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Cystocele/Rectocele

(Pelvic Relaxation; Bladder Prolapse; Fallen Bladder/Rectocoele; Protruding Rectum)

Definition

Connective tissue separates the pelvic organs. The tissue, called fascia, is attached to nearby muscles. The fascia and muscles support the bladder, vagina, and rectum. Defects in the fascia can cause cystoceles and rectoceles.
In a cystocele, there is a defect in the fascia between the bladder and vagina. This allows a part of the bladder wall to bulge into the vagina. There are three grades of cystocele:
  • Grade 1: mildest form, where the bladder drops only partway into the vagina
  • Grade 2: moderate form, where the bladder has sunken far enough to reach the opening of the vagina
  • Grade 3: most severe form, where the bladder sags through the opening of the vagina
Cystocele
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In a rectocele, there is a defect in the fascia between the rectum and the vagina. This allows part of the wall of the rectum to bulge into the vagina.
Rectocele
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The sooner that a cystocele or rectocele is treated, the better the outcome. If you suspect you have this condition, contact your doctor.

Causes

The walls between the vagina and bladder or rectum can be damaged 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

Factors that increase your risk for a cystocele or rectocele include:
  • Age: postmenopausal
  • History of difficult vaginal births
  • History of straining during bowel movements
  • Obesity
  • Smoking

Symptoms

Many cases 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
  • 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 have any of these symptoms, do not assume it is due to cystocele or rectocele. These symptoms may be caused by other, less or more serious health conditions.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may also have a vaginal and rectal exam. Tests for cystocele may include the following:
  • You may need to have images taken of your urine and bowel activity. This can be done with:
    • Voiding cystourethrogram
    • Defecogram
  • Your bodily fluid may need to be tested. This can be done with urine tests.

Treatment

Talk with your doctor about the best 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

  • Your doctor may suggest that you avoid heavy lifting.
  • Kegel exercises, which involve squeezing the pelvic floor muscles, may help to strengthen the muscles around the vagina and bladder.
  • A diet that allows for easy passage of stools may help with a rectocele. The diet should include fiber, liquids, and a stool softener if necessary.

Pessary

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

Estrogen Replacement Therapy

Adding estrogen may help strengthen the walls of the vagina after menopause. It may be delivered in the form of pills, creams, or patches.

Surgery

For severe cases, 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

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

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

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

References

Cystocele (fallen bladder). National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://www.kidney.niddk.nih.gov/kudiseases/pubs/cystocele. Updated June 29, 2012. Accessed March 1, 2013.

Cystocoele, rectocele, and pelvic support surgery. Society of Gynecologic Surgeons website. Available at: http://www.sgsonline.org/sgsinc/patiented/educate%5Farticles/edpro002.htm. Accessed March 1, 2013.

A healthy pregnancy for women with diabetes. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq176.pdf?dmc=1&ts=20130301T1642555353. Accessed March 1, 2013.

Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 22, 2013. Accessed March 1, 2013.

Rectocele. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/rectocele. Updated October 2012. Accessed March 1, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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