A cystocele occurs when part of the bladder bulges into the vagina. A rectocele occurs when part of the rectum sags into the vagina. In both conditions, the walls of the vagina weaken so they are not strong enough to support a separation between the vagina and the bladder or rectum.

There are three grades of cystocele:

• Grade 1: the mildest form, where the bladder drops only partway into the vagina

• Grade 2: a moderate form, where the bladder has sunken far enough to reach the opening of the vagina

• Grade 3: the most severe form, where the bladder sags through the opening of the vagina

The sooner that cystocele or rectocele are treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor.

Causes

Cystocele and rectocele occur when the walls of the vagina have been damaged, usually by one or more of the following factors:

• Difficult vaginal births

• • Multiple births

• • The use of forceps to assist delivery

• • Perineal tears during delivery

• • Episiotomy during birth

• Strain from lifting heavy objects

• Chronic cough

• Chronic constipation

• Weakening of vaginal muscles caused by a lack of estrogen after menopause

Risk Factors

The following factors increase your chance of developing cystocele and rectocele. If you have any of these risk factors, tell your doctor:

• Age: postmenopausal

• History of difficult vaginal births

• History of straining during bowel movements

• Obesity

• Smoking

Symptoms

Many cases of cystocele and rectocele are mild and do not have symptoms.

In more serious cases, the symptoms of cystocele include:

• Urine leakage while laughing, sneezing, or coughing

• Incomplete bladder emptying after urination

• Pain or pressure in the pelvis

• Frequent bladder infections

• Pain during sexual intercourse

• Feeling of tissue bulging out of vagina

Symptoms of rectocele include:

• Pain or pressure in the vagina

• Pain during sexual intercourse

• Pain or pressure in the rectum

• Difficult passage of stool

• Needing to apply pressure on vagina to pass stool

• Feelings of incomplete stool passage

• Feeling of tissue bulging out of vagina

If you experience any of these symptoms do not assume it is due to cystocele or rectocele. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests for cystocele may include the following:

• Pelvic examination

• Voiding cystourethrogram: an x-ray test done during urination

• Urine tests to look for signs of infection

Tests for rectocele may include:

• Examination of the vagina and rectum

• Defecagram: an x-ray test done during defecation

Treatment

Talk with your doctor about the best treatment plan for you. For the mildest cases of cystocele and rectocele, no treatment is needed. For more serious cases, treatment options include the following:

Activity Modification

For cystocele and rectocele, your doctor may suggest that you avoid heavy lifting.

Kegel exercises (squeezing the pelvic floor muscles) may help to strengthen the muscles around the vagina and bladder.

For rectocele, the first line of treatment is often a diet that allows for easy passage of stools. This includes adding fiber, liquids, and a stool softener if necessary.

Pessary

A pessary is a device that is inserted into the vagina to provide support and to keep the bladder and/or rectum in place.

Estrogen Replacement Therapy

Adding estrogen (in the form of pills, creams, or patches) may help strengthen the walls of the vagina after menopause.

Surgery

For severe cases of cystocele and rectocele, surgery may be needed to move the bladder or rectum back into place.

Prevention

To help reduce your chances of getting cystocele and rectocele, take the following steps:

• Avoid heavy lifting.

• Perform Kegel exercises regularly.

• Treat constipation.

• Quit smoking.

• Maintain a healthy weight.

RESOURCES:

American Society of Colon and Rectal Surgeons
http://www.fascrs.org

National Kidney and Urologic Diseases Information Clearinghouse
http://www.kidney.niddk.nih.gov

Society of Gynecologic Surgeons
http://www.sgsonline.org/edpro002.html

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

References:

Cystocele (fallen bladder). National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://www.kidney.niddk.nih.gov/kudiseases/pubs/cystocele. Accessed on September 22, 2005.

Cystocele. University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/wha/wha_cystocel_crs.htm. Accessed on September 22, 2005.

Cystocoele, rectocoele, and pelvic support surgery. Society of Gynecologic Surgeons website. Available at: http://www.sgsonline.org/edpro002.html. Accessed on September 22, 2005.

Rectocele. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=19. Accessed on September 22, 2005.

Rectocele. Mayo Clinic website. Available at: http://www.mayoclinic. com/invoke.cfm?id=AN00529. Accessed on September 22, 2005.