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Sistosel ve Cerrahi Tedavisi

Vaginal anterior wall prolapse, also known as cystocele, is when the supporting tissue between a woman's bladder and the vaginal wall weakens and stretches; allows the bladder to swell into the vagina. Vaginal anterior wall prolapse is also called bladder prolapse, that is, cystocele.

Tightening and weakening of the muscles that support your pelvic organs can cause anterior prolapse. This type of strain occurs during vaginal delivery or with chronic constipation, severe coughing or heavy lifting. Bladder sagging also tends to cause problems after menopause when estrogen levels drop. For mild or moderate sagging, non-surgical treatment is usually effective. In more severe cases, surgery may be required to hold the vagina and other pelvic organs in their proper positions.

Symptoms of sagging bladder

In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms do occur, they may include:

  • Feeling of fullness or pressure in your groin and vagina
  • Increased discomfort when you strain, cough, carry or lift
  • Feeling that you haven't completely emptied your bladder after urinating
  • Recurrent urinary tract infections
  • Pain or incontinence during sexual intercourse
  • In severe cases, a swelling of tissue that protrudes from your vaginal opening and may feel like sitting on an egg

Symptoms and symptoms are usually noticed after prolonged standing and may disappear when lying down.

When to see a doctor?

A severely prolapsed bladder can be bothersome. It can make it difficult to empty the bladder and lead to urinary tract infections. Make an appointment with your doctor if you have any signs or symptoms that bother you.

Causes of sagging urinary bladder

Your pelvic floor is made up of muscles, ligaments, and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time as a result of birth trauma or chronic stretching of the pelvic floor muscles. When this happens, your bladder may slide lower than normal and swell into the vagina (Prolapse of the bladder).

  • Pregnancy and vaginal birth
  • Being overweight or obese
  • Repetitive heavy lifting
  • Filtering with bowel movements
  • Chronic cough or bronchitis

Risk factors

  • Birth: Women who have given birth to one or more children vaginally are at higher risk.
  • Aging: Your risk of anterior prolapse increases as you get older. This is especially true after menopause, when your body's production of estrogen, which helps keep the pelvic floor strong, decreases.
  • Hysterectomy: Removal of your uterus can weaken your pelvic floor support.
  • Genetics: Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
  • Obesity: Overweight or obese women are at higher risk for anterior prolapse.

How to prevent?

Try the following self-care measures:

  • Do Kegel exercises regularly. These exercises can strengthen your pelvic floor muscles, and this is especially important after you have a baby.
  • Treat and prevent constipation. High-fiber foods can help.
  • Avoid heavy lifting and lift properly. When lifting, use your legs rather than your lower back or back.
  • Control the cough. Treat chronic cough or bronchitis and do not smoke.
  • Avoid weight gain. Talk to your doctor to determine your ideal weight and, if necessary, seek advice on weight loss strategies.


  • Pelvic exam. You can have the exam while lying down and standing. During the exam, your doctor will look for a tissue swelling in the vagina that indicates pelvic organ prolapse.
  • Filling out inquiry forms. You can fill out a form that helps your doctor evaluate your prolapse degree and how much it affects your quality of life. The information collected also helps guide treatment decisions.
  • Bladder and urine tests.


Treatment depends on how severe your prolapse is and whether you have related conditions, such as uterine prolapse that enters the vaginal canal. In addition, the presence of your age and additional disease may also change the treatment modality.

  • Mild cases - those with few or no obvious symptoms - typically do not require treatment. So if you don't have any complaints, no treatment is usually required. Along with self-care measures such as exercises that strengthen your pelvic floor muscles, you may choose a wait-and-see approach with occasional doctor visits to see if your prolapse is getting worse. If self-care measures are not effective, treatment for anterior prolapse may include:
  • A supporting device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other caregiver fits the device and shows you how to clean and reinstall it yourself. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
  • Estrogen therapy. Your doctor may recommend estrogen -- usually a vaginal cream, pill, or ring -- especially if you're in menopause. This is because estrogen decreases after menopause, which helps keep pelvic muscles strong.

When surgery is required

Anterior prolapse may require surgery if you have noticeable, bothersome symptoms.

  • How to. Usually, surgery is done vaginally and involves retracting the prolapsed bladder into place, removing extra tissue, and tightening the muscles and ligaments of the pelvic floor. Your doctor may use a special tissue graft to strengthen the vaginal tissues and increase support if your vaginal tissues seem too thin.
  • If you have a prolapsed uterus. If you have uterine prolapse at the same time as the urinary bladder; removal of your uterus may be recommended.

If you're considering getting pregnant, your doctor may recommend postponing surgery until you can have children. Using a pessary can help relieve your symptoms in the meantime. The benefits of surgery may last for years, but there is a risk of recurrence - this could mean another surgery at some point!

Dealing with urinary incontinence: If you have urinary incontinence accompanied by bladder prolapse; A second surgery in the same session or surgery in two sessions may be recommended.

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