Does your bladder feel like it's low? Let's talk about Cystocele!

Do you sometimes feel a fullness, heaviness, or a feeling like something is coming out of your vagina? Or do you often need to urinate, but it feels like nothing is coming out? These are not just random things. You may also have a condition called a cystocele. Don't worry, we'll talk about this in detail and very simply today.

What exactly is a cystocele?

Simply put, a cystocele is a protrusion of your bladder from where it is located into the vagina . Think about it, our organs are held in place by muscles and ligaments. They stretch and contract like rubber bands. So, if these muscles and ligaments around your bladder become weak or stretched, the bladder can't stay in its usual place. That's when the bladder starts to slide down, which means into the vagina. This is what we call a cystocele. This is a condition that belongs to the larger category of pelvic organ prolapse. Some people also call it "the bladder is falling down" or "the bladder is like a hernia." All of these mean the same thing.

Are there types of cystocele? What are they?

Yes, there are three main types of cystocele, depending on the size of the cystocele, that is, how far down the bladder it has descended. Doctors call this a "grade."

• Grade 1 - Mild: This is the mildest stage . Here, the bladder is only slightly lowered into the vagina . You may not even notice this.
• Grade 2 - Moderate: This is the moderate stage . Here, the bladder is down to the opening of the vagina, and may even protrude slightly.
• Grade 3 - Severe: This is the most severe stage . Here, the bladder can be seen protruding completely from the vaginal opening.

This stage determines the nature of the symptoms and the method of treatment.

How serious can this situation be?

It really depends on the grade of your cystocele. For example, if it's a small cystocele like Grade 1 , you might only feel a little discomfort or heaviness. Or you might leak a little urine when you laugh or cough (this is called urinary incontinence). But if it's a Grade 3 cystocele,If it is a serious condition like prolapse, it is something to be concerned about. Because, when the bladder is too low, you may not be able to urinate properly. The bladder may not empty completely. If this happens, there is a higher chance of developing urinary tract infections (UTIs). Sometimes, if this condition continues, it can even damage the kidneys. That is why it is advised to seek medical advice immediately if you have symptoms.

Is the condition called cystocele common?

Yes, indeed. Cystocele is a condition that affects many women. According to medical experts, about 50% of women will experience some form of cystocele at some point in their lives. This means that you are not alone. Many people experience this condition.

Do you also have a cystocele? What are the symptoms?

Now let's see if you have any of these symptoms. Not everyone has the same symptoms. However, there are some common symptoms:

• Feeling or seeing something protruding from the vaginal opening. Some people say "something like a ball is stuck."
• A feeling of fullness, heaviness, or pain in the pelvic area. This feeling may be worse when standing, lifting, or coughing. This discomfort may also worsen as the day progresses and in the evening.
• Needing to urinate more often than usual.
• A feeling that the bladder has not completely emptied when urinating. You may feel the need to urinate again after a while.
• Frequent occurrence of urinary tract infections (UTIs).
• Difficulty inserting menstrual products such as tampons or menstrual cups into the vagina.

If you have one or more of these symptoms, the best thing to do is see a doctor and get checked out.

Why is this happening? What are the reasons?

As we've discussed before, cystoceles are caused by the weakening or stretching of the muscles and ligaments that hold the bladder in place. There are a number of reasons why these muscles can become weak.

• Vaginal births : During normal childbirth, there is a lot of pressure and stretching on the muscles of the pelvic cavity. This effect can increase with factors such as the size of the baby and the time it takes to give birth. This risk is higher for those who have given birth to multiple children vaginally.
• Family history: If a close female relative, such as your mother, sister, or niece, has had a cystocele, you may be at risk of developing it too.
• Obesity :This risk is higher for people who are significantly overweight (doctors define this as having a Body Mass Index (BMI) of over 30). This is because the extra weight puts constant pressure on the pelvic muscles.
• Hysterectomy : Some women may develop this condition after a hysterectomy, as the uterus also helps to support the pelvic organs.
• Decreased estrogen : Estrogen is a female hormone. It helps keep the muscles around the vagina strong. As you age, especially after menopause , estrogen levels in the body decrease. This is also one of the reasons why the muscles weaken and cystoceles occur.
• Frequent heavy lifting or strenuous work.
• Having a long-term cough (e.g. due to diseases such as asthma, bronchitis).
• Prolonged constipation and straining when going to the toilet.

Who is most likely to be affected by this situation?

Although anyone of any age with a vagina can develop a cystocele, some people are at higher risk.

• As you age: The risk increases as the pelvic muscles naturally weaken with age.
• For those who have given birth vaginally.
• Those who have undergone surgery on the pelvic area or uterus (e.g. Hysterectomy).
• For those who are obese.
• For those who have had this condition in their family.

What are the possible complications of cystocele?

A cystocele is usually not life-threatening, but if left untreated, some complications can occur.

• Urinary retention: A lowered bladder can cause the urethra to become tight, and you may not be able to completely empty your bladder when you urinate.
• Kidney damage: Urine remaining in the bladder can cause urine to flow backward (through the ureters), putting pressure on the kidneys, which can eventually damage them. This is a serious condition.
• Frequent urinary tract infections.

That's why we say, if you have symptoms, don't be shy or afraid, but see a doctor.

How do doctors diagnose this?

Only a doctor can tell for sure if you have a cystocele. Usually, a gynecologist or urologist diagnoses the condition. The doctor will ask you about your symptoms and your medical history. Then they will do a physical examination. During this examination, they will examine your vagina to see if your bladder has prolapsed and how far it has. You may be asked to cough or urinate a little to see how far it has prolapsed. Sometimes, the following tests may be done to further confirm the condition:

• Urodynamic testing: This tests your bladder's ability to hold and release urine.
• Cystoscopy: In this, a long, thin, pencil-like tube (cystoscope) with a camera attached is passed through the urethra and into the bladder. This can be used to check for any abnormalities, blockages, tumors, or stones inside the urethra and bladder.

Can you check this yourself?

Only a doctor can make an accurate diagnosis. However, some women feel like they can push something in through their vagina. If you have symptoms of a cystocele, be sure to see a doctor. Do not self-diagnose.

How is a cystocele treated?

Treatment depends on the severity of your cystocele. Mild (Grade 1) cystocele: If you are not experiencing any significant discomfort, you may not need any special treatment. However, it is important to avoid activities such as heavy lifting and straining, as these can make the condition worse. Other mild treatment options include:

• Maintain a healthy weight that suits you. Talk to a doctor about this and get advice.
• Estrogen replacement therapy: This can be helpful, especially for those with low estrogen levels after menopause. It can be given as a cream or as a pill.
• Kegel exercises: This is a very important thing. These exercises strengthen your pelvic floor muscles. That is, the muscles around the urethra, vagina, and anus. When these muscles are strong, they help control bladder prolapse. Ask your doctor or physiotherapist for the correct way to do these exercises.
• A pessary device:This is a ring-like device made of rubber or silicone. It is inserted into the vagina and helps to push the bladder up and hold it in place. This is a temporary solution. Some people can use this if they cannot or do not want to have surgery.

Moderate or Severe (Grade 2 or 3) Cystocele: If the above treatments do not help, surgery may be necessary.

What if surgery is needed?

The main surgery for a severe cystocele is called an anterior colporrhaphy . In this, the surgeon brings the prolapsed bladder back into place and tightens the muscles in the front wall of the vagina that hold it in place. Sometimes, a special mesh can be used to strengthen the weakened tissue. However, there are different opinions about the use of this mesh, so talk to your doctor before making a decision. Cystocele surgery is usually not a major surgery. It is often an outpatient procedure that allows you to go home the same day. It can take several months to fully recover. If you no longer want to have sex, there are other surgical options that close off, shorten, and stop the prolapse. If not only the bladder, but also the uterus, the upper part of the vagina (for those who have had their uterus removed, this is called the apex), or the rectum is also prolapsed, the doctor will explain to you about other surgeries.

How quickly will I feel better after treatment?

If you have a serious cystocele that requires surgery, you may start to feel some relief soon after surgery. However, it may take several weeks to several months to fully recover and return to normal activities. It is very important to follow your doctor's instructions exactly.

Are there ways to prevent this situation?

Some risk factors we can't control, such as family history or aging. However, there are things we can control. They can reduce the risk of developing this condition.

• Maintain a healthy weight that suits you. Consult a doctor or nutritionist for advice on this.
• Avoid constipation. Eat a diet rich in fiber (vegetables, fruits, legumes, whole grains). Drink plenty of water throughout the day. Exercise regularly. These things can help reduce constipation. Then you won't have to strain when you go to the bathroom.
• Protect your pelvic floor muscles when lifting heavy objects. Don't lift heavy objects alone. If you are lifting a heavy object, use proper posture: bend your knees and hips, keep your back straight, and lower yourself to pick up the object. Don't twist while lifting the object.
• Do Kegel exercises regularly. It is best to start doing these exercises during pregnancy. It is important to continue doing these exercises after giving birth.
• If you smoke, stop.Chronic cough caused by smoking puts pressure on the pelvic muscles.

What should you keep in mind if you have a cystocele?

If a doctor tells you that you have a cystocele, don't worry. It can be managed.

The most important thing is to follow your doctor's instructions exactly and make the necessary changes to your lifestyle.

What are the things I shouldn't do?

If you have a cystocele, it's best to stay away from these things:

• Weight lifting and any activity that puts pressure on the pelvic muscles. For example, strenuous exercise, work that puts pressure on the abdomen.
• Don't ignore a chronic cough. If you have a persistent cough, such as bronchitis, get it treated properly. Coughing puts constant pressure on the pelvic muscles.
• Avoid or quit smoking.
• Don't sit in a way that causes constipation. Don't strain when going to the toilet.

What time should I see a doctor?

If you have symptoms of a cystocele, especially if they are interfering with your daily life and work, be sure to see a doctor. Don't be embarrassed or put off.

When do you need to go to an emergency room?

If you have symptoms of cystocele and you are unable to urinate at all , that is, if your urine is blocked, go to the emergency room of your nearest hospital immediately. This is something you should not delay.

What are the important questions to ask the doctor?

When you go to see the doctor, don't forget to ask any questions you have. Here are some questions you can ask:

• "Doctor, how exactly can I tell if I have a cystocele?"
• "If I don't have a cystocele, could some other condition be causing these symptoms?"
• "What kind of treatment does the doctor recommend for me?"
• "Can I control this condition without surgery?"
• "Is it possible for me to develop this condition again after treatment?"
• "What activities and movements should I avoid or not do?"
• "Can I have sex if I have a cystocele? Will it cause any problems?"
• "Should I see a gynecologist or a urologist?"

It is very important to ask questions like these and gain a better understanding of your situation.

Are "Prolapsed bladder" and "Cystocele" the same thing?

No, these are two names for the same condition. "Prolapsed bladder" is just another name for a cystocele. So don't get confused about it.

Finally, a Take-Home Message

A cystocele is not usually life-threatening. However, it can cause you embarrassment, discomfort, and stress. Don't let it stop you from living your life happily and comfortably.

Remember, you are not alone. There are treatments for this condition. If you have symptoms of cystocele and they are affecting your life, see a doctor without hesitation. He or she will review your symptoms and medical history and recommend the most appropriate treatment for you. This will definitely help you feel better and improve your quality of life.

Take care of your body. Because health is the greatest wealth!