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Treatments and drugs
By Mayo Clinic staffCystocele treatment depends on the severity of the condition. Mild cases — those with few or no obvious symptoms — may require no treatment or simple self-care measures such as special exercises to strengthen your pelvic floor muscles. If self-care measures aren't effective, treatment may include:
- Pessary. A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, your doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery. But some women may use pessaries for years.
- Estrogen therapy. Your doctor may recommend using estrogen — either orally or in a vaginal cream — if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.
When surgery is necessary
Severe or especially uncomfortable cases of cystocele may require surgery. This surgery is elective and designed to relieve symptoms related to the cystocele.
In most cases, surgery consists of a vaginal repair. In this procedure, a surgeon elevates the prolapse back into place and tightens the muscles and ligaments of your pelvic floor. This procedure may require the removal of some stretched tissue. While the benefits of this type of surgery can last for many years, there's some risk of recurrence. This is partly because pelvic muscles and nerves continue to weaken as you age.
If the cystocele recurs, you may need surgery again — although it's more difficult to get a good result the second time. In some cases, especially where the tissues needed to support the vagina are unusually thin, using a special type of tissue graft helps thicken the vaginal tissues and increases support. If the cystocele is associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) to help correct the problem and prevent recurrence.
When possible, avoid surgical treatment if you have a large cystocele until you're done having children. If the prolapse is so uncomfortable that you need a vaginal repair, you can still have children — though a Caesarean delivery is recommended.
Dealing with incontinence
Your doctor may recommend one of a number of procedures to elevate the junction between the urethra and bladder (urethral suspension) to help with incontinence. Or, your doctor may recommend collagen injections in your urethra, the tube from your bladder through which urine exits your body, to treat incontinence caused by a cystocele. During a collagen injection, the protein is injected through a narrow tube (cystoscope) into the lining of your urethra. This helps add bulk to the tissues of your urethra, helping to close the gap that allowed urine to leak.
