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  • Midlife Women's Health Center

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    The Minimally Invasive Gynecologic Surgery (MIGS) Center at Massachusetts General Hospital delivers innovative, multidisciplinary care for a full range of gynecologic conditions including endometriosis, fibroids, abnormal uterine bleeding, ovarian cysts/masses, pelvic pain, urinary incontinence and gynecologic cancers.

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    The Massachusetts General Hospital Urogynecology and Pelvic Reconstructive Surgery Program provides comprehensive evaluation and treatment (non-surgical and surgical) for female pelvic floor problems, ie, pelvic organ prolapse and urinary incontinence, helping women return to a normal lifestyle.

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  • Female Urology Program

    The Massachusetts General Hospital Female Urology Program provides advanced and comprehensive care for urinary tract disorders including incontinence, voiding dysfunctions and pelvic prolapse.

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About This Condition


What is a cystocele?

When the wall between the bladder and the vagina weakens, the bladder may drop or sag into the vagina. This disorder in women is called cystocele.

Cystoceles are grouped into grades:


Grade 1

Mild.The bladder droops only a short way into the vagina.

Grade 2

More severe. The bladder has sunk into the vagina far enough to reach the opening of the vagina.

Grade 3

Most advanced. The bladder bulges out through the opening of the vagina.

What causes a cystocele?

A cystocele may be caused by the following:

  • Advancing age  
  • Overweight
  • Child birth
  • Heavy lifting
  • Straining muscles during childbirth
  • Chronic coughing
  • Constipation
  • Repeated straining during bowel movements
  • Previous pelvic surgery
  • Weak muscles around the vagina caused by lack of estrogen after menopause

What are the symptoms of a cystocele?

Symptoms of cystocele include:

  • Feeling of pelvic heaviness or fullness
  • Bulge in the vagina that you can feel
  • Aching or a feeling of pressure in the lower abdomen (belly) or pelvis
  • Lower back pain
  • Frequent urinary tract infections
  • Need to urinate often or urgently
  • Leakage of urine
  • Incomplete emptying of the bladder
  • Constipation
  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement
  • Pain during sex
  • Problems putting in tampons or vaginal applicators
  • Pelvic pressure that gets worse with standing, lifting, or coughing or as the day goes on

How is a cystocele diagnosed?

Your doctor will review your medical history and do a physical and pelvic exam. Other tests may include:

  • Cystourethrogram (also called a voiding cystogram). This is an X-ray of the bladder taken while the woman is urinating and with the bladder and urethra filled with contrast dye. It shows the shape of the bladder and any blockages.

Other tests may be needed to find out if there are any problems in the other areas of the urinary system.

How is a cystocele treated?

Treatment depends on the grade of the cystocele and may include:

  • Activity changes. Avoiding certain activities, such as heavy lifting or straining during bowel movements, that could cause the cystocele to worsen.
  • Kegel exercises. Regular, daily exercises of the pelvic muscles to make them stronger.
  • Pessary. This is a device placed in the vagina to hold the bladder in place.
  • Surgery. May be used to move the bladder back into a more normal position
  • Hormone replacement therapy. This may help to strengthen the muscles around the vagina and bladder. If you are thinking about hormone replacement therapy, talk to your health care provider about the risks and benefits first.

Key points about cystocele

  • A cystocele is when the wall between the bladder and the vagina weakens. This can cause the bladder to drop or sag into the vagina.
  • It may be caused by things that increase pressure on the pelvic muscles.
  • Treatment depends on the severity of the cystocele. It may include avoiding certain activities, surgery, or other methods.

Next steps

Tips to help you get the most from a visit to your health care provider:
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.