Anterior vaginal prolapse (Cystocele)

Diagnosis

The healthcare provider will perform physical assessment and pelvic examination and further investigation to diagnose a cystocele:

• Pelvic examination: A tissue protrusion into the vagina during the examination could be a sign of pelvic organ prolapse. To proper evaluate the prolapse, the doctor will ask the patient to bear down as though during a bowel movement, and contract the pelvic floor muscles, like stopping the flow of urine to measure the strength of these muscles.
• Bladder and urine tests: The tests will determine how fully and effectively the bladder empties. The tests will show if the patient is holding more urine in the bladder than is typical even after emptying the bladder. The doctor may also do a test on a urine sample to investigate for signs of a bladder infection.
• Cystourethrogram: An X-ray of the bladder was taken while the woman was urinating and contrast dye will be injected into the bladder and urethra. It shows the bladder’s shape and any obstructions.

Treatment

If the cystocele has no symptoms or does not affect the quality of life, treatment is not necessary. The doctor may require a few clinic visits to monitor if the condition progresses or not.

If the cystocele has symptoms, the treatment will depend on its severity and any associated disorders, such as urinary incontinence or several types of pelvic organ prolapse.

Nonsurgical treatment:

• Kegel exercises: also called pelvic floor muscle exercise training, are structured routines that helps the pelvic floor muscles to become stronger. This enables the muscles to secure the bladder and other pelvic organs more effectively. Kegel requires instruction and assistance from the doctor or physical therapist to ensure that the routines are executed properly.

Utilizing monitoring tools for biofeedback helps to ensure that the right muscles are being tightened for the ideal duration and intensity. Kegel exercise will result in improvement of your symptoms but not decrease the size of prolapse.

• Vaginal pessary: It is a ring usually made of plastic or rubber and this device will be inserted into the vagina that bladder in place. Although a pessary does not correct or cure the prolapse itself, the additional support it offers may aid with symptoms. Patients are advised how to clean and reinstall it on their own. Pessaries are frequently used by women in place of surgery when the risk of the procedure is high.

Surgical treatment

If non-surgical treatment fails to solve the symptoms, surgical treatment may be necessary to correct the prolapse.

• Anterior colporrhaphy or anterior vaginal repair: entails pulling the prolapsed bladder back into place with stitches and trimming off any extra vaginal tissue. If the vaginal tissues appear to be particularly thin, the doctor may decide to fortify them and provide support using a specific type of tissue graft.
• Hysterectomy: the surgical removal of the uterus is recommended if the anterior prolapsed is caused by prolapsed uterus. In addition to treating the injured pelvic floor muscles, ligaments, and other tissues.
• Uretheral suspension: The doctor may also suggest one of several treatments to support the urethra and lessen the incontinence symptoms. This is applicable if the anterior prolapse is accompanied by stress incontinence which causes urine to leak during physical activity or exertion.
• Obliterative surgery: treatment that narrows or seals off all or a portion of the vagina to give the bladder extra support. After this procedure, a woman can no longer engage in vaginal intercourse.

It is recommended to postpone surgery until after having children if you’re considering getting pregnant. As a temporary remedy, pessary or Kegel exercise may help ease the symptoms. The results of surgery can last for many years, but there is a chance that the prolapse will reoccur, necessitating another surgery.