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by Lowney N
(Pelvic Relaxation; Bladder Prolapse; Fallen Bladder/Rectocoele; Protruding Rectum)

Definition

The pelvic organs are held in place by muscles and tissues that can sometimes weaken and stretch. A cystocele is when the bladder and vaginal wall fall into the vaginal opening. A rectocele is when the rectum bulges into the front of the vagina.

Cystocele
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Copyright © Nucleus Medical Media, Inc.
Rectocele
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Copyright © Nucleus Medical Media, Inc.

Causes

The muscles and tissues can be damaged by difficult vaginal births, such as:

  • Multiple births
  • The use of forceps to help with delivery
  • Tearing or an episiotomy

The muscles and tissues can also be damaged over time from:

Risk Factors

This problem is more common in women who have gone through menopause. Other things that may raise the risk are:

  • A history of difficult vaginal births
  • History of straining during bowel movements
  • Obesity
  • Smoking

Symptoms

Some muscle and tissue weakening may not cause symptoms. People with a severe cystocele may have:

  • Problems controlling the flow of urine or fully emptying the bladder
  • Pelvic pain or pressure
  • Pain during sex
  • Tissue bulging out of vagina

People with a severe rectocele may have:

  • Pain or pressure in the vagina or rectum
  • Pain during sex
  • Problems passing stool or fully emptying
  • Tissue bulging out of the vagina

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done. You may also have a vaginal and rectal exam. This is enough to make the diagnosis.

Treatment

People who do not have symptoms may be watched for signs of change. The goal in others will be to ease symptoms and stop the problem from getting worse. Options are:

Activity Changes

  • Avoiding heavy lifting
  • Doing exercises to strengthen the pelvic floor muscles
  • Increasing fiber in the diet or taking supplements to make stool easier to pass

Pessary

A pessary is a device that is inserted into the vagina. It is used to keep the pelvic organs in place.

Estrogen Replacement Therapy

Estrogen may help strengthen the walls of the vagina after menopause . It may be given as pills, creams, or patches.

Surgery

People with severe problems may need surgery to move the bladder or rectum back into place.

Prevention

The risk of this health problem may be lowered by:

  • Avoid jobs that involve heavy lifting
  • Doing pelvic floor exercises
  • Treating constipation
  • Not smoking
  • Reaching or maintaining a healthy weight

RESOURCES

The American Congress of Obstetricians and Gynecologists  https://www.acog.org 

National Institute of Diabetes and Digestive and Kidney Diseases  https://www.niddk.nih.gov 

CANADIAN RESOURCES

Canadian Urological Association  https://www.cua.org 

The Society of Obstetricians and Gynaecologists of Canada  https://www.sogc.org 

References

Cystocele. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele?dkrd=/health-information/urologic-diseases/bladder-control-problems-women/cystocele-prolapsed-bladder. Accessed April 1, 2022.

Pelvic organ prolapse. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/pelvic-organ-prolapse. Accessed April 1, 2022.

Rectocele expanded information. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/rectocele-expanded-information. Accessed April 1, 2022.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 11/2021
  • Update Date: 04/01/2022