Cystocele – The Treatment And Symptoms

In prolapse of the anterior vaginal wall, the upper part of the anterior vaginal wall descends and in severe cases may protrude outside the vaginal orifice. In such cases, the vesical and vaginal fasciae are thinned out and fail to support the bladder, so that the bladder prolapses with the anterior vaginal wall. This condition is termed Cystocele. In cases when the urethra prolapses along with the lower one third of the anterior vaginal wall it is termed as Urethrocele. In such cases the patient invariably complains of stress incontinence.

Causes: The most important cause of prolapse is atonicity and asthenia that follow menopause. The ligaments and pelvic floor muscles become slack and this is the cause of prolapsed in women of menopausal age. Most of the women complaining of prolapse are of menopausal age.

Some women however, develop prolapse soon after child birth. Postnatal pelvic floor exercises help greatly to restore the tone of the muscles and thus reverse mild cases and considerably reduce severe cases of prolapse.

Birth injury is another important cause.

Peripheral nerve injury such as pudendal nerve injury during child causes prolapse in 60 % of the cases.

Delivery of a big baby also stretches the ligaments and muscles leading to prolapse.

Rapid succession of pregnancies increases the tendency of prolapse.

Prolonged bearing down in the second stage of labour and ventouse extraction of the fetus before the cervix is fully dilated increases the risk of prolapse.

A raised intra abdominal pressure due to chronic bronchitis, large abdominal tumors or obesity tends to worsen Cystocele and other prolapses as well.

Symptoms: The patient complains of something protruding from the vulva. The prolapse is aggravated on coughing, straining or excessive physical work. If the prolapse is large there will be an external swelling. Owing to friction the epithelium of this external mass may become thickened, hypertrophied and keratinized. In some cases there may be an ulcer on the most dependent part of the swelling called a decubitus ulcer.

Vaginal discharge is another common symptom, if there is a decubitus ulcer however the discharge may be blood stained.

Difficulties in coition are common with third degree uterine prolapse.

Micturition disorders are one of the most important symptoms of Cystocele. The defective control of micturition is due to lack of support to the sphincter of the urethra. Some complain of increased frequency of passing urine. Others complain of incomplete emptying of the bladder. Due to retention of urine, patients suffer from recurrent urinary tract infections. In severe degrees of bladder prolapse, patients complain that the more they strain the less easily they can pass urine.

Treatment: In cases of prolapse in young women following childbirth it is better to avoid immediate operative treatment. Since most cases of post natal prolapses respond well to abdominal exercise, massage and perineal exercises when done regularly. This conservative treatment must be followed regularly for 3 to 4 months following delivery.

Anterior Colporrhaphy is the operation performed to repair a Cystocele and Cystourethrocele.

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