Monday, May 5, 2008

Cystocele Images

This is good image of a cystocele seen from the side.












Below is an image of a cystocele seen from the front. It appears to be a grade II.


Cystoceles are graded on a scale of I-IV.

Grade I: Mild bulge with straining only

Grade II: Bulge noticable at rest but not protruding out

Grade III: Bulge is at the vaginal opening

Grade IV: Bulge protruding past the opening.

"Is My Bladder Dropping?"

This is a common question that is asked by many women if they have any urinary incontinence problems.

Urinary incontinence can occur simply on its own as Stress Incontinence (urine lost with excerise or any other activity), or Urge Incontinence (urine lost with uncontrollable urge, Overactive Bladder). Your bladder may be in the normal anatomic position and you may still experience incontinence. This is a totally separate issue, "the leaky faucet" problem, that itself can be treated: see blogs posted below.

"Cystocele" is the term used when the bladder drops from its normal anatomic position. It can occur with incontinence, or on its own. Essentially, the support structures under and next to the bladder become weakened and allow the bladder to push down into the vagina. This leads to a bulge a woman can feel or even see. Many women say they feel they're "sitting on ball", or see something protruding from the vagina. This is more pronounced at the end of the day. If it's uncomfortable, some women will try to push it back in.

Higher grade cystoceles that cause pain, discomfort, or bulge outward and protrude past the vaginal opening should be surgically corrected. Often, many cystoceles are mild and only occur with straining and may not warrant any treatment at all.

Sometimes cystoceles can mask stress incontinence if the urine becomes trapped in the vagina by a kinked urethra, or even have trouble evacuating the bladder leading to a constant sense of urgency and incomplete emptying. Infrequently, this can lead to UTIs.

The most often sited reasons for cystocele formation are: menopause, childbirth, chronic cough conditions (asthma, smoking), and genetic. Sometimes cystoceles occur by themsleves or inconjunction with other organs that protrude from the female pelvis: rectocele (rectum protruding), vaginal vault prolapse, procidentia (uterine prolpase).

Next topic: How do we treat cystoceles?