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In mild cases, it's possible to not even notice any symptoms. When cystocele signs and symptoms do present themselves, they may include:

• A feeling of fullness or pressure in your pelvis and vagina — especially when standing for long periods of time.
• Increased discomfort when you strain, cough, bear down or lift.
• A bulge of tissue that, in severe cases, protrudes through your vaginal opening. The resulting soft bulge may feel like sitting on an egg, and often goes away when you lie down.
• A feeling that you haven't completely emptied your bladder after urinating.
• Loss of urinary control with coughing, laughing or sneezing (stress incontinence). In severe cases, you may not be able to control urination.
• Recurrent bladder infections.
• Pain or urinary leakage during sexual intercourse.

Physicians may refer to a cystocele as an anterior prolapse, as the front (anterior) vaginal wall has collapsed and the bladder is bulging downward into the vagina.

When to see a doctor
A severely prolapsed bladder can be uncomfortable — in some instances, even painful. It can make emptying your bladder difficult, and may lead to bladder infections. Make an appointment with your doctor if you experience:

• A feeling of fullness or pressure in your pelvis and vagina, especially when you bear down
• A soft bulge that protrudes through your vaginal opening
• A feeling that you're unable to completely empty your bladder
• Urinary incontinence
• Repeated bladder infections
• Pain during sexual intercourse

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Your pelvic floor consists of muscles, ligaments and connective tissue that support your bladder, uterus and rectum — the organs that fill your pelvic cavity. If the connections between your pelvic floor muscles and ligaments are weak to begin with, you may be at greater risk of bladder prolapse. Intense pelvic pressure may stretch and weaken these structures, allowing organs such as the bladder sink lower in your body and become prolapsed.

Most common causes
Pregnancy and vaginal childbirth are the most common causes of a cystocele. Women who have only cesarean section deliveries are less likely to develop prolapse.

Other causes
Prolapse may also be caused by straining your pelvic floor muscles through:

• Being overweight or obese
• Repeated heavy lifting
• Straining with bowel movements
• A chronic cough or bronchitis

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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The following factors may increase your risk of experiencing a cystocele:

• Childbirth. Women who have vaginally delivered one or more children have a higher risk of developing prolapse.
• Aging. Your risk of experiencing prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep pelvic muscles strong — decreases.
• Having a hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
• Genetics. Some women are born with weaker connective tissues, making them naturally more susceptible to a cystocele.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

If you have signs or symptoms common to cystocele, make an appointment with your primary care provider. In some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

• Write down any symptoms you've had, and for how long.
• Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

For cystocele, some basic questions to ask your doctor include:

• What is the most likely cause of my symptoms?
• Are there any other possible causes?
• Do I need any tests to confirm the diagnosis?
• What are the goals of treatment in my case?
• What treatment approach do you recommend?
• If the first treatment doesn't work, what will you recommend next?
• Am I at risk of complications from this condition?
• What is the risk that this problem will recur in the future?
• Do I need to follow any restrictions?
• Are there any self-care steps I can take?
• Should I see a specialist?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• What are your symptoms?
• When did you first notice these symptoms?
• Have your symptoms gotten worse over time?
• Do your symptoms include pain? If yes, how severe is the pain?
• Does anything in particular trigger your symptoms, such as coughing or heavy lifting?
• Do your signs and symptoms include urine leakage (urinary incontinence)?
• Do you have frequent bladder infections?
• Do you have pain or urinary leakage during intercourse?
• Have you had a chronic or severe cough?
• Does your work or daily activities involve heavy lifting?
• Do you strain during bowel movements?
• Are you currently being treated or have you recently been treated for any other medical conditions?
• What medications are you taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
• Do any of your first-degree relatives — such as a parent or sibling — have a history of cystocele or other pelvic floor disorders?
• How many children have you delivered? Were your deliveries vaginal or cesarean?
• Do you plan to have children in the future?
• What else concerns you?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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To diagnose a cystocele, your doctor will conduct a pelvic exam. During the pelvic exam, your doctor:

• Will look for the telltale bulge in your vaginal wall that usually makes prolapse easy to diagnose
• May ask you to bear down and push as if you are having a bowel movement so that he or she can see how far the bladder or other organs protrude into the vagina
• May instruct you to contract the muscles of your pelvis (as if you are stopping the stream in the middle of urinating) to check the strength of your pelvic floor muscles

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Cystocele treatment depends on the severity of the condition. Mild cases — those with few or no obvious symptoms — may require no treatment or simple self-care measures such as Kegel exercises to strengthen your pelvic floor muscles. A physical therapist who specializes in pelvic floor disorders may be helpful in teaching these exercises. If self-care measures aren't effective, treatment may include:

• Pessary. A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, your doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery. But some women may use pessaries for years.
• Estrogen therapy. Your doctor may recommend using estrogen — usually a vaginal cream, pill or ring — if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause.

When surgery is necessary
If you have noticeable, uncomfortable symptoms, cystocele may require surgery. This surgery is elective and designed to relieve symptoms related to the cystocele.

In most cases, surgery consists of a vaginal repair. In this procedure, a surgeon elevates the prolapse back into place, removing redundant tissue and tightening the muscles and ligaments of your pelvic floor. While the benefits of this type of surgery can last for many years, there's some risk of recurrence. This is partly because of downward forces of gravity resulting in stretching of tissues again.

If the cystocele recurs, you may need surgery again. In some cases, especially where the tissues needed to support the vagina are unusually thin, using a special type of tissue graft may help thicken the vaginal tissues and increase support. If the cystocele is associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) to help correct the problem and prevent recurrence.

When possible, avoid surgical treatment until you're done having children. A pessary may help to relieve symptoms in the meantime. If the prolapse is so uncomfortable that you need a vaginal repair, you can still have children — though a cesarean delivery is sometimes recommended.

Dealing with incontinence
If your cystocele is accompanied by stress incontinence, your doctor may recommend one of a number of procedures to support the urethra (urethral suspension).

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Kegel exercises, designed to strengthen your pelvic floor muscles, can help both prevent and treat stress incontinence. To perform Kegel exercises, follow these steps:

• Pull in your pelvic floor muscles — the muscles you use to stop urinating.
• Hold them for a count of three and then relax for a count of three.
• Work up to 10 to 15 repetitions at a time.
• Repeat three times daily.

Kegel exercises may be most successful when they're taught by a therapist using biofeedback. Biofeedback uses information from a variety of pain-free monitoring devices to help teach you to control certain involuntary body responses, such as muscle tension. In this case, biofeedback can help ensure you're contracting the proper muscles, and that the intensity and duration of the muscle contractions are optimal.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You can help prevent prolapse with the following measures:

• Do special exercises called Kegels. These exercises are designed to strengthen your pelvic floor muscles. This is especially important after you have a baby.
• Treat and prevent constipation. High-fiber foods can help.
• Avoid heavy lifting, and lift correctly. When lifting, use your legs instead of your waist or back.
• Control coughing. Treat a chronic cough or bronchitis, and don't smoke.
• Avoid weight gain. Talk to your doctor to determine your ideal weight.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.