A cystocele is term for condition known as prolapsed bladder. This is a type of pelvic organ prolapse that occurs when the tissues and muscles that hold the bladder in place are stretched or weakened. This process can cause the bladder to move from its natural position and press into the vagina. A bladder prolapse may develop if a woman’s pelvic muscles become damaged. It is common case during pregnancy, labor, childbirth, or a previous pelvic surgery or are weakened by aging. In rare cases, a cystocele can be present at birth, and then it is called congenital cystocele. A cystocele may cause leaking of urine, especially during coughing, laughing, or jumping. It may also cause difficulty emptying the bladder, which may progress to a bladder infection known as cystitis
. Exercises to strengthen the pelvic floor muscles, called Kegel exercises, may help relieve symptoms of a cystocele. A health professional may recommend use of a pessary, which is an instrument placed in the vagina to support the uterus. In severe cases, surgery may be needed as the only treatment for prolapsed bladder.
What is prolapsed bladder?
Childbirth and aging are two factors working against the female structure, because during birth, the muscles and skin of the birth canal, or vagina, are stretched and torn. They repair over time but are never exactly the same, and after that, as we age, all the muscles of our body thin and weaken. As a result of these effects, the walls of the vagina can commonly sag. The front wall of the vagina holds up the bladder, while the back wall holds the lower gut, or rectum. The womb takes up a spot in the middle, so all these organs are involved when the vagina relaxes too much. Many women have the feeling of pelvic pressure or trouble holding their urine immediately after childbirth, but for some, this feeling goes away only to return as they get older. These are the main signs of problem called pelvic relaxation. When severe, it can be difficult to hold any urine at all and extra force may be needed to move bowels. A prolapsed bladder, uterus, or rectum can occur. This means that part of these organs may slide from its normal position to partial exposure outside your body. A fallen organ cannot repair itself, so contact your healthcare provider as soon as you know you have a problem. You should watch for signs like urine leakage, feeling of a ball shaped formation or pressure in the area, or pain or soreness of exposed tissue.Signs and symptoms for prolapsed bladder
In mild cases of prolapsed bladder, it is possible to not even notice a bulge. When signs or symptoms do present themselves, they may include feeling of fullness or pressure in your pelvis and vagina, and this is especially when standing for long periods of time. Woman may also feel increased discomfort when she strain, cough, bear down or lift. A bulge of tissue that, in severe cases, protrudes through vaginal opening is also common symptom. The resulting soft bulge may feel walnut or even grapefruit-sized, and often goes away when patient lie down. Some women also reported a feeling that they have not completely emptied their bladder after urinating. Loss of urinary control with coughing, laughing or sneezing is called stress incontinence and is also common symptom for prolapsed bladder In severe cases, patient may not be able to control urination at all. The main symptom for recurrent bladder infection is pain or urinary leakage during sexual intercourse. When other organs join the bladder in moving into the space in the front part of the vagina, the condition is called anterior prolapse.
Examination
During an exam, you may be asked to cough or push to help show the problem, and tests of the nerves, muscles, and urine will help tell if exercises or surgery is needed. In mild cases, muscle tightening exercises may be all that is needed, while hormones, such as estrogen, are helpful in older women. In serious cases, surgery may be needed to put the organs back into their proper working location, where the womb is often removed with this surgery because of the pressure it puts on the bladder. In the older women who may not be able to have surgery, other treatments may be recommended for prolapsed bladder.
Causes of prolapsed bladder
Pregnancy and childbirth are the most common causes of a cystocele as you could already hear. This is because the muscles and ligaments that support and hold woman’s vagina in place may become stretched and weakened during labor and delivery. For this reason, cystoceles are more common after woman had multiple pregnancies. However, not everyone who has had a baby develops a cystocele. Some women have very strong supporting muscles and ligaments in the pelvis and may never have any problem. Women who have only Caesarean section deliveries do not develop prolapse. Bladder prolapse also may be caused by straining your pelvic floor muscles through being overweight or obese, repeated heavy lifting, straining with bowel movements, or due to chronic cough or bronchitis.
Treatment for prolapsed bladder
Treatment depends on the severity of each condition on its own. Mild cases are those with few or no obvious symptoms. These cases may require no treatment or simple self-care measures such as special exercises to strengthen your pelvic floor muscles. If self-care measures are not effective, treatment may include process called pessary. Vaginal pessary is a plastic or rubber ring that is inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, the doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery, but sut some women may use pessaries for years. Estrogen therapy could also help in some cases. The doctor may recommend using estrogen, either orally or in a vaginal cream, especially if you have already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after woman enters menopause.
When is surgery necessary for prolapsed bladder?
Severe or especially uncomfortable cases of cystocele may require special surgery. This surgery is elective and designed to relieve symptoms related to the cystocele or prolapsed bladder. In most cases, surgery consists of a vaginal repair, and in this procedure, a surgeon elevates the prolapse back into place and tightens the muscles and ligaments of woman’s pelvic floor. This procedure may require even removal of some stretched tissue. While the benefits of this type of surgery can last for many years, there is also some risk of recurrence. This is partly because pelvic muscles and nerves continue to weaken as you age and this is natural process that cannot be stopped. If the cystocele recurs, you may need surgery again, although it is more difficult to get a good result the second time. In some cases, especially where the tissues needed to support the vagina are unusually thin, using a special type of tissue graft helps thicken the vaginal tissues. The goal is to increase vagina support. In other cases, doctor may recommend a hysterectomy, which is removal of the uterus, to help correct the problem and prevent recurrence of the same. When possible, you should avoid surgical treatment if you have a large cystocele until you are done having children. If the prolapse is so uncomfortable that you need a vaginal repair, you can still have children, though a Caesarean delivery is recommended after that surgery. It is very common question what is the surgical and recovery time. Each person that undergo surgery because of bladder prolapse should talk with the doctor about all benefits and risks for this surgery type. Then, doctor and patient should together decide if surgery is the best option. The fact is that about one hour of surgery is necessary to position the bladder back into its normal position. The incisions are almost always limited to the vaginal area, and post-operative discomfort is not generally significant for these patients. Most patients are discharged to home morning after the operation. About 30% of patients will need to be discharged home with a catheter, which will be removed five to seven days later in the doctor’s or surgeon’s office. You should avoid heavy lifting, heavy exercise, or sexual activity for six weeks. Walking, including stairs is fine immediately after the operation for prolapsed bladder. However, after you came home, it would be the best to follow directions that your doctor told you. Only that way you will heal as it is recommended and probably avoid recurrent bladder prolapse.
Dealing with incontinence
The doctor may recommend collagen injections in the urethra, the tube from the bladder through which urine exits the body, to treat incontinence caused by a cystocele. During a collagen injection, the protein is injected through a narrow tube called cytoscope into the lining of urethra. This helps add bulk to the tissues of urethra, helping to close the gap that allowed urine to leak. Evaryone with problem of incontinence should be aware that is common world wide problem and nothing you should be ashamed of. Talk about this problem with your doctor and seek the best solution.
Who is at risk for bladder prolapse?
Bladder prolapse tends to occur in older women who have had multiple children, and particularly after menopause, some women may notice that their bladder has fallen, which could lead to prolapsed bladder.
Most common causes of inflamed bladder
An inflamed bladder is medically called interstitialIncidence
Interstitial cystitis affects between 700,000 and 1 million Americans. This disorder can have a long-lasting adverse impact on quality of life, and is far more common in women than in men. Of the estimated 1 million Americans with bladder problems, up to 90 percent are women.
Possible causes
No one really knows what causes this condition, although there are many theories. Some of the most common suggest that interstitial cystitis is an autoimmune, hereditary, infectious, or allergic condition, but none of these have been proved. Although some of the symptoms of this disease are similar to those of bacterial infection, medical tests reveal no organisms in the urine and patients do not respond to antibiotic therapy. It is interesting that, in recent years, a substance found almost exclusively in the urine of people with interstitial cystitis has been isolated, and named “antiproliferative factor” because it appears to block the normal growth of cells that line the inside wall of the bladder.
Diet: There is no scientific evidence linking diet to interstitial cystitis, but many doctors and patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Also, many patients feel that smoking makes their symptoms worse.
Possible symptoms
Although symptoms vary significantly among patients, people with interstitial cystitis may have some of the following common symptoms:
• An urgent need to urinate
• Pressure, pain and tenderness around the bladder, pelvis and perineum
• A bladder that won't hold as much urine as it did before
• Pain during sexual intercourse and painful ejaculation
• Discomfort or pain in the penis or scrotum
• Chronic pelvis pain
• In many women, the symptoms get worse before their menstrual period.
Risk factors
There are several risk factors associated with interstitial cystitis. Some of the most common are:
• Sex – Women receive a diagnosis of interstitial cystitis far more often than men or children do.
• Age – Most people with interstitial cystitis are diagnosed in their 30s or 40s
• Other chronic disorders - Irritable bowel
Diagnosis
It can be difficult to detect interstitial cystitis because signs resemble those of many other disorders.
• Patient’s history: The first step in diagnosis of interstitial cystitis should be taking medical history and asking the patient to describe symptoms.
• Urinalysis and Urine Culture: Examining urine under a microscope and culturing the urine can detect and identify the primary organisms known to infect the urinary tract. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic.
• Cystoscopy: This test, sometimes used to rule out other causes of bladder pain, involves an examination of the bladder through a thin tube with a tiny camera – a cystoscope. This procedure is generally performed with general or regional anesthetics to reduce discomfort. During cystoscopy under anesthesia, a sample of tissue may be removed from the bladder and the urethra for examination under a microscope to check for bladder cancer and other rare causes of bladder pain.
• Biopsy: A tissue sample examination under a microscope.
Possible complications
Interstitial cystitis can result in a number of complications, including:
• Lesser bladder capacity
• Reduced quality of life
• Relationship troubles
• Emotional troubles
Treatment
Unfortunately, there is no simple treatment to eliminate the symptoms of interstitial cystitis, and no one treatment works for everyone.
Medications:
Most commonly doctors prescribe an oral medication called pentosan (Elmiron®). This is the only oral drug approved by the FDA specifically for interstitial cystitis. The funny thing is, no one really knows how it works. Some say that it may be restoring the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It takes two to four months before a patient begins to feel pain relief, and up to six months to experience a decrease in urinary frequency. There are also several possible side effects such as minor gastrointestinal disturbances and possible hair loss. Not for use by pregnant women, Elmiron may cause bleeding and loss of pregnancy.
Other oral medications that may improve the symptoms of interstitial cystitis include ibuprofen (Advil®, Motrin®, others) and other non-steroidal pain medications. Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil®), may help relax bladder and block pain.
Nerve root modulation:
Sacral nerves, which run from th lower spinal cord to the bladder, pelvic floor, and lower bowel, regulate bladder and bowel control. A method of nerve stimulation called sacral nerve root modulation can be very helpful for people with interstitial cystitis. A small wire is placed next to the sacral nerves to determine if bladder symptoms will respond to neuromodulation. If the results are positive, a small battery-operated device is surgically implanted in the patient’s upper buttocks.
Bladder distention:
Some patients notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention - stretching of the bladder with water or gas.
Medications instilled into the bladder:
Although this is a very old method of treatment, it is still considered very helpful. The prescription medication dimethyl sulfoxide, or DMSO, is placed into the bladder through a thin, flexible tube. The solution is sometimes mixed with other medications, such as a local anesthetic or bicarbonate to change the pH levels of the DMSO. After remaining in the bladder for 15 minutes, the solution is expelled through urination. However, DMSO can adversely affect the patient’s liver.
Surgery
Doctors rarely use surgery to treat interstitial cystitis because partial or complete removal of the bladder doesn't relieve pain. Besides, it can lead to several other complications.
Surgical options include:
• Bladder augmentation: During this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of colon, but the pain still remains and most women need to empty their bladders with a catheter multiple times a day.
• Fulguration: This is a minimally invasive method which involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
• Resection: Another minimally invasive method, also involving insertion of instruments through the urethra to cut around any ulcers.
Useful diet habits
The foundation of therapy is a modification of diet to help patients avoid food which will further irritate the damaged bladder wall. Common bad diet habits include caffeine, herbal and green teas, sodas, concentrated fruit juice, multivitamins, monosodium glutamate, chocolate, and potassium-rich foods such as bananas. A patient should cut out all these, leaving just the basics, and then introduce new food one step at a time, to find out his trigger-food.
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