In this guide, I share insights from my work as a midwife, menopause and pelvic floor therapist about the symptoms, causes, and treatment options for cystocele (bladder prolapse). You’ll also find practical tips on what you can do to support your pelvic floor and prevent further prolapse. If you are mainly looking for a certified medical device to help relieve your symptoms, you can find a proven solution here.

Table of Contents:

What is a Cystocele?

All pelvic organs are held in place by a stable network of connective tissue and muscles. Certain factors, such as pregnancy, can strain this system. This is why bladder or uterine prolapse mostly affects women.

A cystocele (also called bladder prolapse) occurs when the bladder descends toward the vagina and pelvic floor. Pelvic organ prolapse can occur in different forms, often in combination and with varying severity:

• Cystocele – also called bladder prolapse
• Uterine prolapse – often combined with vaginal wall prolapse
• Vaginal wall prolapse – often after hysterectomy or childbirth
• Rectocele – prolapse of the rectum

Symptoms and Diagnosis

The following symptoms may indicate a cystocele:

• A feeling of pressure or a foreign body sensation in the vagina
• Difficulty or incomplete emptying of the bladder
• Bladder weakness and urinary incontinence (e.g. post micturition dribble)
• Pain or discomfort during sex (dyspareunia)
• Menstrual discomfort
• Lower back pain

Ultimately, a professional examination by a doctor or pelvic floor therapist will provide clarity on the cause and severity of your symptoms.

Causes and Risk Factors

Pregnancy and childbirth are the most common triggers, but there are other causes and risk factors:

• Chronic constipation: Straining during bowel movements increases pressure on the bladder and uterus and can cause incontinence.
• Excess body weight: Being overweight puts constant downward pressure on the bladder and pelvic organs.
• Weak connective tissue: Weakened tissue can no longer hold the organs properly.
• Chronic coughing: Persistent coughing strains the bladder and pelvic floor muscles and affects organ stability.
• Menopause: Hormonal changes weaken connective tissue, making women more prone to pelvic organ prolapse (POP) and incontinence.
• Incorrect lifting or carrying: Poor technique when lifting heavy loads weakens the pelvic floor and increases the risk of stress incontinence.

Cystocele Grades (Stages 1 to 4 Explained)

All types of vaginal prolapse (cystocele, rectocele, uterine prolapse) are classified into four grades according to the POP-Q system (Pelvic Organ Prolapse Quantification System):

1. Grade 1: The bladder has slightly descended but remains above the hymenal rim.
2. Grade 2: The bladder has descended to the hymenal rim or is visible at the vaginal opening.
3. Grade 3: The bladder protrudes beyond the hymenal rim but is still partially inside the vaginal canal.
4. Grade 4: A complete prolapse with the bladder entirely outside the vaginal opening.

The hymenal rim refers to a thin, elastic tissue ring located just inside the vaginal entrance. These classifications help determine the severity and guide treatment planning.

How to Fix a Prolapsed Bladder – With and Without Surgery

The choice of treatment options for a cystocele depends on the severity of symptoms and the grade of prolapse. A doctor or pelvic floor therapist can advise which option is best for you.

Pelvic Muscle Training

A pelvic floor therapist can teach you the correct exercises and technique. Medical Kegel balls with proven effectiveness, such as Viball®, can support your pelvic floor in daily life – even without active exercises.

Reducing Risk Factors

Addressing and reducing the causes mentioned above is essential for successful treatment.

Therapeutic Pessaries

Special support pessaries can be used for pelvic organ prolapse, but contraceptive pessaries are not suitable.

Surgery

Surgery in a specialized clinic is the last option when conservative treatments fail. Explore all non-surgical methods first.

Which Pelvic Muscle Training Really Works?

If your childbirth was a few months ago

A mild prolapse of the front vaginal wall shortly after childbirth is not unusual. The connective tissue still needs time to recover. Start with gentle pelvic muscle training and increase the intensity gradually. Begin in horizontal positions – lying on your back, stomach, or in the knee-elbow position. I have developed special exercises (with Viball®) that you can find below. Viball® can also be worn during the day, strengthening your pelvic floor, vagina, and bladder. A pleasant side effect: It provides erotic stimulation and benefits your pelvic floor health.

If your childbirth was over a year ago

After one year, the connective tissue is usually recovered. If not, seek professional advice to adjust your training. Focus on both contraction and relaxation of the pelvic floor, targeting fast-twitch (FT) and slow-twitch (ST) fibers. Medical Kegel balls like Viball® in various sizes and weights can provide additional training impulses.

With consistent training and lifestyle adjustments, surgery can often be avoided. Even after surgery, pelvic floor exercises remain necessary, so prevention is better than surgery.

How Kegel Balls Can Help

Not every Kegel ball strengthens the pelvic floor, despite what the erotic industry claims. Only certified medical products like Viball® have proven their safety and effectiveness. They work in two ways:

• Passive pelvic floor training (long-term use)

  Wear a larger Viball® Light version during daily activities. It stays in place without muscle effort. Gentle vibrations stimulate the fast-twitch fibers (important for bladder control), while stronger vibrations encourage conscious contractions and activate muscle fibers.

• Active pelvic floor training (short-term use)

  Use a smaller Viball® that requires active holding with your pelvic muscles. Its weight provides extra training stimulus and improves muscle awareness during exercises.

Everyday Tips for Bladder and Pelvic Floor Support

• Maintain good posture while standing or sitting to naturally engage core and pelvic muscles.
• Be mindful during toilet visits: sit upright when urinating; for bowel movements, use a footstool and push gently instead of straining.
• Stand up correctly by placing one foot forward, exhaling, and engaging your pelvic floor before rising.
• Prevent constipation with a healthy diet, fluids, and physical activity.
• Roll onto your side before getting up from lying down.
• Engage your pelvic floor and core muscles before coughing or sneezing.
• Lift heavy objects with a straight back, exhale, and consciously engage your pelvic muscles.
• Get a pelvic floor check-up with a specialist who can use ultrasound and manual examination to provide tailored treatment advice.

FAQ: Cystocele – Quick Answers

• What are the symptoms of a cystocele?
  A cystocele often feels like a heaviness or bulge in the vagina. If you also notice urinary leakage or incomplete bladder emptying, consult a specialist. Read more here.
• Is vaginal prolapse the same as cystocele?
  Vaginal prolapse is a general term for pelvic organs shifting from their normal position. A cystocele is a specific type involving the bladder.
• How can I fix a cystocele without surgery?
  Mild cases can improve with pelvic muscle training, lifestyle changes, and medical Kegel balls like Viball®. Learn more here.
• Does cystocele always require surgery?
  No. Surgery is only considered for severe cases. Most women benefit from conservative methods first. See all treatment options.

Related Topics:

• Vaginismus and Vaginal Muscle Spasms
• Anal Fissure
• Pelvic Floor Training with Kegel Balls
• Kegel Balls: Effects, Use, and Differences
• Kegel Balls for Pelvic Floor Weakness After Pregnancy
• Hemorrhoids: Causes, Home Remedies, Treatment
• Hemorrhoids After Birth and Pregnancy