the uterus or the top of the vagina. In central cystocele, the support (fascia) directly under the bladder is weakened, and if the uterus is not prolapsed, we can lift the bladder back into place (anterior repair, or anterior colporrhaphy). This is a procedure performed under local anesthesia, the operation takes 20 minutes, and we discharge patients home immediately after the first urination, which usually occurs within half an hour after the operation. In cases where the cystocele is accompanied by significant uterine prolapse, this surgical approach is not the best option, as the cystocele will likely recur.
Similarly, this surgical method is less successful in lateral cystoceles, where the bladder support has detached from the lateral pelvic wall. In this case, we need to lift the bladder with a specially tailored mesh. This is a procedure performed under local anesthesia, or even under sedation. The operation takes 45 minutes, and we discharge patients home after the first urination. We rarely decide to place a temporary catheter in the bladder.
In cases where the cystocele is accompanied by a lowered uterus, we lift both laparoscopically, which is done under general anesthesia. The operation takes approximately 60 minutes, and we discharge patients home the day after the operation. Only such an approach provides a guarantee that the cystocele and uterine prolapse will most likely not recur.”
And yes, one more thing…. vaginal laser is completely useless and ineffective in treating cystoceles, despite perhaps different promises from those who sell vaginal lasers to women who (blindly) trust them. Laser energy does not penetrate deep enough into the vaginal wall to address the fascia, it doesn’t even penetrate half the thickness of the vaginal mucosa, but it can cause a burn! If the laser does induce some “effect”, it’s merely a placebo effect that completely wears off after a few weeks or, in exceptional cases, months!“
