Conditions & Treatments

Cystocele (Fallen Bladder)

Cystocele is the name for a hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

Cystocele (Fallen Bladder)

What is a cystocele?

Cystocele is the name for a disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

What are the results of a cystocele?

In addition to discomfort, the resulting dropped bladder can cause two kinds of problems:

  • Urine leakage

  • Incomplete emptying of the bladder

The dropped bladder stretches the opening into the urethra, and urine may leak when a woman does any action that causes pressure on the bladder, such as coughing.

What are the grades of cystoceles?

 

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 result from the following:

  • Heavy lifting

  • Straining muscles during childbirth

  • Repeated straining during bowel movements

  • Weakened muscles around the vagina caused by lack of estrogen after menopause

How is a cystocele diagnosed?

In addition to a complete medical history and physical examination, (which may reveal the fallen part of the bladder through the vagina), diagnostic procedures for a cystocele may include a cystourethrogram (also called a voiding cystogram). This is an X-ray of the bladder during urination and with the bladder and urethra filled with contrast medium to determine the shape of the bladder and any obstructions.

Other tests and procedures may be necessary to determine if there are any problems in the other areas of the urinary system.

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 or pelvis

  • Lower back pain

  • Leakage of urine or constipation

  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement

  • Sexual difficulties

  • Problems with inserting tampons or applicators

  • Pelvic pressure gets worse with standing, lifting, or coughing or as the day goes on 

What is the treatment for cystoceles?

Specific treatment for cystoceles will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Activity modification. Avoid activities, such as heavy lifting or straining, that could cause the cystocele to worsen.

  • Pessary. A device placed in the vagina to hold the bladder in place.

  • Surgery. A procedure to move the bladder back into a more normal position

  • Estrogen replacement therapy. This may help to strengthen the muscles around the vagina and bladder.

If you are considering hormone replacement therapy, the decision to start should be made only after you and your doctor have evaluated the risk versus benefit ratio based on your individual medical history.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

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Imaging

  • Pediatric Imaging
    The Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.
  • Adult Medicine Imaging
    The Adult Medicine Imaging Program at Massachusetts General Hospital Imaging offers a wide range of diagnostic exams and minimally invasive, image-guided treatments, all provided using leading-edge equipment and interpreted by specialty-trained radiologists.
Department of Urology

  • 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.
Obstetrics and Gynecology

  • Minimally Invasive Gynecologic Surgery Center
    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.
  • Midlife Women's Health Center
    The Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.
  • Benign Gynecology Program
    The Benign Gynecology Program at the Massachusetts General Hospital Department of Obstetrics & Gynecology delivers compassionate, expert care for the full range of gynecologic issues.
  • Urogynecology and Pelvic Reconstructive Surgery Program
    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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