Connective tissue separates the pelvic organs. The tissue, called fascia, is attached to nearby muscles. The fascia and muscles support the bladder, vagina, and rectum. Defects in the fascia can cause cystoceles and rectoceles.
In a cystocele, there is a defect in the fascia between the bladder and vagina. This allows a part of the bladder wall to bulge into the vagina. There are three grades of cystocele: Grade 1: mildest form, where the bladder drops only partway into the vaginaGrade 2: moderate form, where the bladder has sunken far enough to reach the opening of the vaginaGrade 3: most severe form, where the bladder sags through the opening of the vagina
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In a rectocele, there is a defect in the fascia between the rectum and the vagina. This allows part of the wall of the rectum to bulge into the vagina.
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The sooner that a cystocele or rectocele is treated, the better the outcome. If you suspect you have this condition, contact your doctor.
The walls between the vagina and bladder or rectum can be damaged by one or more of the following factors:
Multiple birthsThe use of forceps to assist deliveryPerineal tears during deliveryEpisiotomy
Strain from lifting heavy objectsChronic cough
Weakening of vaginal muscles caused by a lack of estrogen after
Postmenopausal women are at increased risk.
Factors that increase your risk for a cystocele or rectocele include: History of difficult vaginal birthsHistory of straining during bowel movementsObesitySmoking
Many cases are mild and do not have symptoms.
In more serious cases, the symptoms of cystocele include: Urine leakage while laughing, sneezing, or coughingIncomplete bladder emptying after urinationPain or pressure in the pelvisPain during sexual intercourseFeeling of tissue bulging out of vagina
Symptoms of rectocele include: Pain or pressure in the vaginaPain during sexual intercoursePain or pressure in the rectumDifficult passage of stoolNeeding to apply pressure on the vagina to pass stoolFeelings of incomplete stool passageFeeling of tissue bulging out of vagina
You will be asked about your symptoms and medical history. A physical exam will be done. You may also have a vaginal and rectal exam. Tests for cystocele may include the following:
You may need to have images taken of your urine and bowel activity. This can be done with: Voiding cystourethrogramDefecogram
Your bodily fluid may need to be tested. This can be done with urine tests.
Talk with your doctor about the best plan for you. For the mildest cases of cystocele and rectocele, no treatment is needed. For more serious cases, treatment options include the following:
Your doctor may suggest that you avoid heavy lifting.Kegel exercises, which involve squeezing the pelvic floor muscles, may help to strengthen the muscles around the vagina and bladder.A diet that allows for easy passage of stools may help with a rectocele. The diet should include fiber, liquids, and a stool softener if advised.
A pessary is a device that is inserted into the vagina. It can provide support to keep the bladder and/or rectum in place.
Adding estrogen may help strengthen the walls of the vagina after
It may be delivered in the form of pills, creams, or patches.
For severe cases,
may be needed to move the bladder or rectum back into place.
To help reduce your chances of getting cystocele and rectocele, take the following steps: Avoid heavy lifting.Perform Kegel exercises regularly.Treat constipation.
If you smoke, talk to your doctor about ways to
Maintain a healthy weight.
Cystocele (fallen bladder). National Kidney and Urologic Diseases Information Clearinghouse website. Available at:
http://www.kidney.niddk.nih.gov/kudiseases/pubs/cystocele. Updated March 26, 2014. Accessed October 27, 2014.
A healthy pregnancy for women with diabetes.
The American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq176.pdf?dmc=1&ts=20130301T1642555353. Published December 2011. Accessed October 27, 2014.
Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 20, 2014. Accessed October 27, 2014.
Rectocele. American Society of Colon and Rectal Surgeons website. Available at:
http://www.fascrs.org/patients/conditions/rectocele. Updated October 2012. Accessed October 27, 2014.
Last reviewed December 2014 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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