When people talk about the pelvic floor, the subject is often urinary leaks. But the pelvic floor can suffer from other problems linked to a lack of tone — a prolapse, for instance.
Also called "organ prolapse", prolapse can take different forms and is named after the organ or organs that descend.
The most common prolapse in women is called a cystocele. It corresponds to a descent of the bladder. A closer look at the symptoms, the causes and the treatments of this condition.
What is a cystocele?
A cystocele is characterised by a descent of the bladder against the vaginal wall. In a cystocele, the bladder leaves its natural position (in front of the vagina, behind the pubic symphysis) to descend partly into the vagina.
Bladder descent can progress and come outside if it is not treated in time. In that case, a bulge becomes visible outside the body. A cystocele has 4 severity stages:
- Grade 1: the bladder descent is slight and the prolapse remains intravaginal
- Grade 2: the bladder reaches the vulva, without coming outside
- Grade 3: the prolapse extends beyond the vulvar opening
- Grade 4: the prolapse is fully externalised
What are the symptoms of a cystocele?
A gynaecological examination is usually what detects the symptoms of a cystocele. In most cases, women may feel a sensation of pelvic or vaginal heaviness. This symptom should alert them and lead them to book an appointment with their healthcare professional.
Generally, urinary problems can be symptomatic of a bladder descent:
- urinary incontinence
- a sense of not being able to empty the bladder completely
- recurrent cystitis
- discomfort during sexual intercourse…
What are the causes of a bladder descent?
The pelvic floor is one of the main culprits behind the appearance of a cystocele. Repeated pressure on the pelvic floor causes it to weaken. It will no longer be able to support the organs when the pressure becomes too great.
All the factors that affect pelvic floor tone can encourage the appearance of a cystocele. Examples include:
- childbirth
- carrying heavy loads, repeatedly and often
- high-impact sports such as running, tennis, skipping…
- excess weight
- chronic constipation
- chronic cough (smoking, asthma…)
How can you prevent a genital prolapse?
To limit the risks, it is possible to put preventive lifestyle and dietary measures in place. You can easily adapt your diet to prevent obesity and constipation. Practising a gentle physical activity regularly to protect your pelvic floor can also be beneficial.
Regular pelvic floor rehabilitation is also beneficial, as it helps to tone the pelvic floor muscles that support the bladder and the genital organs.
What treatments are there for a cystocele?
There are several ways to treat a bladder descent. Proposing the right treatment for a patient's cystocele depends on many factors, such as:
- her age
- the grade of the cystocele
- the impact of symptoms on quality of life
- the discomfort experienced…
In every case, treatment is adapted to the symptoms and the severity of the cystocele.
First, conservative treatment including lifestyle and dietary measures (weight loss, tackling any constipation, becoming aware of excess pressure on the pelvic floor, adapting sporting practice, and so on) will be proposed. In addition, your healthcare professional will also prescribe pelvic floor rehabilitation sessions.
Next, the doctor will consider treatment using conservative devices (pessaries in particular). And, as a last resort, they will discuss surgery with you. Here too, there are several surgical techniques. They are to be discussed with the surgeon according to the stage of the cystocele and the patient's wishes.
Pelvic floor rehabilitation to treat grades 1 and 2
Pelvic floor rehabilitation is effective on cystocele (and on prolapses in general). It focuses on strengthening the muscles that make up the pelvic floor.
In this way, pelvic floor rehabilitation counters increases in intra-abdominal pressure and therefore helps to act against the cystocele. Muscular work on the pelvic floor also helps to densify the supporting connective tissue, which further improves how well the bladder is held in place.
For this, different forms of pelvic floor rehabilitation are possible. You can go to your physiotherapist or your midwife or, if you already know how to contract your pelvic floor correctly, continue on your own at home.
Maintaining your pelvic floor with exercises at home
You can also tone it from home thanks to a probe for self-training at home. The Emy biofeedback probe has, for example, already helped many users keep their cystocele symptoms from getting worse.
Emy Trainer makes it possible to strengthen your pelvic floor anywhere and, above all, at your own pace.
Find out more about the Emy probe
Clinical effectiveness of the Emy Trainer solution
The effectiveness of this medical device has been clinically proven. According to users, the first training results are visible from 3 weeks onwards.
The probe works with a free app, "Emy – Pelvic floor exercises". It offers playful games based on medical protocols, easily accessible from your smartphone.
Easing the symptoms of a cystocele
Pelvic floor rehabilitation is one way to help ease symptoms in cases of cystocele.
Because doing pelvic floor exercises regularly will let you maintain this part of your body. Either to reduce the symptoms of the cystocele, or as prevention to avoid a prolapse appearing.
In every case, by strengthening your pelvic floor and above all keeping it toned over time, you will regain control of your body for greater self-confidence.
Wearing a pessary
Pessaries are small devices inserted into the vagina that help to hold the bladder in place. They are a "mechanical" support solution and can take different shapes: ring, disc or cube.
As such, they are temporary devices. They can be used occasionally during a sporting activity, or worn daily while waiting for an operation, for example.
Surgery
When the cystocele reaches an advanced grade, surgical treatment may be considered. Depending on the patient's age, the operations can differ.
Simpler surgery by the vaginal route will be preferred for older women who are no longer sexually active. More reliable surgery by the abdominal route may be preferred in other cases.
In every case, we advise you to consult a gynaecologist or a urologist. These healthcare professionals will be able to guide you towards the most effective solution for resolving your problem.
Sources
- Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214, American College of Obstetricians and Gynecologists, November 2019, Obstetrics and Gynecology 134(5):e126-e142 – link
- Evaluation and Management of Pelvic Organ Prolapse, Rubin Raju, Brian J Linder, December 2021, Mayo Clinic Proceedings 96(12):3122-3129 – link
- Conservative prevention and management of pelvic organ prolapse in women, Suzanne Hagen, Diane Stark, December 2011, Cochrane Database of Systematic Reviews 2011(12):CD003882 – link
- Epidemiology and outcome assessment of pelvic organ prolapse, Matthew D Barber, Christopher Maher, November 2013, International Urogynecology Journal 24(11):1783-90 – link
- Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence, Jochum F et al., February 2022, Journal of Gynecology Obstetrics and Human Reproduction 51(2):102280 – link
