A cystocele, commonly known as a prolapsed bladder, occurs when the wall between the bladder and the vagina weakens, allowing the bladder to bulge into the vaginal space. This condition is particularly common in women who have experienced childbirth, menopause, or chronic straining from constipation or heavy lifting. Symptoms may include urinary incontinence, a feeling of fullness in the pelvis, or a noticeable bulge in the vaginal area.

Fortunately, there are several effective treatment options for cystocele, ranging from lifestyle changes to surgical interventions. The choice of treatment depends on the severity of the prolapse, the patient’s overall health, and personal preferences.

For mild cases, certain lifestyle changes may alleviate symptoms and prevent further progression:

• Pelvic floor exercises (Kegels): Strengthening the pelvic muscles can improve support for the bladder. Regular Kegel exercises are simple and effective for many women.

• Weight management: Losing excess weight reduces pressure on the pelvic organs.

• Avoiding heavy lifting: Preventing activities that strain the pelvic floor can help minimise symptoms.

• Treating chronic cough or constipation: Addressing conditions that cause repeated straining can prevent worsening of the prolapse.

A vaginal pessary is a non-surgical option involving a silicone device inserted into the vagina to support the bladder. Pessaries come in various shapes and sizes and are ideal for women who:

• Prefer to avoid surgery

• Are not good surgical candidates due to other health issues

• Want temporary relief, such as women planning future pregnancies.

The pessaries are changed every three months and patient satisfaction is usually high.

Pelvic floor physical therapy goes beyond basic Kegel exercises and involves specialised training to strengthen the pelvic muscles, often under the guidance of a physiotherapist. This treatment may include biofeedback and electrical stimulation to enhance muscle awareness and function.

While medications do not directly treat the prolapse, they can help manage associated symptoms. For post-menopausal women, topical oestrogen therapy may improve the strength and elasticity of the vaginal tissues, offering some symptom relief.

Surgery is considered when non-surgical methods fail or the cystocele significantly affects quality of life. Surgical options include:

• Anterior vaginal wall repair (colporrhaphy) — this is the most common procedure wherein the weakened tissue supporting the bladder is tightened.

• Mesh repairs — while previously common, the use of mesh in vaginal repairs has declined due to safety concerns and potential complications.

• Minimally invasive or robotic surgery — these approaches offer quicker recovery times and smaller incisions.

Patients should have an open discussion with their gynaecologist to weigh the risks and benefits of surgery, particularly regarding recovery time and long-term outcomes.

Advancements in technology have introduced non-invasive options like pelvic floor chairs such as the Pelvic Power Pro that uses electromagnetic stimulation to strengthen the pelvic muscles without effort from the patient. These treatments are promising for individuals seeking convenient, non-surgical solutions.

Cystocele is a common but treatable condition. Early intervention with conservative measures can prevent progression while surgical options provide effective solutions for more severe cases. Women experiencing symptoms should not feel embarrassed or delay seeking medical advice. A consultation with an obstetrician-gynaecologist or urogynaecologist can guide you toward the best treatment plan tailored to your needs.

Your health and quality of life matter — don’t hesitate to take the first step toward feeling better.

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician. He is located at 3D Gynaecology Limited, 23 Tangerine Place, Kingston 10. Feel free to contact Dr Daley at ddaley@3dgynae.com.

A cystocele, commonly known as a prolapsed bladder, occurs when the wall between the bladder and the vagina weakens, allowing the bladder to bulge into the vaginal space.