Confirming the Disease Name
Bladder prolapse (cystocele) is the medically accepted term for a form of pelvic organ prolapse in which the front wall of the vagina descends together with the bladder, bulging into the vagina or protruding outside the vaginal opening.
1) Disease Description (Causes and Symptoms)
- Causes and pathophysiology
- Occurs when the bladder descends through the anterior vaginal wall due to weakening of the pelvic floor muscles and connective tissue. It is mainly associated with childbirth (especially repeated childbirth or difficult labor), decreased estrogen due to menopause, chronic increases in intra-abdominal pressure (coughing, constipation, lifting heavy objects), and congenital tissue weakness.
- Changes in the structure of the bladder and urethra may cause urethral obstruction or kinking, which can lead to difficulty urinating or increased residual urine.
- Main symptoms
- A feeling of pressure or a foreign body in the vagina or pelvis; a lump felt inside the vagina or outside the labia
- Urine leakage when intra-abdominal pressure increases (urinary incontinence), frequent urination, difficulty urinating (having to strain when urinating), a feeling of incomplete emptying, or inability to urinate completely
- Recurrent urinary tract infections, painful intercourse, and, rarely, difficulty with bowel movements
2) Treatment Methods
- Conservative treatment (preferred for mild to moderate cases)
- Pelvic floor muscle strengthening exercises (Kegel exercises) — regular instruction and continued practice are recommended
- Weight management, prevention of constipation (dietary fiber and fluids), smoking cessation (to prevent chronic coughing), and limiting heavy lifting
- Pessary insertion — non-surgical mechanical support; useful for patients who do not want surgery or who have a high surgical risk
- If an infection is present, treatment of the urinary tract infection (antibiotics) and urinary tract hygiene management
- Drug treatment
- There are no medications that directly correct bladder prolapse. In postmenopausal women, topical estrogen (vaginal cream or vaginal suppository) may improve the health of the vaginal mucosa and tissues and help relieve symptoms (to be used at the doctor's discretion).
- Surgical treatment (moderate to severe cases or persistent symptoms)
- Anterior colporrhaphy — suturing and strengthening the anterior vaginal wall to restore the bladder to its original position
- Mesh reinforcement — may be used to increase support, but because of the risk of complications such as infection, pain, and mesh exposure, the indications and choice of material should be carefully considered
- There is a possibility that repeat surgery may be needed if the condition recurs
- Postoperative care and precautions
- Monitoring is needed for surgical-site infection, difficulty urinating (temporary), recurrence, and changes in sexual function
- Follow the attending physician's instructions regarding avoiding heavy lifting during the recovery period and when to resume sexual intercourse
3) Checklist Before an Outpatient Visit (Documents and Preparation)
- Documents/items to bring and preparation
- A list of current medications (including prescription drugs, over-the-counter drugs, and herbal medicines)
- History of previous surgeries (especially pelvic or abdominal surgery), childbirth history (number of vaginal deliveries and whether there was difficult labor), menopausal status, and history of hormone therapy
- Recent urinary tract infection test results (urine culture) and a urinary symptom diary (frequency and circumstances of urinary incontinence, frequent urination, and difficulty urinating)
- Urination records (voiding diary and urine volume), and recent pelvic examination, ultrasound, or urodynamic test results, if available
- Lifestyle habits (smoking, handling heavy objects at work, exercise and dietary habits)
- Items likely to be evaluated during the outpatient visit
- Physical (pelvic) examination; if necessary, urinalysis and urine culture, pelvic ultrasound, a voiding diary or urodynamic testing, fluoroscopy, or voiding cystourethrography (in specific cases)
Example questions (items for the patient to write down)
- When the symptoms first began and factors that worsen them (coughing, bowel movements, exercise, etc.)
- Situations and frequency of urine leakage (only when coughing, during activity, continuously, etc.)
- Whether there is pain or discomfort during intercourse and whether there is any effect on bowel movements
4) Examples of General Questions to Ask the Doctor
- What is causing my symptoms, and how severe are they?
- Is there a possibility that non-surgical methods (exercises or a pessary) will improve my condition?
- If surgery is necessary, which surgery do you recommend, and what are its advantages, disadvantages, and risks?
- What is the likelihood of recurrence after surgery, and how would recurrence be managed?
- What effects could this have on urinary or sexual function, and how long is the recovery period?
- Would medication (for example, topical estrogen) be helpful? What are the side effects?
5) Examples of Disease-Specific Questions
- If you are planning to have more children: “I am planning to have another child in the future. When would be the best time to treat the bladder prolapse? Does the method of delivery (cesarean section versus vaginal delivery) affect it?”
- If considering mesh: “Could you explain the possible complications of using vaginal mesh (exposure, infection, and pain), the likelihood of repeat surgery, and the alternative options?”
Additional Information
- When to visit a hospital urgently: Contact a medical professional immediately if you suddenly cannot urinate at all (urinary retention), or if you have a high fever, severe pain, or heavy bleeding.
- Summary: Mild bladder prolapse may improve with conservative management, but if symptoms interfere with daily life or complications (such as urinary tract infections or urinary incontinence) are present, consult a specialist to consider appropriate testing and treatment (a pessary or surgery).