Cystocele, also known as a bladder prolapse, is a common condition affecting women, particularly as they age or after childbirth. To understand cystocele, it's important to grasp the basic anatomy of the female pelvis. The pelvic floor is a group of muscles and tissues that support the pelvic organs, including the bladder, uterus, and rectum. Cystocele occurs when the supportive structures of the pelvic floor weaken, allowing the bladder to droop into the vagina.

Causes and Risk Factors

Several factors contribute to this weakening. Some are listed below.

• Childbirth: Vaginal childbirth, especially if it involves prolonged labor, multiple deliveries, or the use of forceps or vacuum extraction, is a significant risk factor for bladder prolapse. The stretching and tearing of pelvic floor muscles and tissues during childbirth can weaken the support for the bladder.
• Aging: As women age, the muscles and tissues in the pelvic floor naturally weaken, increasing the risk of pelvic organ prolapse, including cystocele. Hormonal changes during menopause can further contribute to tissue laxity and pelvic floor weakening.
• Genetics: Some individuals may have a genetic predisposition to pelvic floor disorders, including bladder prolapse. A family history of pelvic organ prolapse can increase one's risk of developing the condition.
• Obesity: Excess weight puts additional pressure on the pelvic floor muscles and tissues, increasing the risk of pelvic organ prolapse, including bladder prolapse. Maintaining a healthy weight through diet and exercise can help reduce this risk.
• Chronic Constipation and Straining: Chronic constipation and straining during bowel movements can weaken the pelvic floor muscles over time, predisposing individuals to pelvic organ prolapse, including cystocele. Eating a high-fiber diet, staying hydrated, and adopting healthy bowel habits can help prevent constipation and reduce this risk.
• Heavy Lifting and Straining: Jobs or activities that involve heavy lifting or repetitive straining can strain the pelvic floor muscles and increase the risk of pelvic organ prolapse, including bladder prolapse. Proper lifting techniques and avoiding excessive strain on the pelvic floor can help reduce this risk.
• Previous Pelvic Surgery: Previous pelvic surgeries, such as hysterectomy or surgery for pelvic organ prolapse, can weaken the supportive structures of the pelvic floor and increase the risk of bladder prolapse.
• Chronic Coughing: Conditions such as chronic obstructive pulmonary disease (COPD) or smoking-related chronic coughing can put strain on the pelvic floor muscles and increase the risk of bladder prolapse.
• Connective Tissue Disorders: Certain connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome, can affect the strength and integrity of pelvic floor tissues, increasing the risk of pelvic organ prolapse.
• Ethnicity: Some studies suggest that ethnicity may play a role in the prevalence of pelvic organ prolapse, with higher rates reported in certain ethnic groups.

Bladder Prolapse Symptoms

The symptoms of cystocele can vary in severity but often include a sensation of pressure or fullness in the pelvis, a feeling of something bulging into the vagina, urinary issues like difficulty emptying the bladder completely or urinary incontinence, pain or discomfort during intercourse, and recurrent urinary tract infections (UTIs).

Impact on Daily Life

Bladder prolapse, can significantly impact a woman's daily life due to its associated symptoms and challenges. Physical discomfort is one of the most notable effects, with sensations of pressure, fullness, or a bulging feeling in the pelvic region making it difficult to focus on daily tasks. Urinary symptoms such as difficulty emptying the bladder completely, frequent urination, and urinary incontinence can be embarrassing and disruptive, affecting social activities and travel. Pain or discomfort during sexual intercourse may lead to decreased intimacy in relationships, affecting emotional well-being. Limitations in physical activity can arise due to fear of exacerbating symptoms, leading to a more sedentary lifestyle. Psychological impacts like frustration, anxiety, and depression may result from chronic discomfort and embarrassment. Work and social life may also be affected, with concerns about urinary leakage impacting job performance and social interactions. Difficulties with personal hygiene due to urinary leakage or incomplete bladder emptying can lead to feelings of embarrassment and self-consciousness, affecting confidence and self-esteem. Seeking medical evaluation and treatment is crucial for improving quality of life and managing the impact of cystocele symptoms. 

What to expect at the doctor’s office?

When visiting a doctor's office for a cystocele diagnosis, individuals can expect a comprehensive assessment aimed at understanding their symptoms, medical history, and pelvic anatomy. Here's what to expect during a typical appointment:

• Medical History: The doctor will start by taking a detailed medical history, including information about the individual's symptoms, duration, severity, and any factors that may contribute to bladder prolapse, such as childbirth, previous pelvic surgeries, or chronic medical conditions.
• Symptom Evaluation: The doctor will inquire about specific symptoms related to bladder prolapse, such as pelvic pressure, urinary incontinence, difficulty emptying the bladder completely, or discomfort during sexual intercourse. It's essential to provide detailed information about symptoms to help guide diagnosis and treatment.
• Physical Examination: A pelvic examination is typically performed to assess the extent of bladder prolapse and evaluate the condition of the pelvic floor muscles and supportive structures. During the pelvic exam, the doctor will visually inspect the vaginal walls and may use a speculum to visualize the cervix and vagina. They will also manually assess the position of the bladder and other pelvic organs.
• Voiding Diary: In some cases, the doctor may ask the individual to keep a voiding diary to record urinary habits, including frequency of urination, urgency, and episodes of urinary leakage. This information can help identify patterns and assess the severity of urinary symptoms.
• Additional Tests: Depending on the individual's symptoms and medical history, additional tests may be ordered to further evaluate bladder function and pelvic anatomy. These tests may include a urinalysis to check for urinary tract infections, urodynamic studies to assess bladder function, imaging studies such as ultrasound or MRI, or specialized tests like cystoscopy to visualize the inside of the bladder.
• Discussion of Treatment Options: Once a diagnosis of bladder prolapse is confirmed, the doctor will discuss treatment options based on the individual's symptoms, severity of prolapse, and personal preferences. Treatment options may include conservative measures such as pelvic floor exercises, lifestyle modifications, or pessary use, as well as surgical intervention for those with more severe symptoms or prolapse.
• Follow-Up Plan: Depending on the treatment plan, the doctor will establish a follow-up schedule to monitor progress, adjust treatment as needed, and address any concerns or new symptoms that may arise. 

Treatments Available for Bladder Prolapse

Treatment options depends on the severity of symptoms and the individual's preferences. Treatment options range from conservative measures to surgical intervention

• Pelvic Floor Exercises (Kegel Exercises): These exercises aim to strengthen the pelvic floor muscles, which can help support the bladder and alleviate symptoms of bladder prolapse. Regular and proper practice of Kegel exercises under the guidance of a healthcare provider can lead to improvement in symptoms.
• Lifestyle Modifications: Making certain lifestyle changes can help manage symptoms of bladder prolapse. These may include maintaining a healthy weight, avoiding heavy lifting and straining, managing chronic coughing (if present), and adopting proper bowel habits to prevent constipation.
• Pessary: A pessary is a removable device inserted into the vagina to provide support to the bladder and other pelvic organs. It helps to alleviate symptoms of bladder prolapse by holding the bladder in its correct position. Pessaries come in various shapes and sizes, and selection should be done by a healthcare provider to ensure proper fit and comfort.
• Estrogen Therapy: For postmenopausal women, topical estrogen therapy may be recommended to improve the strength and elasticity of vaginal tissues. This can help alleviate symptoms of bladder prolapse and improve overall vaginal health.
• Physical Therapy: Pelvic floor physical therapy, also known as pelvic rehabilitation therapy, involves exercises, manual techniques, and biofeedback to strengthen the pelvic floor muscles and improve pelvic support. This approach can be particularly beneficial for individuals with pelvic floor muscle weakness contributing to bladder prolapse.
• External Support Devices: Bladder prolapse support devices are available on the market. Products like FemiCushion are helpful to keep the prolapse supporter inside the body to eliminate painful symptoms while strengthening the pelvic muscles.
• Surgical Repair: In cases where conservative measures do not provide sufficient relief or if the prolapse is severe, surgical intervention may be necessary. Surgical repair of bladder prolapse typically involves restoring the supportive structures of the pelvic floor and repositioning the bladder to its normal position. There are various surgical techniques available, including traditional open surgery and minimally invasive procedures such as laparoscopic or robotic-assisted surgery.
• Combination Therapy: In some cases, a combination of treatments may be recommended to effectively manage bladder prolapse. For example, pelvic floor exercises or pessary use may be combined with estrogen therapy or physical therapy to optimize outcomes. 

When is surgery necessary for Cystocele?

Surgery becomes necessary in several scenarios. Firstly, when conservative treatments like pelvic floor exercises, pessary use, or lifestyle modifications fail to provide relief from symptoms such as pelvic pressure or urinary incontinence, surgery may be the next step. Additionally, in cases of severe prolapse where the bladder significantly protrudes into the vaginal space, surgical intervention is often required to restore normal pelvic anatomy and function. Individuals experiencing recurrent or worsening symptoms despite prior treatment attempts may also benefit from surgery to address underlying anatomical defects and provide long-term symptom relief. If bladder prolapse significantly impacts quality of life, including daily activities, sexual intimacy, or work, surgery may be recommended to improve symptoms and overall well-being. Complications associated with bladder prolapse, such as urinary retention or recurrent urinary tract infections, may necessitate surgical correction to prevent further health issues. Lastly, individuals may opt for surgery for personal reasons, such as enhancing pelvic support after childbirth or improving sexual function. Ultimately, the decision to undergo surgery should be made in consultation with a healthcare provider, considering factors such as symptoms, overall health, and treatment goals. Various surgical techniques are available, each with its own risks and benefits, and thorough discussion with the healthcare provider is essential to make an informed decision. 

How can FemiCushion help? 

FemiCushion is an innovative solution tailored to provide relief and assistance for individuals facing pelvic organ prolapse (POP) or related pelvic floor difficulties. Consisting of cushions, holders, and supportive underwear, this system is crafted for external use to ease the discomfort and symptoms associated with POP.

Each FemiCushion kit includes various silicone cushions and fabric holders, complemented by specialized prolapse underwear. These components are strategically positioned over the pelvic region to offer gentle yet efficient support to the prolapsed organs, while simultaneously relieving pressure on the pelvic floor muscles. Engineered with discretion and comfort in mind, the prolapse undergarment allows individuals to wear it throughout the day without impeding their daily activities.

FemiCushion Research Study

A research study carried out at Showa University Northern Yokohama Hospital and published in The Journal of Obstetrics and Gynecology Research investigated the efficacy of FemiCushion in addressing pelvic organ prolapse (POP) using magnetic resonance imaging (MRI). The study involved twelve participants ranging in age from 56 to 84 years, all diagnosed with severe stages 3 or 4 of POP.

The main findings of the study are as follows:

• FemiCushion demonstrated significant effectiveness in repositioning prolapsed pelvic organs.
• The device yielded results comparable to those of a pessary, but without the associated risks such as vaginal erosion and bleeding.
• FemiCushion not only lifted the prolapsed organs but also provided upward support to the perineal body while closing the hiatuses.
• Individuals with severe POP experienced a notable reduction in prolapse severity after using FemiCushion.
• Even with a short usage period, as little as one month, FemiCushion showed improvements in POP. 

These findings underscore the potential of FemiCushion as a non-invasive treatment option for POP, offering similar benefits to a pessary while mitigating certain risks. The study's outcomes signify promising advancements in the management of pelvic organ prolapse, especially for individuals with severe stages of the condition.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.