Cystocele (Prolapsed Bladder): Symptoms and Treatment Options

Note: I use the therapeutic term “cystocele”. Other terms such as bladder prolapse, prolapsed bladder or bladder descent likewise refer to the condition discussed in this guide.

In this guide, I share information from my practice as a midwife, certified pelvic floor therapist* and menopause therapist on the causes, symptoms and treatment of cystocele, also known as bladder prolapse.

The medical term “prolapse” refers to a descent or dropping of organs in the uro-genital or anal region, particularly the vagina, uterus, bladder or rectum. One or more of these organs may be affected at the same time.

Pelvic organ prolapse conditions such as cystocele are not generally regarded as “diseases” in the strict medical sense, but rather as complaints, disorders or conditions that mainly affect women's health.

The weaker the pelvic floor muscles become, the more pronounced a bladder prolapse may be. For this reason, you should strengthen your pelvic floor muscles through pelvic floor exercises and/or with medical Kegel balls during everyday life.

Contents

What Is a Cystocele?

All organs in the body are connected through a stable system of connective tissue and muscles that keeps each organ in its proper position. Various factors can place strain on and alter this system, particularly pregnancy. This is why bladder or uterine prolapse occurs predominantly in women.

A cystocele is a condition in which the bladder descends downwards towards the vagina and pelvic floor. There are several forms of organ prolapse, which frequently occur together in different stages.

• Bladder prolapse, also referred to as bladder descent or cystocele
• Uterine prolapse, usually in combination with vaginal prolapse
• Vaginal prolapse, most commonly after removal of the uterus
• Bowel prolapse, also known as a rectocele

Symptoms and Diagnosis of a Cystocele

The following symptoms may indicate a cystocele:

• A sensation of a foreign body in the vagina
• Difficult or incomplete emptying of the bladder
• Urine leakage and urinary incontinence (post-void dribbling)
• Pain during sexual intercourse or penetration
• Menstrual discomfort
• Back pain (lower back and lumbar region)

Nevertheless, a professional examination and diagnosis by a physician or qualified therapeutic professional is essential in order to determine the cause and severity of your symptoms.

Cystocele – Rectocele?

The frequent search for “cystocele / rectocele” as a combination and the demand for images suggest that many affected women with Grade 1 or Grade 2 symptoms receive no treatment for a long time. Both cystocele and rectocele, as well as more advanced prolapses, form a type of bulge that may protrude from the vagina in Grade 3 or Grade 4 cases. As a result, their appearance can be quite similar.

Causes and Risk Factors

In addition to pregnancy and childbirth, there are several other causes and risk factors:

• Frequent constipation: Straining during bowel movements places stress on the uterus and bladder and promotes incontinence.
• Overweight: Increased body mass and weight tend to push the uterus and bladder downwards.
• General connective tissue weakness: Weak connective tissue can no longer support the organs adequately.
• Chronic coughing: Continuous pressure on the bladder and pelvic floor muscles caused by coughing contributes to bladder weakness and negatively affects many pelvic organs.
• Menopause: During menopause, connective tissue becomes weaker and may contribute to various conditions affecting women, including uterine prolapse, bladder prolapse and/or incontinence.
• Incorrect lifting and carrying techniques: These weaken the pelvic floor muscles and contribute to urine leakage and incontinence, especially stress incontinence. This type of bladder weakness is particularly common in women.

Stages of Pelvic Organ Prolapse

Pelvic organ prolapse affecting the vagina, bladder, uterus or rectum is generally classified into three or four grades, depending on the extent of the prolapse in relation to the vaginal opening.

Classification into Four Grades

The medical classification into four grades is based on the POP-Q System (Pelvic Organ Prolapse Quantification System) or similar medical systems. In medicine, the term “grade” is used rather than “stage”:

• Grade 1: The affected structure has descended slightly but remains above the hymenal ring (the boundary of the vaginal opening).
• Grade 2: The affected structure reaches the hymenal ring or is visible at the level of the vaginal opening.
• Grade 3: Partial prolapse, where the affected structure extends clearly beyond the hymenal ring but remains partially inside the vagina.
• Grade 4: Complete prolapse, in which the organ is completely visible outside the vaginal opening.

This classification helps guide diagnosis and treatment planning, ranging from conservative measures such as pelvic floor exercises to surgical intervention.

Classification into Three Grades

In non-clinical contexts, such as patient education, organ prolapse conditions like cystocele or rectocele are often classified into only three grades.

This simplified classification is intended to improve understanding and help illustrate symptoms more clearly through images or photographs. The three grades are described as follows:

Grade 1 (Mild Prolapse)

• The affected structure (for example the bladder, uterus or rectum) descends slightly but remains completely within the vagina.
• Symptoms are often absent or minimal but may include a mild sensation of pressure, bladder weakness or stress incontinence.

Grade 2 (Moderate Prolapse)

• The organ descends further and reaches the vaginal opening.
• Affected individuals often experience symptoms such as a pronounced sensation of a foreign body, difficulty urinating or passing stool, and significant pressure in the pelvic area.

Grade 3 (Severe Prolapse)

• The organ protrudes beyond the vaginal opening and becomes visible or palpable from the outside.
• Symptoms are usually severe and include pain, considerable difficulty emptying the bladder or bowel, pain during sexual intercourse and limitations in daily life.

In this simplified classification, no distinction is made between partial prolapse and complete prolapse within Grade 3.

Treatment and Therapy of Cystocele

Which of the following treatment options are suitable for a bladder prolapse, and whether surgery is necessary, depends among other factors on the severity of the condition.

For an accurate diagnosis and appropriate treatment, the detailed POP-Q classification is preferred. You should seek medical advice for this purpose.

Pelvic Floor Training

A professional pelvic floor therapist can teach you appropriate pelvic floor exercises and ensure they are performed correctly. Medical Kegel balls with proven effectiveness, such as Viball®, can support your pelvic floor training in everyday life. Even without actively performing pelvic floor exercises, the balls strengthen the pelvic floor through vibration. Although Viball® trains your pelvic floor even without active exercises, suitable pelvic floor exercises remain very important.

Reducing Risk Factors

It is important to address the causes listed above so that your treatment can be effective.

Therapeutic Pessaries

These are specialised supportive pessaries. Contraceptive pessaries are not suitable for this purpose.

Surgery

A partial prolapse (Grade 3) or complete prolapse (Grade 4) of the bladder can only be corrected surgically in a specialist clinic. However, before considering surgery, you should make use of the treatment options available to you. And there are quite a few.

Pelvic Floor Training – The Best Method

The best method of pelvic floor training for bladder prolapse depends on the following factors:

If Childbirth Was Only a Few Months Ago

A mild prolapse during the first months after childbirth or pregnancy is not unusual. In most cases, it involves a descent of the anterior vaginal wall. In this situation, the connective tissue still needs time to recover and initially requires gentle pelvic floor training followed by gradually increasing intensity. This training should initially be performed in a horizontal position, such as lying on your stomach or in the knee-elbow position. For this purpose, I have developed special exercises (with Viball®) based on my practical experience. You can also wear Viball® during everyday life to strengthen the muscles of the pelvic floor, vagina and bladder. A pleasant side effect is its erotic stimulation, which also benefits the pelvic floor.

In addition, you should pay attention to appropriate physical behaviour and avoid heavy lifting and carrying (for example a baby carrier with your child). If more than a year has passed since childbirth, the connective tissue that was heavily stressed by pregnancy and delivery will normally have recovered. If this has not happened, you should definitely begin strengthening your pelvic floor.

Here too, contraction and relaxation of the pelvic floor should be actively trained, with particular focus on the fast-twitch (FT) and slow-twitch (ST) muscle fibres. Training aids can provide valuable support. Particularly suitable in this context are medical Kegel balls, which are available in different sizes and weights.

Consistent active and passive pelvic floor training in everyday life, combined with appropriate behavioural measures, can often help avoid surgery. Furthermore, surgery does not restore the original condition. Even after surgery, exercises and adapted everyday habits remain necessary. Prevention is therefore always preferable to an operation.

If Childbirth Was More Than One Year Ago

After more than one year, the connective tissue that was heavily stressed by pregnancy and childbirth will normally have recovered. If this has not happened, you should definitely begin pelvic floor training and suitable pelvic floor exercises. Here too, contraction and relaxation of the pelvic floor must be actively trained, with particular focus on the fast-twitch (FT) and slow-twitch (ST) muscle fibres. Training aids can also provide effective support, preferably certified medical Kegel balls.

Help Through Medical Kegel Balls

Not every Kegel ball strengthens the pelvic floor. Nor does the term “medical” alone guarantee effectiveness. Only certified medical devices such as Viball® are required to demonstrate both effectiveness and safety of use. They work in two ways:

• Passive stimulation of the pelvic floor muscles (during daily life)
  You wear the largest possible Viball® in the “Light” version (reduced weight) during everyday activities. The correct size does not need to be actively held in place by the vaginal muscles but remains comfortably positioned without effort. Depending on movement, it generates different vibration patterns: the finer impulses stimulate the fast-twitch muscle fibres, which are an important component of the bladder sphincter muscles and help reduce urine leakage and incontinence. The stronger impulses stimulate the slow-twitch muscle fibres of the pelvic floor. They encourage conscious contractions and support muscle development.
• Active pelvic floor training (pelvic floor exercises)
  For this purpose, you use a smaller Viball® that must be consciously held in place by the pelvic floor muscles. It helps you become more aware of your pelvic floor during exercises. Its weight provides an additional training stimulus.

Tips for Daily Life with a Cystocele

• Maintain good upright posture, both when standing and when sitting.
• Pay attention to your posture on the toilet: remain upright while urinating. During bowel movements, use a footstool, round your back and allow the stool to pass without straining.
• When standing up, place one foot slightly in front of the other, contract your pelvic floor while exhaling and straighten up with a straight back.
• Support healthy bowel movements through nutrition and physical activity.
• When getting out of bed, first roll onto your side before sitting up.
• Before coughing or sneezing, contract your pelvic floor and deep abdominal muscles whenever possible.
• Lift correctly: keep your back straight, exhale and contract your pelvic floor.
• Treat yourself to a pelvic floor check-up with a specialised professional (physiotherapist or pelvic floor therapist).

Disadvantages After Cystocele Surgery

A common consequence of surgery is the formation of scar tissue and/or numb areas within the vagina caused by severed nerves. This may lead to reduced sensation during sexual intercourse.

Gentle massage using FMS Dilators may help stimulate reinnervation of the vagina. FMS Dilators are also suitable for other conditions such as hemorrhoids.

They are made from borosilicate glass, are extremely smooth and hygienic, and are available in many sizes for precise adaptation. They are certified medical devices with proven effectiveness. Their safety of use is confirmed by the CE mark.

Frequently Asked Questions (FAQ)

Can You Die from Pelvic Organ Prolapse?

In most cases, pelvic organ prolapse is not a life-threatening condition. However, serious complications may occur if it remains untreated. Medical supervision is therefore important.

How Do You Live with a Cystocele?

A combination of pelvic floor exercises, lifestyle adjustments and, where appropriate, aids such as pessaries can help control symptoms. In more advanced cases, surgery may be necessary.

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