Cystocele (Fallen Bladder)

What is a cystocele?

Cystocele is the name for a disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

What are the results of a cystocele?

In addition to discomfort, the resulting dropped bladder can cause two kinds of problems:

  • Urine leakage

  • Incomplete emptying of the bladder

The dropped bladder stretches the opening into the urethra, and urine may leak when a woman does any action that causes pressure on the bladder, such as coughing.

What are the grades of cystoceles?


Grade 1

Mild. The bladder droops only a short way into the vagina.

Grade 2

More severe. The bladder has sunk into the vagina far enough to reach the opening of the vagina.

Grade 3

Most advanced. The bladder bulges out through the opening of the vagina.

What causes a cystocele?

A cystocele may result from the following:

  • Heavy lifting

  • Straining muscles during childbirth

  • Repeated straining during bowel movements

  • Weakened muscles around the vagina caused by lack of estrogen after menopause

How is a cystocele diagnosed?

In addition to a complete medical history and physical examination, (which may reveal the fallen part of the bladder through the vagina), diagnostic procedures for a cystocele may include a cystourethrogram (also called a voiding cystogram). This is an X-ray of the bladder during urination and with the bladder and urethra filled with contrast medium to determine the shape of the bladder and any obstructions.

Other tests and procedures may be necessary to determine if there are any problems in the other areas of the urinary system.

What are the symptoms of a cystocele?

Symptoms of cystocele include:

  • Feeling of pelvic heaviness or fullness

  • Bulge in the vagina that you can feel

  • Aching or a feeling of pressure in the lower abdomen or pelvis

  • Lower back pain

  • Leakage of urine or constipation

  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement

  • Sexual difficulties

  • Problems with inserting tampons or applicators

  • Pelvic pressure gets worse with standing, lifting, or coughing or as the day goes on 

What is the treatment for cystoceles?

Specific treatment for cystoceles will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Activity modification. Avoid activities, such as heavy lifting or straining, that could cause the cystocele to worsen.

  • Pessary. A device placed in the vagina to hold the bladder in place.

  • Surgery. A procedure to move the bladder back into a more normal position

  • Estrogen replacement therapy. This may help to strengthen the muscles around the vagina and bladder.

If you are considering hormone replacement therapy, the decision to start should be made only after you and your doctor have evaluated the risk versus benefit ratio based on your individual medical history.