A cystocele is a type of pelvic organ prolapse in which the bladder sags into the front wall of the vagina because its supporting tissues have weakened. It is linked to vaginal childbirth, aging, menopause, obesity and chronic straining.
Key symptoms
- Feeling or seeing a bulge in the vagina
- Pelvic pressure that worsens at the end of the day
- Urinary leakage, urgency or frequent urination
- Slow stream or feeling that the bladder does not empty
- Needing to push the bulge back to urinate
What you find on exam
- Pelvic exam at rest and with straining (Valsalva)
- Bulge of the anterior vaginal wall seen with a split speculum
- Stage the prolapse (POP-Q)
- Check for vaginal atrophy and prolapse of other compartments
Tests
- Urinalysis and urine culture
- Post-void residual by bladder scanner or catheter
- Urodynamic testing before surgery in selected patients
Treatment basics
- Pelvic floor muscle exercises with physical therapy
- Vaginal pessary fitted in the office
- Vaginal estrogen for atrophy
- Weight loss, treatment of constipation and avoiding heavy straining
- Surgical repair (anterior colporrhaphy) if symptoms persist
Red flags
- Inability to urinate (urinary retention)
- Fever and flank pain suggesting a kidney infection
- Ulcer or bleeding on the prolapse or from a pessary
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.