Over the years, some pathological changes occur in the body. Older women may experience a pathology such as cystocele – the support of the pelvic floor weakens, due to which the bladder descends and begins to put pressure on the walls of the vagina.
If the disease can be detected at an early stage, surgery can be avoided in most cases. The patient is prescribed drug therapy based on preparations containing estrogen – it is the lack of this hormone that leads to a decrease in tissue elasticity. Additionally, it is recommended to perform a set of special exercises aimed at strengthening the muscles of the vagina and pelvic floor. A woman may be shown to use a pessary, a medical silicone ring that supports the muscles of the vagina.
If the patient, when the first symptoms of the disease appeared, did not turn to a specialist, irreversible changes are possible, which can be eliminated exclusively through surgery. Most often, we are talking about plastic cystocele – in this case, the anterior wall of the vagina is reinforced with a special synthetic mesh.
More often, the disease is diagnosed in women who have given birth over 50 years of age. In some cases, protrusion of the bladder into the vaginal cavity is also found in younger patients, which is a consequence of trauma during childbirth or anomalies in the development of the pelvic organs.
Symptoms of a cystocele
Even at an early stage of the disease, there are some signs that indicate its development. These include a slight involuntary release of urine when laughing or coughing. Most often, we are talking about a temporary prolapse of the bladder – after a certain period of time, the organ rises on its own and all symptoms disappear. At this stage, it is not always possible to identify pathology during examination by a gynecologist, a more detailed clinical picture allows you to see an ultrasound of the pelvic organs.
Periodic lowering of the bladder provokes an increasing stretching of the muscles of the vagina, and after a while its lower part is constantly in the vaginal cavity. In this case, the woman suffers from partial urinary incontinence, frequent urge to urinate, difficulty urinating, a feeling of heaviness in the lower abdomen. Also, when walking or sitting, there is a feeling that there is a ball inside, which brings discomfort. In fact, this ball that a woman feels inside herself is not a diverticulum, but a lowered front wall of the vagina, sagging under the pressure of the penis.
At this stage, effective treatment is mandatory surgical intervention. A woman experiences quite severe pain, urination becomes difficult or impossible without mechanical reduction of the bladder.
The main causes of the disease
The main reason why the pelvic floor muscles weaken is age-related changes in the body. In the zone of increased risk are women who have given birth to two or more children, as well as those whose labor activity was associated with constant physical exertion and weight lifting.
Other causes of cystocele development:
- Climax. Menopause is accompanied by a change in the hormonal background, and an acute estrogen deficiency negatively affects the elasticity of all tissues and muscles.
- Chronic constipation – a woman has to constantly push, which can cause prolapse of both the rectum and the vagina. In this case, hemorrhoids and cystocele most often develop in parallel.
- Difficult childbirth, during which there were injuries and ruptures of the walls of the vagina.
- Operations on the pelvic organs can lead to such negative consequences as a critical decrease in the elasticity of the pelvic floor.
- Hereditary predisposition – connective tissue dysplasia, which underlies the disease, can be transmitted through the female line.
Patients who are at risk should definitely visit a gynecologist at least once every 6 months. And when the first symptoms of a cystocele are detected, one should not expect that the problem will disappear on its own – only timely treatment will help to avoid surgery.
Treatment of cystocele
Conservative therapy is effective only at an early stage of the disease. If the walls of the vagina are stretched to such an extent that the bladder falls in or bulges out, surgery is necessary. The goal of surgical intervention is not only to achieve the correct anatomical location of the pelvic organs, but also to consolidate the result by creating strong muscle fascia. The most effective way to strengthen the muscles of the vagina is to install bioinert prostheses.
At the stage of preparation for surgery, a woman must pass a general clinical blood test, urinalysis, vaginal swabs for the presence of genital infections and bacterial lesions. In addition, if we are not talking about emergency intervention, the procedure is scheduled for a date that does not coincide with menstruation.
A patient diagnosed with a cystocele is most often shown anterior colpography – an operation during which the anterior wall of the vagina is strengthened with sutures made using a special technology. The resulting “mesh” keeps the bladder in the correct anatomical position and prevents re-bulging.
The operation is performed under local or general anesthesia. Technically, this is a very complex procedure that requires certain skills and knowledge. The success of cystocele treatment directly depends on the skill of the surgeon.
Recovery period
Immediately after the operation, the patient is transferred to the general ward. In the operating room, a urinary catheter is installed, and a tampon with a healing ointment with a disinfectant effect is inserted into the vagina.
In the first 4 days after surgery, the patient was prescribed bed rest. On the fifth day, it is allowed to get up and walk a little, it is forbidden to sit, since in this position there is strong pressure on the walls of the vagina. If the patient suffers from severe pain during this period, the doctor may prescribe analgesics.
Full recovery will take about 2 months – during this period it is forbidden to have sex, swim in the pool or open water. It is important to monitor your diet, to prevent the development of constipation. Physical activity is contraindicated.