A midline cystocele (anterior prolapse) occurs in women when the bladder begins to bulge into the vagina as a result of the weakening and stretching of the support tissues between the bladder and the vaginal wall. It is also often referred to as a prolapsed bladder.
The primary reason for an anterior prolapse is the overall weakening of the pelvic muscles. The pelvic floor is a large band of muscles, often referred to as the Kegel muscles, which cradles the pelvic organs - the bladder the reproductive organs - and controls the openings of the anus, urethra, and vagina. If the pelvic floor becomes weak, it can no longer adequately support the bladder which then begins to descend into the vagina.
The biggest factor which contributes to pelvic floor weakness is pregnancy and childbirth. The weight of a growing baby puts lots of pressure on the pelvic floor, and during labor, the muscles become severely stretched. An anterior prolapse might occur directly after childbirth, or it may occur more gradually as the effects of gravity force the bladder lower and lower.
For some women, cystocele may occur at a later point in life many years after having children, namely during or after the menopause when lowering levels of estrogen result in muscles becoming weaker all over the body, including the pelvic floor.
Other factors such as frequent coughing, chronic constipation and straining to pass stools, frequently lifting very heavy objects, and being overweight can all put pressure on the pelvic floor and contribute to weakness.
Midline cystocele (anterior prolapse) symptoms: are signs that you might be suffering from anterior prolapse:
In very mild cases of anterior prolapse, these symptoms may not be severe enough to notice, or they may occur very gradually as the prolapse gets worse.
In very severe cases of cystocele, women may feel the bladder protruding into the top of the vagina which will feel like sitting on an object.
Midline cystocele (anterior prolapse) treatment: There is a range of treatment methods available for cystocele, the success of each varying with the severity of the prolapse.
Pelvic floor exercise, often deemed "Kegels," is the process of working out the pelvic floor muscles in order to make them stronger. To do a Kegel correctly, one must tense the muscles only in the pelvic region - a little like stopping urination mid flow - rather than muscles in the abs, buttocks or thighs. Contract the muscles for 10 seconds, then relax for 10 seconds, and repeat 10 to 15 times.
This exercise should be done three times a day for the best results. If you struggle to hold the contraction for the full 10 seconds, to begin with, start with three seconds and gradually increase each week as your muscles become stronger.
Although they will not do anything to rectify a cystocele, pessaries are often used to manage the condition either permanently or on a temporary basis until another treatment is possible. Pessaries are plastic or rubber devices, often in a ring shape but other types are available, which are inserted into the vagina to support the prolapsed bladder.
Pessaries must be selected and initially fitted by a health care professional who will choose a device which fits correctly and provides adequate support. However, they should be removed and cleaned regularly and healthcare providers will show patients how to do this and how to reinsert pessaries correctly at home.
For more severe cases of anterior prolapse where pelvic floor strengthening has not been possible or successful, surgery may be the solution. There are various different surgical techniques used to either pull together loose tissues or create a sling for the pelvic floor to lift the prolapsed bladder and restore strength to the pelvic floor.
The surgery usually requires a general anesthetic and patients may need to stay in hospital for one or two days. Full recovery takes around 6 weeks, but women are usually advised to avoid strenuous activity, heavy lifting or standing for long periods for about three months until the tissues are fully healed.