Anterior Prolapse (Cystocele)

What is an Anterior Prolapse?

Anterior prolapse, also commonly referred to as a cystocele is a condition known as a fallen bladder. It affects women and is a form or pelvic organ prolapse in which the supportive wall of tissue that holds the vaginal wall and bladder in place weakens and/or stretches. This causes the organs in a woman’s pelvis to move and shift and collapse on top of one another. In this case, the bladder is the organ that moves.

When a woman suffers from a cystocele, her bladder is impeding on her vagina. Because the bladder is out of place, its normal function may be affected by this positioning and the function of the vagina may be affected as well.

There are numerous possible causes for anterior prolapse. The strain of childbirth can sometimes cause anterior prolapse as can frequent constipation. In some cases a severe cough or other forms of physical strain like improper heavy lifting can also cause a cystocele. And, finally, one of the most common causes of pelvic muscle weakening in women is menopause because estrogen helps to keep those pelvic muscles strong.

What are the Symptoms of an Anterior Prolapse?

When a woman suffers from anterior pelvic prolapse, the most common symptom is discomfort in the lower abdomen and pelvic region. Depending on the severity of the prolapse, the woman may also have issues with their bladder. This can mean that they have difficulty emptying their bladder or that they have bladder leakage.

Symptoms include

Bladder leakage when sneezing, coughing, or laughing can all be symptoms of a cystocele. Pain or bladder leakage during sexual intercourse as well as frequent bladder infections can also be problems with anterior prolapse. And in the most severe cases of a cystocele a bulge may actually protrude from the vagina.

Anterior Prolapse (Cystocele) Causes

The primary cause of an anterior prolapse is the weakness of the muscles and ligaments which support the pelvic organs. The pelvic floor is a band of muscles which runs underneath the bladder and uterus toward the vagina. When the pelvic floor becomes weak, it is less effective in supporting the bladder, which can result in it dropping from its normal position.

One of the most common causes of pelvic floor weakness is pregnancy and childbirth. During pregnancy, the growing baby puts pressure on the pelvic floor, causing the muscles to stretch. Vaginal childbirth then causes the muscles to stretch even further and then become weak.

This trauma can result in a cystocele straight away, but more commonly it doesn’t occur until many years later, after further strain on the muscles and the effects of gravity cause the bladder to shift downwards. It’s also important to note that as we age, our tissues and muscles naturally weaken, particularly after menopause, which is why some women develop a cystocele later in life.

It is also possible to weaken the pelvic floor with the following:

  • Repetitive straining during bowel movements
  • Chronic constipation
  • Chronic or violent coughing
  • Frequent heavy lifting
  • Being obese and therefore carrying excess weight.

How is an Anterior Prolapse Treated?

In mild or moderate cases of anterior prolapse, physicians will often recommend that the patient not pursue medical or surgical treatment for the condition. The pelvic wall and muscles can repair themselves and move the bladder back into place on their own.

Treatment includes

However, in severe cases or cases in which the condition does not resolve, a supportive device can be placed inside the vaginal wall to add structure and stability. Surgery to repair the weakened muscles  by lifting the bladder back into place and removing any extra tissue so that the muscles can be tightened and secured into place.

Anterior Prolapse Prevention

The most effective way to prevent a cystocele is to keep the pelvic floor muscles strong and healthy. When performed daily, simple pelvic floor exercises, also known as Kegels, will help to keep a healthy pelvic floor in good condition before and during pregnancy, and will help it to regain strength after childbirth to reduce the risk of anterior prolapse.

It’s also helpful to avoid repetitively straining the pelvic floor muscles. Individuals who suffer from regular constipation and therefore straining during bowel movements could try eating more fiber and doing more exercise to ensure they have more regular and smoother bowel movements.

Those who are overweight can reduce their risk of cystocele by losing weight. Individuals who are at an increased risk of prolapse due to already having children should avoid regularly lifting very heavy things, or should engage their pelvic floor correctly each time they lift something heavy.