A cystocele is the medical term for a prolapsed bladder, which occurs when the tissues and structures supporting the urinary bladder in its normal anatomical position weakens and stretches. It is a type of hernia where the bladder protrudes into the vaginal wall. A cystocele is also known by common terms like a fallen, drooping or dropped bladder. The terms ‘collapsed bladder‘ or ‘weak bladder‘ is at times used to describe a cystocele but this is incorrect as it denotes a compromised bladder.
A cystocele is more frequently seen in women who have multiple vaginal childbirths and is one of the reasons that some women opt for elective cesarean sections. However, a cystocele can still affect women who have cesarean section deliveries although the risk is less than with vaginal delivery.
How does a cystocele occur?
The bladder is supported in the pelvis by surrounding structures as outlined under bladder location, ligaments and the pelvic floor. This is a collection of muscles, fascia and ligaments that cup the pelvic contents, providing support for these structures as well as the abdominal contents. The pelvic contents rest on the pelvic floor, more specifically the levator ani muscles, and its position maintained with the pelvic cavity by the pelvic ligaments.
Pelvic floor disorders may arise due to a number of causes where the pelvic ligaments are stretched and weakened and the pelvic floor muscles and fascia also stretch. Sometimes nerve damage may further contribute to muscle weakness thereby leading to inadequate support by the lax muscle.
A cystocele is essentially a hernia and other structures may also protrude into the vagina, depending on the degree of prolapse. This includes the uterus (prolapsed uterus), rectum (rectocele) and even portions of the small intestine (enterocele). In some cases, the urethra also drops down with the bladder and this is known as a cystouretherocele.
A cystocele is associated with straining just like other types of hernias and the risks for developing a cystocele are often similar to those of abdominal hernias (refer to what is a hernia for more information on types, causes and risk factors of abdominal hernias). Increased pressure within the abdominal and pelvic cavity causes pressure against the supporting walls. The walls and supporting ligaments weaken over time and cannot maintain the normal tension to contain these organs within its respective cavities. Increased pressure and straining may occur for any number of reasons, including pregnancy, childbirth, obesity and chronic constipation.