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Definition

What is anterior prolapse?

Anterior prolapse, also known as a cystocele, occurs when the supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder.

Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease.

For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.

How common is anterior prolapse?

Please discuss with your doctor for further information.

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Symptoms

What are the symptoms of anterior prolapse?

The common symptoms of anterior prolapse are:

  • A feeling of fullness or pressure in your pelvis and vagina
  • Increased discomfort when you strain, cough, bear down or lift
  • A feeling that you haven’t completely emptied your bladder after urinating
  • Repeated bladder infections
  • Pain or urinary leakage during sexual intercourse
  • In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg

Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.

In mild cases of anterior prolapse, you may not notice any signs or symptoms.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes anterior prolapse?

Prolapse can develop for many reasons. The major cause is stress on this supportive “hammock” when giving birth. Women who have many pregnancies, deliver vaginally, or have long or difficult childbirth are at higher risk.

Other causes that can lead to prolapse are:

  • Heavy lifting
  • Chronic coughing (or other lung problems)
  • Constipation
  • Frequent straining to pass stool
  • Obesity
  • Menopause (when estrogen levels start to drop)
  • Prior pelvic surgery
  • Aging

Risk factors

What increases my risk for anterior prolapse?

There are many risk factors for anterior prolapse, such as:

  • Women who have vaginally delivered one or more children have a higher risk of anterior prolapse.
  • Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen — which helps keep the pelvic floor strong — decreases.
  • Having your uterus removed may contribute to weakness in your pelvic floor support.
  • Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.
  • Women who are overweight or obese are at higher risk of anterior prolapse.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is anterior prolapse diagnosed?

Prolapse can be found with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing. Your health care provider may measure how serious the prolapse is and what parts of the vagina are falling.

Other tests and imaging studies may also be done to check the pelvic floor, such as:

  • Cystoscopy
  • Urodynamics
  • X-rays
  • Ultrasound
  • MRI

How is anterior prolapse treated?

Treatment depends on how severe your anterior prolapse is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (uterine prolapse).

Mild cases — those with few or no obvious symptoms — typically don’t require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles.

If self-care measures aren’t effective, anterior prolapse treatment might involve:

  • A supportive device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.
  • Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — especially if you’ve already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.

When surgery is necessary

If you have noticeable, uncomfortable symptoms, anterior prolapse may require surgery.

  • How it’s done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of the pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.
  • If you have a prolapsed uterus. For anterior prolapse associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues.
  • If you’re thinking about becoming pregnant, your doctor may recommend that you delay surgery until after you’re done having children. Using a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there’s some risk of recurrence — which may mean another surgery at some point.

Dealing with incontinence

If your anterior prolapse is accompanied by stress incontinence — involuntary loss of urine during strenuous activity — your doctor may recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage anterior prolapse?

The following lifestyles and home remedies might help you cope with anterior prolapse:

Kegel exercises strengthen your pelvic floor muscles, which support the uterus, bladder and bowel. A strengthened pelvic floor provides better support for your pelvic organs and relief from symptoms associated with anterior prolapse.

To perform Kegel exercises, follow these steps:

  • Tighten (contract) your pelvic floor muscles — the muscles you use to stop urinating.
  • Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
  • Work up to holding the contraction for 10 seconds at a time.

Do three sets of 10 repetitions of the exercises each day.

Ask your health care provider for feedback on whether you’re using the right muscles. Kegel exercises may be most successful when they’re taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you’re tightening the proper muscles with optimal intensity and length of time.

Once you’ve learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you’re sitting at your desk or relaxing on the couch.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 11, 2017 | Last Modified: August 11, 2017

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